Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis

ObjectiveA diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best comparator is unclear. We performed a network meta-analysis addressing these uncertainties.DesignWe searched the medical literature through to 2 April 2021 to identify RCTs of a low FODMAP diet in IBS. Efficacy was judged using dichotomous assessment of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. Data were pooled using a random effects model, with efficacy reported as pooled relative risks (RRs) with 95% CIs, and interventions ranked according to their P-score.ResultsWe identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis.ConclusionIn a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.

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Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation

Nutrients ◽

10.3390/nu12040928 ◽

2020 ◽

Vol 12 (4) ◽

pp. 928 ◽

Cited By ~ 6

Author(s):

Antonietta Gerarda Gravina ◽

Marcello Dallio ◽

Mario Romeo ◽

Antonietta Di Somma ◽

Gaetano Cotticelli ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Symptom Control ◽

Bowel Dysfunction ◽

Positive Effects ◽

Diet Regimen ◽

Irritable Bowel ◽

Fodmap Diet ◽

The Impact

Introduction: Irritable bowel syndrome represents one of the most difficult gastroenterological diseases to treat, that usually induces the patients to follow different drug therapies, often not useful in symptom control. In this scenario low FODMAP diet could have positive effects in patients with irritable bowel syndrome, even because this type of diet regimen is characterized by a low gluten amount due to the exclusion of cereals. Methods: We enrolled 120 patients with irritable bowel syndrome, according to the Rome IV criteria, who were referred to Hepatogastroenterology Division of the University of Campania L. Vanvitelli from June to December 2018. They underwent a low FODMAP diet for six weeks, followed by a gradual weekly reintroduction of every category of food for three months. The patients had a follow-up evaluation for six months after the end of food reintroduction period. We measured abdominal pain with subjective numerical scale from 0 to 10. We evaluated other gastrointestinal symptoms with a questionnaire about symptoms of lower digestive tract, evaluating their frequency and intensity. We also evaluated the impact of irritable bowel syndrome on daily life with neurological bowel dysfunction score. Results: We obtained a good patient-adherence to diet and a statistically significant decrease of abdominal pain, bloating, flatulence, diarrhea, constipation, and neurological bowel dysfunction score (p < 0.001) at the end of the diet. These results remained constant in the follow-up period. Conclusions: We recommend the use of a low FODMAP diet regimen in patients with irritable bowel syndrome in order to control the symptoms and improve the quality of life.

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Some antispasmodic drugs for the irritable bowel syndrome

Drug and Therapeutics Bulletin ◽

10.1136/dtb.24.24.93 ◽

1986 ◽

Vol 24 (24) ◽

pp. 93-95

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Intestinal Disease ◽

Bowel Habit ◽

Dietary Advice ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is commonly diagnosed when the typical symptoms of irregular bowel habit, abdominal pain and distension, and a feeling of incomplete defaecation are not associated with other gastro-intestinal disease. The management of the patient with IBS has been covered previously1 but if dietary advice, reassurance and simple psychotherapy have proved unhelpful the doctor may be under pressure to prescribe as symptoms are usually recurrent. We now review the evidence to support the use of some antispasmodic drugs.

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Intestinal microbiota fingerprint in subjects with Irritable Bowel Syndrome responders to a low FODMAP diet

Food & Function ◽

10.1039/d0fo03162c ◽

2021 ◽

Author(s):

Fernanda Valdez-Palomares ◽

Rafael Nambo-Venegas ◽

Jacqueline Uribe-García ◽

Alfredo Mendoza-Vargas ◽

Omar Granados-Portillo ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Intestinal Microbiota ◽

Gastrointestinal Disorder ◽

Functional Gastrointestinal Disorder ◽

Bowel Habit ◽

Altered Bowel Habit ◽

Irritable Bowel ◽

Fodmap Diet

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habit. IBS patients report that FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet induce...

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Irritable bowel syndrome: new insights into symptom mechanisms and advances in treatment

F1000Research ◽

10.12688/f1000research.7992.1 ◽

2016 ◽

Vol 5 ◽

pp. 780 ◽

Cited By ~ 15

Author(s):

Robin Spiller

Keyword(s):

Irritable Bowel Syndrome ◽

New Agents ◽

Enteric Nerves ◽

Inflammatory Bowel ◽

Magnetic Resonance Imaging Mri ◽

Irritable Bowel ◽

Fodmap Diet ◽

And Function ◽

The Impact

Despite being one of the most common conditions leading to gastroenterological referral, irritable bowel syndrome (IBS) is poorly understood. However, recent years have seen major advances. These include new understanding of the role of both inflammation and altered microbiota as well as the impact of dietary intolerances as illuminated by magnetic resonance imaging (MRI), which has thrown new light on IBS. This article will review new data on how excessive bile acid secretion mediates diarrhea and evidence from post infectious IBS which has shown how gut inflammation can alter gut microbiota and function. Studies of patients with inflammatory bowel disease (IBD) have also shown that even when inflammation is in remission, the altered enteric nerves and abnormal microbiota can generate IBS-like symptoms. The efficacy of the low FODMAP diet as a treatment for bloating, flatulence, and abdominal discomfort has been demonstrated by randomized controlled trials. MRI studies, which can quantify intestinal volumes, have provided new insights into how FODMAPs cause symptoms. This article will focus on these areas together with recent trials of new agents, which this author believes will alter clinical practice within the foreseeable future.

