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Further research needed to determine first-line therapy for IBS in primary care
  1. Anupam Rej,
  2. David S Sanders,
  3. Imran Aziz
  1. Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Dr Anupam Rej, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; anupam.rej{at}

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We read with great interest the excellent study by Carbone et al,1 which evaluated the role of a fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP)-lowering diet versus otilonium bromide (OB) in patients with irritable bowel syndrome (IBS). The study is an important addition to the growing literature evaluating the role of diets in IBS,2 but is unique by being the first to be conducted within primary care and while also delivering its dietary education via a smart phone application. The investigators found the FODMAP-lowering diet to be superior to OB at weeks 4 (62% vs 51%, p=0.02) and weeks 8 (71% vs 61%, p=0.03), and concluded that it should be considered the first-line treatment for IBS in primary care.1 However, we believe there remain unanswered questions that need to be addressed before making these recommendations.

First, the …

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  • Contributors AR, DSS and IA wrote the initial manuscript. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DSS receives an educational grantfrom Schaer (a gluten‐free food manufacturer). Dr Schaer did not have any input in drafting of this manuscript. The remaining authors disclose no conflicts of interest.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.