Introduction Irritable bowel syndrome (IBS) is a functional GI disorder, which can be debilitating and difficult to treat. There is growing evidence that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), improves symptoms in IBS. We aimed to retrospectively investigate the effects of a low FODMAPs diet in addition to traditional dietary advice, in patients with IBS symptoms. Furthermore, we aimed to assess the symptom response during long-term follow up including after gradual re-introduction of high FODMAPs foods.
Method All the tertiary referrals seen by a FODMAPs trained dietitian were reviewed (2013–2016). Patients with IBS symptoms, regardless of underlying medical or surgical conditions were included (however those with concomitant active IBD and coeliac disease were excluded). At the initial dietetic consultation, patients were evaluated for IBS symptoms by a questionnaire (4-point Likert scale). Subsequently, advice regarding low FODMAPs diet as well as traditional dietary advice was given. Symptom response was assessed at 3, 6 and 12 months follow up, by use of the same questionnaire. Gradual re-introduction of high FODMAPs foods was aimed to commence at the initial follow up.
Results A total of 164 patients were reviewed. Thirty-seven patients were excluded due to failure to attend the initial follow up, and we have deemed them to be a treatment failure. Hundred and twenty seven patients (77% patients, with 85% were female) completed the initial 3 months follow up. Forty-five percent (74/164) and twenty-five percent (41/164) of the patients had continued follow up at 6 and 12 months respectively. Of the 127 patients who returned for follow up, their baseline symptoms were as following: abdominal pain (89%), bloating (91%), flatulence (91%), faecal urgency (76%), incomplete evacuation (79%), nausea (54%), heartburn (50%), regurgitation (57%) and lethargy (92%).
All symptoms were significantly improved at the initial follow up (p<0.0001 for all). Most patients (66%) were satisfied with their symptoms. In patients who had longer follow up duration, all symptoms remained significantly improved compared to the baseline (p<0.0001 for composite symptom at 6 and 12 months). After re-introduction of high FODMAPs foods, patients maintained their symptomatic response (p<0.0001 for composite symptom). The best symptom improvement was seen in those who were fully adherent to the FODMAPs diet (p<0.0001 for all symptoms).
Conclusion In this retrospective cohort study, low FODMAPs diet in addition to traditional dietary advice, significantly improved all IBS symptoms, with 77.5% of patients compliant with diet. Patients were able to maintain symptomatic response beyond 3 months and after re-introduction of high FODMAPs foods.
Disclosure of Interest None Declared
- irritable bowel syndrome