Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

doi:10.3748/wjg.v23.i18.3356

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World Journal of Gastroenterology

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Randomized Controlled Trial

World J Gastroenterol. May 14, 2017; 23(18): 3356-3366
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3356

Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

Natalia Pedersen, Dorit Vedel Ankersen, Maria Felding, Henrik Wachmann, Zsuzsanna Végh, Line Molzen, Johan Burisch, Jens Rikardt Andersen, Pia Munkholm

Natalia Pedersen, Department of Gastroenterology, Slagelse Hospital, 4200 Slagelse, Denmark

Dorit Vedel Ankersen, Line Molzen, Johan Burisch, Pia Munkholm, Gastroenterology Unit, North Zealand Hospital, 3600 Frederikssund, Denmark

Maria Felding, Jens Rikardt Andersen, Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen, Denmark

Henrik Wachmann, Department of Statistics, Larix A/S, 2730 Herlev, Denmark

Zsuzsanna Végh, First Department of Medicine, Semmelweis University, 1083 Budapest, Hungary

Author contributions: Pedersen N and Ankersen DV contributed equally to this work; Pedersen N, Ankersen DV, Felding M, Andersen JR and Munkholm P designed the research; Pedersen N, Ankersen DV, Felding M performed the research; Ankersen DV and Felding M educated patients in the use of LFD; Pedersen N, Ankersen DV and Wachmann H analysed the data; Pedersen N, Ankersen DV wrote the paper, which was critically revised by all co-authors; all the authors contributed to this manuscript.

Institutional review board statement: The study was approved by Ethics Committee of Science, Denmark (protocol H-2-2012-05/38987).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: Data set are available from the corresponding author (natalia.pedersen@regionh.dk). The Danish Data Protection Agency approved the study design for ensuring the protection of the data. The presented data are anonymized and the risk of identification is low. No additional data are available.

Correspondence to: Dr. Natalia Pedersen, Department of Gastroenterology, Slagelse Hospital, Ingemannsvej 24, 4200 Slagelse, Denmark. natalia.pedersen@zeniavej.dk

Telephone: +45-29919548 Fax: +45-29919547

Received: November 15, 2016
Peer-review started: November 17, 2016
First decision: December 24, 2016
Revised: January 24, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: May 14, 2017
Processing time: 181 Days and 0.5 Hours

Abstract

AIM

To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD).

METHODS

This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life.

RESULTS

Eighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P < 0.01). At week 6, the LFD group showed a significantly lower median IBS-SSS (median 115; inter-quartile range [IQR] 33-169) than ND group (median 170, IQR 91-288), P = 0.02. Furthermore, the LFD group had a significantly greater increase in SIBDQ (median 60, IQR 51-65) than the ND group (median 50, IQR 39-60), P < 0.01.

CONCLUSION

In a prospective study, a low-FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.

Keywords: Inflammatory bowel disease; Web-based management; Irritable bowel syndrome; Low-FODMAP diet

Core tip: This is one of the first randomized controlled studies showing that low-FODMAP diet had ameliorative effect on irritable bowel syndrome (IBS)-like symptoms in a Danish inflammatory bowel disease (IBD) population in remission. The IBD quality of life were also improved on the same diet. Based on the results of this study, a low-FODMAP diet could be recommended for IBD patients in remission who are experiencing IBS-like symptoms. The diet requires guidance from a dietician for closely monitoring of the nutritional adequacy with dietary restriction.