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Applying a Low-FODMAP Dietary Intervention to a Female Ultraendurance Runner With Irritable Bowel Syndrome During a Multistage Ultramarathon

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.2017-0398 ◽

2019 ◽

Vol 29 (1) ◽

pp. 61-67 ◽

Cited By ~ 5

Author(s):

Stephanie K. Gaskell ◽

Ricardo J.S. Costa

Keyword(s):

Irritable Bowel Syndrome ◽

Dietary Intervention ◽

Gastrointestinal Symptoms ◽

Irritable Bowel Syndrome Symptom ◽

Carbohydrate Intake ◽

Severe Nausea ◽

Dietary Analysis ◽

Irritable Bowel ◽

Fodmap Diet ◽

The Impact

Malabsorption of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) in response to prolonged exercise may increase incidence of upper and lower gastrointestinal symptoms (GIS), which are known to impair exercise performance. This case study aimed to explore the impact of a low-FODMAP diet on exercise-associated GIS in a female ultraendurance runner diagnosed with irritable bowel syndrome, competing in a 6-day 186.7-km mountainous multistage ultramarathon (MSUM). Irritable bowel syndrome symptom severity score at diagnosis was 410 and following a low-FODMAP diet (3.9 g FODMAPs/day) it reduced to 70. The diet was applied 6 days before (i.e., lead-in diet), and maintained during (5.1 g FODMAPs/day) the MSUM. Nutrition intake was analyzed through dietary analysis software. A validated 100-mm visual analog scale quantified GIS incidence and severity. GIS were modest during the MSUM (overall mean ± SD: bloating 27 ± 5 mm and flatulence 23 ± 8 mm), except severe nausea (67 ± 14 mm) experienced throughout. Total daily energy (11.7 ± 1.6 MJ/day) intake did not meet estimated energy requirements (range: 13.9–17.9 MJ/day). Total daily protein [1.4 ± 0.3 g·kg body weight (BW)−1·day−1], carbohydrate (9.1 ± 1.3 g·kg BW−1·day−1), fat (1.1 ± 0.2 g·kg BW−1·day−1), and water (78.7 ± 6.4 ml·kg BW−1·day−1) intakes satisfied current consensus guidelines, except for carbohydrates. Carbohydrate intake during running failed to meet recommendations (43 ± 9 g/hr). The runner successfully implemented a low-FODMAP diet and completed the MSUM with minimal GIS. However, suboptimal energy and carbohydrate intake occurred, potentially exacerbated by nausea associated with running at altitude.

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Irritable Bowel Syndrome with Diarrhea

10.2310/gastro.5445 ◽

2018 ◽

Author(s):

Judy Nee ◽

Jacqueline L. Wolf

Keyword(s):

Irritable Bowel Syndrome ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Treatment Options ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Dietary Advice ◽

Emerging Therapies ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

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Irritable bowel syndrome

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0308 ◽

2020 ◽

pp. 2951-2959

Author(s):

Adam D. Farmer ◽

Qasim Aziz

Keyword(s):

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Recurrent Abdominal Pain ◽

Bowel Habit ◽

Western World ◽

Older Individuals ◽

Butyl Bromide ◽

Rome Iii ◽

Fermentable Carbohydrates ◽

Irritable Bowel

Symptoms suggestive of disturbed lower gastrointestinal function without adequate explanation are very common in adults in the Western world, up to 15% of whom experience such symptoms at any one time, although most do not seek medical advice. The currently used terms are best viewed as an attempt to provide some clinically useful, rather than pathophysiologically accurate, categorization of patients and their symptoms based on disordered gut–brain interactions. Irritable bowel syndrome is defined according to the Rome III criteria as recurrent abdominal pain or discomfort associated with a change in bowel habit for at least 6 months, with symptoms experienced on at least 3 days of at least 3 months. Many subtypes are recognized. Routine haematological and biochemical screening is usually performed on the assumption that it will be normal. Features that raise the suspicion of organic disease and indicate a need for further investigation include the onset of symptoms in middle-aged or older individuals, weight loss, or blood in the stool. Management remains empirical: no single pharmacological agent or group of agents has ever been found to be consistently effective. The principal task of the physician is to provide explanation and reassurance (sometimes supplemented by psychological treatments), but particular symptoms are often treated as follows: (1) constipation—defecation may be eased by supplementary dietary fibre and poorly absorbed fermentable carbohydrates which increase faecal bulk and soften the stool; osmotic laxatives and enemas are used for the severely constipated patient, as well as more novel agents; (2) diarrhoea—attention to diet is often helpful, as are simple antidiarrhoeal agents; and (3) abdominal pain—antispasmodics (e.g. hyoscine butyl bromide) are frequently used, as are antidepressants.

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