What is the optimal FODMAP threshold in IBS?

Rej, Anupam; Sanders, David S.; Buckle, Rachel Louise; Trott, Nick; Aziz, Imran; Shaw, Christian Charles

doi:10.1111/jgh.15470

Cited by 8 publications

(16 citation statements)

References 14 publications

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“…A recent randomized controlled study, including only patients with IBS‐D, evaluated the efficacy and acceptability of short‐term strict low FODMAP diet and of a long‐term “modified” FODMAP diet compared with traditional dietary advice, and showed that both, strict and modified low FODMAP diet, are acceptable and lead to significant improvement in symptoms and quality of life 188 . However, the valid threshold for reduction of FODMAPs in the short and long‐term has not been identified 189 …”

Section: Resultsmentioning

confidence: 99%

“…Studies have shown a reduction of Bifidobacteria and other microbial changes as well as iron and calcium deficiency that may negatively impact patients' health. The complexity of the diet requires the involvement of experienced dieticians 187–190 …”

Section: Resultsmentioning

confidence: 99%

“…188 However, the valid threshold for reduction of FODMAPs in the short and long-term has not been identified. 189 Sustained symptom relief with "adapted" low FODMAPs has been demonstrated by several long-term observational studies. 190 Extensive long-term restrictions are not recommended due to the risk of dietary inadequacy related to the exclusion of many nutrientrich foods, difficulties in adherence, costs, and social difficulties.…”

mentioning

confidence: 98%

“…The complexity of the diet requires the involvement of experienced dieticians. [187][188][189][190] Statement 2.8: UEG/ESNM recommend AGAINST a gluten free diet for patients with IBS-D, but there is no evidence for FDr.…”

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confidence: 99%

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Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

et al. 2022

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 98%

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confidence: 99%

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Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

et al. 2022

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“…Major challenges in instituting LFD in most countries include: poor knowledge of FODMAP content of local diet, restrictive nature of LFD, poor social acceptance of LFD, and so forth 37–39 . We employed the best possible approach of restricting (not completely avoiding) food items that were known to have high FODMAP content, 40 and this proved sufficient to provide symptomatic relief. Our dietician guided patients regarding cheap and easily available alternative foods with low FODMAP content, and then step‐wise FODMAP re‐introduction according to individual tolerance, due to which nutritional adequacy was also maintained.…”

Section: Discussionmentioning

confidence: 99%

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Nohria

Batta

Dhaliwal

et al. 2021

J of Gastro and Hepatol

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Background and Aim Prospective trials evaluating efficacy of specific diet restriction in functional dyspepsia (FD) are scarce. We aimed to assess efficacy of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet in FD, compared with traditional dietary advice (TDA). Methods In this prospective, single‐blind trial, patients with FD (Rome IV) were randomized into low FODMAP diet (LFD) and TDA groups, for 4 weeks (phase I). In phase II (4–12 weeks), LFD group was advised systematic re‐introduction of FODMAPs. Symptom severity and quality of life were assessed using “Short‐Form Nepean Dyspepsia Index (SF‐NDI).” Primary outcome was symptomatic response (symptom score reduction of ≥ 50%), at 4 weeks. Study was registered with CTRI (2019/06/019852). Results Of 184 patients screened, 105 were randomized to LFD (n = 54) and TDA (n = 51) groups. At 4 weeks, both groups showed significant reduction in SF‐NDI symptom scores compared with baseline, with no significant difference in inter‐group response rates [LFD: 66.7% (36/54); TDA: 56.9% (29/51); P = 0.32]. On sub‐group analysis, patients with postprandial distress syndrome or bloating had significantly better symptomatic response with LFD (P = 0.04). SF‐NDI quality of life scores improved significantly in both groups. On multivariate analysis, factors predicting response to LFD were bloating and male gender. Incidences of adverse events (minor) were similar in both groups. Conclusions In patients with FD, LFD and TDA lead to significant symptomatic and quality of life improvement. Patients with postprandial distress syndrome or bloating respond significantly better to LFD. Therefore, dietary advice for FD should be individualized according to FD subtype.

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Management of Irritable Bowel Syndrome With Diarrhea

Marasco,

Cremon,

Barbaro

et al. 2024

Journal of Clinical Gastroenterology

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Irritable bowel syndrome (IBS) with diarrhea (IBS-D) affects ~1% of the general population and is characterized by abdominal pain associated with diarrhea. IBS-D symptoms significantly impact the quality of life of patients. Major uncertainties remain regarding the optimal management of these patients. Several therapies have been investigated over the years for the treatment of IBS-D. In the initial management, commonly prescribed approaches with an effect on global IBS symptoms include a low Fermentable Oligo-, Di-, Mono-Saccharides and Polyols diet and probiotics, while antispasmodics are used for targeting abdominal pain and loperamide for diarrhea only. Additional therapeutic options for the relief of global IBS symptoms include rifaximin, 5-HT3 antagonists, gut-directed psychological therapies, and eluxadoline, while tricyclic antidepressants can target abdominal pain and bile acid sequestrants diarrhea. Promising evidence exists for the use of mesalazine and fecal microbiota transplantation in IBS-D, although further evidence is needed for definitive conclusions regarding their efficacy.

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What is the optimal FODMAP threshold in IBS?

Cited by 8 publications

References 14 publications

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Management of Irritable Bowel Syndrome With Diarrhea

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