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Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet in patients with diarrhea‐predominant irritable bowel syndrome: A prospective, randomized trial
Author(s) -
Goyal Omesh,
Batta Shaveta,
Nohria Sahil,
Kishore Harsh,
Goyal Prerna,
Sehgal Rishabh,
Sood Ajit
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15410
Subject(s) - medicine , irritable bowel syndrome , gastroenterology , randomized controlled trial , diarrhea
Background and Aim Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet improves irritable bowel syndrome (IBS) symptoms. Data on long‐term “modified” FODMAP diet are emerging. We aimed to assess efficacy and acceptability of short‐term “strict” low FODMAP diet (LFD) and long‐term “modified” FODMAP diet in patients with diarrhea‐predominant IBS (IBS‐D). Methods This prospective randomized trial included patients with IBS‐D (Rome IV) and IBS severity scoring system (IBS‐SSS) ≥ 175. In phase I (4 weeks), patients were randomized to strict LFD and traditional dietary advice (TDA) groups. From 4 to 16 weeks, LFD group was advised systematic reintroduction of FODMAPs (“modified” FODMAP diet). Response was defined as > 50‐point reduction in IBS‐SSS. Results Of the total 166 patients with IBS‐D screened, 101 (mean age 41.9 ± 17.1 years, 58% male) were randomized to LFD ( n = 52) and TDA ( n = 49) groups. Both at 4 and 16 weeks, total IBS‐SSS and IBS quality of life score reduced significantly in both groups, but there was significantly greater reduction in LFD group. By intention‐to‐treat analysis, responders in LFD group were significantly higher than TDA group (4 weeks—62.7% [32/51] vs 40.8% [20/49], respectively, P = 0.0448; 16 weeks—52.9% [27/51] vs 30.6% [15/49], respectively; P = 0.0274). Compliance to LFD was 93% at 4 weeks and 64% at 16 weeks. Energy, carbohydrate, fat, and fiber intake showed reduction in LFD group at 4 weeks, which improved till 16 weeks. Conclusions Strict LFD for short‐term and “modified” LFD for long term in IBS‐D patients is acceptable and leads to significant improvement in symptoms and quality of life.