Original Article
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World J Gastroenterol. Nov 21, 2014; 20(43): 16215-16226
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16215
Ehealth: Low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome
Natalia Pedersen, Nynne Nyboe Andersen, Zsuzsanna Végh, Lisbeth Jensen, Dorit Vedel Ankersen, Maria Felding, Mette Hestetun Simonsen, Johan Burisch, Pia Munkholm
Natalia Pedersen, Johan Burisch, Pia Munkholm, Digestive Disease Centre, Medical Section, Herlev University Hospital, 2730 Copenhagen, Denmark
Nynne Nyboe Andersen, Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen, Denmark
Zsuzsanna Végh, Digestive Disease Centre, Medical Section, Herlev University Hospital, 2730 Copenhagen, Denmark
Zsuzsanna Végh, Department of Medicine, Veszprém Megyei Csolnoky Ferenc Kórház, 8200 Veszprém, Hungary
Lisbeth Jensen, Mette Hestetun Simonsen, Nutrition Department, Herlev University Hospital, 2730 Copenhagen, Denmark
Dorit Vedel Ankersen, Maria Felding, Clinical Nutrition, Faculty of Science, University of Copenhagen, 1870 Copenhagen, Denmark
Author contributions: Andersen NN, Pedersen N and Munkholm P designed the research; Pedersen N and Andersen NN performed the research; Jensen L, Simonsen MH, Ankersen DV and Felding M educated patients in the use of LFD; Pedersen N, Végh Z and Burisch J prepared the data tables and performed the statistical analyses; Pedersen N wrote the paper, which was critically revised by all co-authors.
Correspondence to: Natalia Pedersen, MD, Digestive Disease Centre, Medical Section, Herlev University Hospital, Herlev Ringvej 75, 2730 Copenhagen, Denmark. natalia.pedersen@zeniavej.dk
Telephone: +45-2-9919548 Fax: +45-2-9919547
Received: June 11, 2014
Revised: July 14, 2014
Accepted: July 24, 2014
Published online: November 21, 2014
Abstract

AIM: To investigate the effects of a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols diet (LFD) and the probiotic Lactobacillus rhamnosus GG (LGG) in irritable bowel syndrome (IBS).

METHODS: Randomised, unblinded controlled trial on the effect of 6-wk treatment with LFD, LGG or a normal Danish/Western diet (ND) in patients with IBS fulfilling Rome III diagnostic criteria, recruited between November 2009 and April 2013. Patients were required to complete on a weekly basis the IBS severity score system (IBS-SSS) and IBS quality of life (IBS-QOL) questionnaires in a specially developed IBS web self-monitoring application. We investigated whether LFD or LGG could reduce IBS-SSS and improve QOL in IBS patients.

RESULTS: One hundred twenty-three patients (median age 37 years, range: 18-74 years), 90 (73%) females were randomised: 42 to LFD, 41 to LGG and 40 to ND. A significant reduction in mean ± SD of IBS-SSS from baseline to week 6 between LFD vs LGG vs ND was revealed: 133 ± 122 vs 68 ± 107, 133 ± 122 vs 34 ± 95, P < 0.01. Adjusted changes of IBS-SSS for baseline covariates showed statistically significant reduction of IBS-SSS in LFD group compared to ND (IBS-SSS score 75; 95%CI: 24-126, P < 0.01), but not in LGG compared to ND (IBS-SSS score 32; 95%CI: 18-80, P = 0.20). IBS-QOL was not altered significantly in any of the three groups: mean ± SD in LFD 8 ± 18 vs LGG 7 ± 17, LFD 8 ± 18 vs ND 0.1 ± 15, P = 0.13.

CONCLUSION: Both LFD and LGG are efficatious in patients with IBS.

Keywords: Irritable bowel syndrome, Web-based management, Low FODMAP diet, Lactobacillus rhamnosus GG, Disease severity, Irritable bowel syndrome-quality of life

Core tip: This is one of the first studies confirming the efficacy of a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols diet (LFD) in a Danish population with irritable bowel syndrome (IBS). The Lactobacillus rhamnosus GG (LGG) also has beneficial effects on IBS symptoms, particularly in diarrhoeal and alternating IBS subtypes. Web-based monitoring (such as at: http://www.ibs.constant-care.dk) of disease severity and quality of life appears to be feasible among patients with IBS. LFD and LGG should be recommended for patients with IBS. The web-based monitoring of disease severity is promising means and should be more widely implemented among patients with IBS.