Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies

Péter Varjú, Nelli Farkas, Péter Hegyi, András Garami, Imre Szabó, Anita Illés, Margit Solymár, Áron Vincze, Márta Balaskó, Gabriella Pár, Judit Bajor, Ákos Szűcs, Orsolya Huszár, Dániel Pécsi, József Czimmer, Péter Varjú, Nelli Farkas, Péter Hegyi, András Garami, Imre Szabó, Anita Illés, Margit Solymár, Áron Vincze, Márta Balaskó, Gabriella Pár, Judit Bajor, Ákos Szűcs, Orsolya Huszár, Dániel Pécsi, József Czimmer

Abstract

Background: Irritable bowel syndrome (IBS) and functional digestive tract disorders, e.g. functional bloating, carbohydrate maldigestion and intolerances, are very common disorders frequently causing significant symptoms that challenge health care systems. A low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) diet is one of the possible therapeutic approaches for decreasing abdominal symptoms and improving quality of life.

Objectives: We aimed to meta-analyze data on the therapeutic effect of a low-FODMAP diet on symptoms of IBS and quality of life and compare its effectiveness to a regular, standard IBS diet with high FODMAP content, using a common scoring system, the IBS Symptom Severity Score (IBS-SSS).

Methods: A systematic literature search was conducted in PubMed, EMBASE and the Cochrane Library as well as in the references in a recent meta-analysis. Adult patients diagnosed with IBS according to the Rome II, Rome III, Rome IV or NICE criteria were included in the analysis.

Statistical methods: Mean differences with 95% confidence intervals were calculated from studies that contained means, standard deviation (SD) or mean differences and SD of differences and p-values. A random effect model was used because of the heterogeneity (Q test (χ2) and I2 indicator). A p-value of less than 0.05 was chosen to indicate a significant difference.

Results: The literature search yielded 902 publications, but only 10 were eligible for our meta-analysis. Both regular and low-FODMAP diets proved to be effective in IBS, but post-diet IBS-SSS values were significantly lower (p = 0.002) in the low-FODMAP group. The low-FODMAP diet showed a correlation with the improvement of general symptoms (by IBS-SSS) in patients with IBS.

Conclusions: This meta-analysis provides high-grade evidence of an improved general symptom score among patients with irritable bowel syndrome who have maintained a low-FODMAP diet compared to those on a traditional IBS diet, therefore showing its superiority to regular IBS dietary therapy. These data suggest that a low-FODMAP diet with dietitian control can be a candidate for first-line therapeutic modality in IBS. Because of a lack of data, well-planned randomized controlled studies are needed to ascertain the correlation between improvement of separate key IBS symptoms and the effect of a low-FODMAP diet.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart for the systematic…
Fig 1. Flow chart for the systematic literature search.
Fig 2. Forest plot of IBS-SSS DIMs,…
Fig 2. Forest plot of IBS-SSS DIMs, comparing pre- vs. post-intervention values within groups (low-FODMAP and control).
IBS-SSS = Irritable Bowel Syndrome Symptom Severity Score (0–500); DIM = Difference in Means; FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
Fig 3. Forest plot of IBS-SSS DIMs,…
Fig 3. Forest plot of IBS-SSS DIMs, comparing pre- and post-intervention values between groups (low-FODMAP vs. control).
IBS-SSS = Irritable Bowel Syndrome Symptom Severity Score (0–500); DIM = Difference in Means; FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

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