Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2017; 23(25): 4632-4643
Published online Jul 7, 2017. doi: 10.3748/wjg.v23.i25.4632
Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs
Ruth M Harvie, Alexandra W Chisholm, Jordan E Bisanz, Jeremy P Burton, Peter Herbison, Kim Schultz, Michael Schultz
Ruth M Harvie, Kim Schultz, Michael Schultz, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
Ruth M Harvie, Alexandra W Chisholm, Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand
Jordan E Bisanz, Jeremy P Burton, Departments of Surgery and Microbiology & Immunology, Western University, Ontario N6A 5B8, Canada
Peter Herbison, Department of Preventative and Social Medicine, University of Otago Dunedin 9016, New Zealand
Author contributions: Harvie RM, Chisholm AW and Schultz M designed the research, Bisanz JE and Burton JP designed the microbiome analysis; Harvie RM conducted the research with the exception of the microbiome analysis which was conducted by Bisanz JE; Bisanz JE analyzed the microbiome data, all other data was analyzed by Harvie RM with oversight by Herbison P; Harvie RM, Bisanz JE and Schultz M wrote the paper; Schultz K was responsible for data acquisition and input and proof-read the manuscript; Schultz M had primary responsibility for the final content.
Institutional review board statement: This study was reviewed and approved by the Upper South Regional Ethics Committee, New Zealand (#URA/11/05/2011).
Clinical trial registration statement: This study is registered at http://www.anzctr.org.au/. The registration identification number is ANZCTR342998.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors report no conflicts of interest.
Data sharing statement: Demultiplexed sequence and associated metadata was deposited in the NCBI short read archive with BioProject accession PRJNA392762.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Michael Schultz, Associate Professor, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9016, New Zealand. michael.schultz@otago.ac.nz
Telephone: +64-3-4740999 Fax: +64-3-4709358
Received: November 15, 2016
Peer-review started: November 18, 2016
First decision: December 19, 2016
Revised: January 6, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: July 7, 2017
Processing time: 233 Days and 13.5 Hours
Abstract
AIM

To investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol (FODMAP) diet on irritable bowel syndrome (IBS) symptoms and quality of life (QoL).

METHODS

Participants with IBS (Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS (IBS symptom severity scoring system, 0-500 points increasing with severity), IBS QoL questionnaire (0-100 increasing with QoL), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis.

RESULTS

Fifty participants were enrolled into group I (n = 23) or group II (n = 27). Participants in both groups were similar in baseline values but with more men in group I. There was a significantly lower IBS SSS (275.6 ± 63.6 to 128.8 ± 82.5 vs 246.8 ± 71.1 to 203.6 ± 70.1) (P < 0.0002) and increased QoL (68.5 ± 18.0 to 83 ± 13.4 vs 72.9 ± 12.8 to 73.3 ± 14.4) (P < 0.0001) in group I vs group II at 3 mo. The reduced IBS SSS was sustained at 6 mo in group I (160 ± 102) and replicated in group II (124 ± 76). Fiber intake decreased on the low FODMAP diet (33 ± 17 g/d to 21 ± 8 g/d) (P < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet.

CONCLUSION

This study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.

Keywords: Irritable bowel syndrome; FODMAP; Short chain fermentable carbohydrates; Microbiota; Diet; Microbiome

Core tip: Dietary education by a dietitian on a low FODMAP diet leads to a reduction in symptoms and an improvement in quality of life. Commencing a low FODMAP diet does not appear to alter microbial diversity in patients with irritable bowel syndrome (IBS). Patients with IBS when guided by a dietitian on reintroducing FODMAP containing foods to tolerance are able to increase their intake of fiber to recommended levels without significant worsening of symptoms.