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Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome.
Aliment Pharmacol Ther. 2017 06; 45(12):1506-1513.AP

Abstract

BACKGROUND

The low Fermentable Oligo-, Di- Monosaccharides, and Polyoles (FODMAP) diet is a new treatment option for irritable bowel syndrome (IBS). Experts refer to the diet as supported by high level of evidence, but an evaluation of the quality of trials is lacking.

AIM

To provide a systematic review of the quality of trials on the symptomatic effects of the low FODMAP diet for IBS.

METHODS

Pubmed and EMBASE were searched for randomised controlled trials (RCTs) reporting effect of the low FODMAP diet on IBS symptoms. The quality of trials was evaluated by estimating risk of bias and assessing trial methodology.

RESULTS

Nine RCTs were eligible, including 542 patients. The intervention period was from 2 days to 6 weeks and one trial included a 6-month follow-up. Three trials intervened by providing meals, controlling with a diet high in FODMAP content. In six trials, the intervention was instruction by a dietician and a variety of control interventions were used, all with limited established efficacy. Domains with a high risk of bias were identified for all the trials. High risk of bias dominated domains regarding blinding, with only one trial double-blinded.

CONCLUSIONS

The RCTs on the low FODMAP diet are characterized by high risk of bias. The diet has not been studied in a randomised, controlled setting for more than 6 weeks and trials examining the effect of the important reintroduction period are lacking. There is a risk that the symptomatic effects reported in the trials are driven primarily by a placebo response.

Authors+Show Affiliations

Department of Gastroenterology, Zealand University Hospital, Køge, Denmark. Department of Clinical Medicine, Copenhagen University, Denmark.Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.Department of Gastroenterology, Zealand University Hospital, Køge, Denmark. Department of Clinical Medicine, Copenhagen University, Denmark.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

28440580

Citation

Krogsgaard, L R., et al. "Systematic Review: Quality of Trials On the Symptomatic Effects of the Low FODMAP Diet for Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics, vol. 45, no. 12, 2017, pp. 1506-1513.
Krogsgaard LR, Lyngesen M, Bytzer P. Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome. Aliment Pharmacol Ther. 2017;45(12):1506-1513.
Krogsgaard, L. R., Lyngesen, M., & Bytzer, P. (2017). Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 45(12), 1506-1513. https://doi.org/10.1111/apt.14065
Krogsgaard LR, Lyngesen M, Bytzer P. Systematic Review: Quality of Trials On the Symptomatic Effects of the Low FODMAP Diet for Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2017;45(12):1506-1513. PubMed PMID: 28440580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome. AU - Krogsgaard,L R, AU - Lyngesen,M, AU - Bytzer,P, Y1 - 2017/04/25/ PY - 2016/08/19/received PY - 2016/09/04/revised PY - 2017/03/06/accepted PY - 2017/4/26/pubmed PY - 2017/10/7/medline PY - 2017/4/26/entrez SP - 1506 EP - 1513 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 45 IS - 12 N2 - BACKGROUND: The low Fermentable Oligo-, Di- Monosaccharides, and Polyoles (FODMAP) diet is a new treatment option for irritable bowel syndrome (IBS). Experts refer to the diet as supported by high level of evidence, but an evaluation of the quality of trials is lacking. AIM: To provide a systematic review of the quality of trials on the symptomatic effects of the low FODMAP diet for IBS. METHODS: Pubmed and EMBASE were searched for randomised controlled trials (RCTs) reporting effect of the low FODMAP diet on IBS symptoms. The quality of trials was evaluated by estimating risk of bias and assessing trial methodology. RESULTS: Nine RCTs were eligible, including 542 patients. The intervention period was from 2 days to 6 weeks and one trial included a 6-month follow-up. Three trials intervened by providing meals, controlling with a diet high in FODMAP content. In six trials, the intervention was instruction by a dietician and a variety of control interventions were used, all with limited established efficacy. Domains with a high risk of bias were identified for all the trials. High risk of bias dominated domains regarding blinding, with only one trial double-blinded. CONCLUSIONS: The RCTs on the low FODMAP diet are characterized by high risk of bias. The diet has not been studied in a randomised, controlled setting for more than 6 weeks and trials examining the effect of the important reintroduction period are lacking. There is a risk that the symptomatic effects reported in the trials are driven primarily by a placebo response. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/28440580/Systematic_review:_quality_of_trials_on_the_symptomatic_effects_of_the_low_FODMAP_diet_for_irritable_bowel_syndrome_ L2 - https://doi.org/10.1111/apt.14065 DB - PRIME DP - Unbound Medicine ER -