Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2016; 22(15): 4009-4019
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.4009
Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet
Louise Maagaard, Dorit V Ankersen, Zsuzsanna Végh, Johan Burisch, Lisbeth Jensen, Natalia Pedersen, Pia Munkholm
Louise Maagaard, Dorit V Ankersen, Pia Munkholm, Department of Gastroenterology, North Zealand University Hospital, 3600 Frederikssund, Denmark
Zsuzsanna Végh, First Department of Medicine, Semmelweis University, 1083 Budapest, Hungary
Johan Burisch, Department of Gastroenterology, Hvidovre University Hospital, 2650 Hvidovre, Denmark
Lisbeth Jensen, Department of Gastroenterology, Herlev University Hospital, 2730 Herlev, Denmark
Natalia Pedersen, Department of Gastroenterology, Slagelse University Hospital, 4200 Slagelse, Denmark
Author contributions: Maagaard L and Munkholm P designed the research; all authors contributed to the set-up and content of the questionnaires; Maagaard L performed the research; Maagaard L and Végh Z analysed the data; Maagaard L wrote the paper and all the co-authors made critical revisions of its content; all authors approved the final manuscript.
Supported by the Danish patient society of inflammatory bowel disease and irritable bowel syndrome patients, Colitis Crohn Foreningen.
Institutional review board statement: Not needed for a simple questionnaire analysis according to rules of the Ethics Committee of Science, Denmark.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent before study enrolment.
Conflict-of-interest statement: None to declare.
Data sharing statement: Questionnaires and data set are available from the corresponding author at The Danish Data Protection Agency approved the study design. Participants gave informed written consent for data sharing and furthermore, the presented data are anonymised and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Louise Maagaard, MD, Department of Gastroenterology, North Zealand University Hospital, Frederikssundsvej 30, 3600 Frederikssund, Denmark.
Telephone: +45-22447021
Received: October 29, 2015
Peer-review started: October 30, 2015
First decision: November 27, 2015
Revised: January 7, 2016
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: April 21, 2016

AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease.

METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS fulfilling the ROME III criteria, who previously attended an outpatient clinic for low FODMAP diet (LFD) dietary management and assessment by a gastroenterologist, were invited to participate in a retrospective questionnaire analysis. The questionnaires were sent and returned by regular mail and gathered information on recall of dietary treatment, efficacy, symptoms, adherence, satisfaction, change in disease course and stool type, and quality of life. Before study enrolment all patients had to sign an informed written consent.

RESULTS: One hundred and eighty patients were included, 131 (73%) IBS and 49 (27%) IBD patients. Median age was 43 years (range: 18-85) and 147 (82%) were females. Median follow-up time was 16 mo (range: 2-80). Eighty-six percent reported either partial (54%) or full (32%) efficacy with greatest improvement of bloating (82%) and abdominal pain (71%). The proportion of patients with full efficacy tended to be greater in the IBD group than in the IBS group (42% vs 29%, P = 0.08). There was a significant reduction in patients with a chronic continuous disease course in both the IBS group (25%, P < 0.001) and IBD group (23%, P = 0.002) along with a significant increase in patients with a mild indolent disease course of 37% (P < 0.001) and 23% (P = 0.002), respectively. The proportion of patients having normal stools increased with 41% in the IBS group (P < 0.001) and 66% in the IBD group (P < 0.001). One-third of patients adhered to the diet and high adherence was associated with longer duration of dietary course (P < 0.001). Satisfaction with dietary management was seen in 83 (70%) IBS patients and 24 (55%) IBD patients. Eighty-four percent of patients lived on a modified LFD, where some foods rich in FODMAPs were reintroduced, and 16% followed the LFD by the book without deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients.

CONCLUSION: These data suggest that a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients.

Keywords: Low FODMAP, Irritable bowel syndrome, Inflammatory bowel disease, Adherence, Disease course

Core tip: This is a retrospective study based on patient-reported questionnaires to evaluate the low FODMAP diet (LFD) dietary course of patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). Effect was reported by 86% of patients with greatest relief of abdominal pain and bloating. Long-term IBS disease course and stool type improved significantly after dietary intervention. One-third of patients were adherent and the majority was satisfied with the treatment. These are the first data on changes of long-term IBS disease course following LFD treatment and the longest FU to date of IBS and IBD patients treated with the LFD with a median FU of 16 mo.