Issue 24

Clinical Question

Can a low-FODMAP diet address persistent GI symptoms in IBD patients with quiescent disease?

Editor’s Bottom Line

FODMAP restriction appears to be a useful strategy for IBD patients with symptoms but no evidence of disease activity.

Reference

Cox SR, Lindsay JO, Fromentin S, et al. Effects of Low-FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial. Gastroenterol. Epub ahead of print October 2, 2019; https://doi.org/10.1053/j.gastro.2019.09.024.

Synopsis

A small body of research indicates that limiting intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can reduce luminal water, colonic gas and distension in IBD patients with quiescent disease and persistent symptoms. In this study, investigators in the United Kingdom randomized 52 patients with quiescent Crohn’s disease or ulcerative colitis to follow either a low-FODMAP diet or a sham diet for 4 weeks. In addition to having IBD, eligible subjects met Rome III criteria for diarrhea-predominant irritable bowel syndrome (IBS-D), mixed subtype IBS (IBS-M), unsubtyped IBS (IBS-U), functional bloating (FB) or functional diarrhea (FD) at baseline. Patients were on a stable medical regimen and had not used antibiotics, probiotics or prebiotics during the eight weeks preceding the study. Several groups of patients, including those with extensive colon resection, bile acid malabsorption and constipation-predominant symptoms, were excluded.

Results showed that 52% of those in the low-FODMAP group reported adequate relief of intestinal symptoms after four weeks, compared to 16% of those adhering to a control diet (P=0.007). At four weeks, both bloating and flatulence were significantly less severe in the low-FODMAP diet group than the control diet group. Those in the low-FODMAP group had a mean 67-point reduction in the IBS-severity score (IBS-SS), compared to a mean 34-point reduction in the control group, although this was not statistically significant. Patients adhering to a low-FODMAP diet had higher scores on the health-related quality of life index after four weeks (81.9±1.2 vs. 78.3±1.2; P=0.042). While the low-FODMAP diet significantly decreased the abundance of Bifidobacterium adolescentis, B. longum, and Faecalibacterium prausnitzii, all of which are believed to regulate the immune response, a low-FODMAP diet did not affect microbiome diversity or markers of inflammation.

Details

Study Design: Single-blind, sham-controlled trial
Funding: The Kenneth Rainin Foundation
Allocation: Randomized
Setting: Multicenter
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.