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

Table 1 Baseline characteristics of the patients

	Low-FODMAP diet, n = 44	Normal diet,n = 45	P value
Male/Female	12 (27)/32 (73)	10 (23)/35 (77)	0.64
Age, median (range)	40 (20-70)	41 (24-69)	0.55
Body mass index, median (range)	25 (18-39)	24 (18-52)	0.44
Smoking			0.01
Current	8 (18)	2 (4)
Former	19 (43)	12 (28)
Never	17 (39)	30 (68)
IBD diagnosis type			0.93
Ulcerative colitis (UC)	30 (68)	31 (69)
Crohn’s disease (CD)	14 (32)	14 (31)
UC extent			0.34
E1, proctitis	7 (23)	11 (36)
E2, left side	15 (50)	10 (32)
E3, extensive	8 (27)	10 (32)
CD location			0.51
L1, small bowel	4 (29)	3 (21)
L2, colonic	4 (29)	7 (50)
L3, ilea-colonic	6 (42)	4 (29)
CD behavior			0.13
B1, inflammatory	6 (43)	11 (79)
B2, stricturing	6 (43)	2 (14)
B3, penetrating	2 (14)	1 (7)
IBD duration, median (range)	7 (1-40)	5 (1-39)	0.41
IBD disease activity (yes)	6 (14%)	7 (16%)	0.52
UC disease activity (SCCAI)	3 (1-4)	2 (1-4)	0.75
CD disease activity (HBI)	7 (3-8)	5 (4-11)	0.61
IBS severity (IBS-SSS)	210 (190-270)	245 (180-320)	0.40
IBS-quality of life	73 (19-99)	77 (30-98)	0.25
Short-IBD-quality of life (SIBDQ)	47 (42-55)	50 (40-57)	0.88
C-reactive protein (mg/L), median (range)	2 (2-35)	2 (2-52)	0.32
Faecal calprotectin (μg/L), median (range)	50 (2-1259)	39 (2-1600)	0.28
FODMAPs (g/d), median (range)	24 (9-81)	26 (4-58)	0.53
Surgery prior study	11 (25)	2 (4)	0.01
Medication: Yes/No	34/10	38/7	0.41
5-ASA/Sulphasalazine	23 (52)	25 (55)
Azathioprine (AZA)/Methotrexate	4 (9)	7 (15)/1 (2)
Biologicals ± AZA	5 (11)	4 (9)

Data are expressed as n (%), median (IQR: Interquartile range). IBD: Inflammatory bowel disease; IBS: Irritable bowel disease; SSS: Symptom severity scale; SCCAI: Simple clinical colitis index; HBI: Harvey Bradshaw index.

Table 2 Results of main outcomes in inflammatory bowel disease patients on low-FODMAP diet

	Number	Week 0	Week 6	P value
Irritable Bowel Syndrome-Symptom Severity System (IBS-SSS)
Low-FODMAP	37	210 (190-270)	115 (33-169)	< 0.001
Normal diet	41	245 (180-320)	170 (91-288)	< 0.001
			0.021
Simple Clinical Colitis Index (SCCAI)
Low-FODMAP	24	3 (1-4)	1 (0-3)	0.04
Normal diet	29	2 (1-4)	2 (1-4)	0.98
			0.021
Harvey and Bradshaw Index (HBI)
Low-FODMAP	9	7 (3-8)	3 (1-5)	0.05
Normal diet	12	5 (4-11)	6 (3-9)	0.25
			0.091
Irritable Bowel Syndrome Quality of Life (IBS-QOL)
Low-FODMAP	36	73 (19-99)	78 (18-99)	< 0.01
Normal diet	41	77 (30-98)	81 (26-99)	0.30
			0.091
Short Inflammatory Bowel Disease Questionnaire (SIBDQ)
Low-FODMAP	34	47 (42-55)	60 (51-65)	< 0.01
Normal diet	40	50 (40-57)	50 (39-60)	0.54
			< 0.011

¹P: Mann-Whitney U test comparison of change in outcomes between treatment groups at 6-wk. All data are presented as median (IQR: Interquartile range). P: Wilcoxon signed rank test, comparison of paired samples 0 vs 6-wk for all subjects; All IBS-QOL results on 0-100 scale (0 worst, 100 best).

Table 3 Results of irritable bowel syndrome-symptom severity system response in subgroups of inflammatory bowel disease patients on low FODMAP

	Number	Week 0	Week 6	P value
Ulcerative colitis (UC)
UC	55 (71)	220 (190-300)	124 (40-198)	< 0.01
LFD	26 (47)	225 (187-260)	120 (36-170)	< 0.01
ND	29 (53)	220 (185-315)	141 (52-263)	< 0.01
0.371
Crohn’s disease (CD)
CD	23 (29)	245 (170-320)	170 (56-294)	< 0.01
LFD	11 (48)	210 (160-320)	58 (18-173)	0.02
ND	12 (52)	250 (172-382)	220 (57-357)	0.54
0.021
UC vs CD, P = 0.241
IBD-Remission by SCCAI/HBI
Remission	65 (83)	230 (175-305)	140 (39-212)	< 0.01
LFD	31 (48)	220 (170-250)	105 (26-167)	< 0.01
ND	34 (52)	242 (177-322)	175 (77-298)	< 0.01
< 0.011
IBD Mild-to-Moderate Activity by SCCAI/HBI
Activity	13 (17)	210 (200-350)	140 (103-252)	0.53
LFD	6 (46)	210 (194-391)	169 (105-332)	0.17
ND	7 (54)	260 (200-330)	140 (96-211)	0.06
0.531
Remission vs Activity, P < 0.011
FC-remission (≤ 100 μg/g UC, ≤ 200 μg/g CD), n = 53
Remission	53 (73)	220 (179-305)	113 (34-225)	< 0.01
LFD	25 (47)	220 (174-305)	60 (29-169)	< 0.01
ND	28 (53)	230 (180-307)	174 (66-298)	< 0.01
0.061
FC-activity (> 100 μg/g UC; > 200 μg/g CD), n = 20
Activity	20 (27)	250 (204-330)	160 (110-211)	< 0.01
LFD	11 (55)	210 (200-250)	157 (95-198)	0.04
ND	9 (45)	320 (230-360)	170 (103-291)	0.03
0.501
FC-Remission vs FC-Activity, P = 0.291
CRP-remission (< 10 mg/L), n = 75
Remission	75 (96)	230 (180-320)	140 (50-211)	< 0.01
LFD	35 (47)	210 (187-260)	114 (30-169)	< 0.01
ND	40 (53)	248 (180-320)	176 (78-288)	< 0.01
< 0.011
CD, prior surgery (bowel/ileo-coecal resections), n = 13/23 (57%)
LFD	11	225 (178-302)	10 (32-223)	< 0.01
ND	2	-	-

¹P: Mann-Whitney U test comparison of change in outcomes between treatment groups at 6-wk. All data are presented as median (IQR: Interquartile range), n (%) (- only 2 cases). P: Wilcoxon signed rank test, comparison of paired samples within each treatment group. IBS: Irritable bowel syndrome; SSS: Severity score system; IBD: Inflammatory bowel disease; LFD: Low FODMAP diet; ND: Normal Diet.