A Service Evaluation of FODMAP Restriction, FODMAP Reintroduction and Long-term Follow-up in the Dietary Management of Irritable Bowel Syndrome

Overview

Journal J Hum Nutr Diet

Date 2024 Nov 5

PMID 39498596

Authors

Rosie Foulkes

Paru Shah

Alice Twomey

Lara Dami

Danielle Jones

Miranda C E Lomer

Affiliations

Soon will be listed here.

Abstract

Background: The dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), called the low-FODMAP diet (LFD), is frequently used to manage irritable bowel syndrome (IBS). This service evaluation aimed to assess the long-term effectiveness of the LFD in managing IBS symptoms and whether symptom response and dietary adherence to the LFD were associated.

Methods: This observational service evaluation collected data via questionnaires during clinical dietetic appointments for IBS management. Symptom severity was reported at baseline, short term (following FODMAP restriction) and long term (following FODMAP reintroduction). Additional data that captured experiences following the LFD were collected at long-term follow-up.

Results: Of 184 patients, 14% reported satisfactory relief from global symptoms at baseline, which increased to 69% at short-term follow-up and 57% at long-term follow-up (p < 0.001). The most notable improvements in individual symptoms between baseline and long-term follow-up were abdominal bloating (72% baseline, 48% long term, p < 0.001), abdominal pain (61% baseline, 30% long term, p < 0.001) and flatulence (71% baseline, 40% long term, p < 0.001). High adherence with the LFD at short-term follow-up was not associated with long-term symptom improvement, but there was an association between long-term adherence and global symptom severity (p = 0.032). Completion of FODMAP reintroduction as per protocol was associated with long-term symptom improvement (p = 0.049).

Conclusions: The LFD is an effective treatment for managing IBS symptoms in the long term, particularly, when the diet is adhered to and reintroduction is completed as per dietetic education. Further randomised-controlled trials are required to explore the cause-and-effect relationship between LFD and IBS symptom management.

Citing Articles

A service evaluation of FODMAP restriction, FODMAP reintroduction and long-term follow-up in the dietary management of irritable bowel syndrome.

Foulkes R, Shah P, Twomey A, Dami L, Jones D, Lomer M J Hum Nutr Diet. 2024; 38(1):e13393.

PMID: 39498596 PMC: 11589392. DOI: 10.1111/jhn.13393.

References

Staudacher H, Rossi M, Kaminski T, Dimidi E, Ralph F, Wilson B . Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterol Motil. 2021; 34(4):e14241. DOI: 10.1111/nmo.14241. View

Oka P, Parr H, Barberio B, Black C, Savarino E, Ford A . Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(10):908-917. DOI: 10.1016/S2468-1253(20)30217-X. View

Tuck C, Reed D, Muir J, Vanner S . Implementation of the low FODMAP diet in functional gastrointestinal symptoms: A real-world experience. Neurogastroenterol Motil. 2019; 32(1):e13730. DOI: 10.1111/nmo.13730. View

Muhammad Nawawi K, Belov M, Goulding C . Low FODMAP diet significantly improves IBS symptoms: an Irish retrospective cohort study. Eur J Nutr. 2019; 59(5):2237-2248. DOI: 10.1007/s00394-019-02074-6. View

Lovell R, Ford A . Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012; 10(7):712-721.e4. DOI: 10.1016/j.cgh.2012.02.029. View

Whigham L, Joyce T, Harper G, Irving P, Staudacher H, Whelan K . Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome. J Hum Nutr Diet. 2015; 28(6):687-96. DOI: 10.1111/jhn.12318. View

Bohn L, Storsrud S, Tornblom H, Bengtsson U, Simren M . Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013; 108(5):634-41. DOI: 10.1038/ajg.2013.105. View

Staudacher H, Lomer M, Anderson J, Barrett J, Muir J, Irving P . Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012; 142(8):1510-8. DOI: 10.3945/jn.112.159285. View

Ankersen D, Weimers P, Bennedsen M, Haaber A, Fjordside E, Beber M . Long-Term Effects of a Web-Based Low-FODMAP Diet Versus Probiotic Treatment for Irritable Bowel Syndrome, Including Shotgun Analyses of Microbiota: Randomized, Double-Crossover Clinical Trial. J Med Internet Res. 2021; 23(12):e30291. PMC: 8715363. DOI: 10.2196/30291. View

10.

Goyal O, Batta S, Nohria S, Kishore H, Goyal P, Sehgal R . Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet in patients with diarrhea-predominant irritable bowel syndrome: A prospective, randomized trial. J Gastroenterol Hepatol. 2021; 36(8):2107-2115. DOI: 10.1111/jgh.15410. View

11.

OKeeffe M, Jansen C, Martin L, Williams M, Seamark L, Staudacher H . Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterol Motil. 2017; 30(1). DOI: 10.1111/nmo.13154. View

12.

Svedlund J, Sjodin I, DOTEVALL G . GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci. 1988; 33(2):129-34. DOI: 10.1007/BF01535722. View

13.

Staudacher H, Lomer M, Farquharson F, Louis P, Fava F, Franciosi E . A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017; 153(4):936-947. DOI: 10.1053/j.gastro.2017.06.010. View

14.

Staudacher H, Ralph F, Irving P, Whelan K, Lomer M . Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet. J Acad Nutr Diet. 2019; 120(4):535-547. DOI: 10.1016/j.jand.2019.01.017. View

15.

Mearin F, Lacy B, Chang L, Chey W, Lembo A, Simren M . Bowel Disorders. Gastroenterology. 2016; . DOI: 10.1053/j.gastro.2016.02.031. View

16.

Black C, Staudacher H, Ford A . Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2021; 71(6):1117-1126. DOI: 10.1136/gutjnl-2021-325214. View

17.

Sperber A, Bangdiwala S, Drossman D, Ghoshal U, Simren M, Tack J . Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2020; 160(1):99-114.e3. DOI: 10.1053/j.gastro.2020.04.014. View

18.

Maagaard L, Ankersen D, Vegh Z, Burisch J, Jensen L, Pedersen N . Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol. 2016; 22(15):4009-19. PMC: 4823251. DOI: 10.3748/wjg.v22.i15.4009. View

19.

de Roest R, Dobbs B, Chapman B, Batman B, OBrien L, Leeper J . The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract. 2013; 67(9):895-903. DOI: 10.1111/ijcp.12128. View

20.

Whelan K, Martin L, Staudacher H, Lomer M . The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J Hum Nutr Diet. 2018; 31(2):239-255. DOI: 10.1111/jhn.12530. View