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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.
PLoS One. 2017; 12(8):e0182942.Plos

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.

Authors+Show Affiliations

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary. Szentágothai Research Centre, University of Pécs, Pécs, Hungary.Institute of Bioanalysis, University of Pécs, Pécs, Hungary.Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary. Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary. Hungarian Academy of Sciences - University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary.Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.First Department of Surgery, Semmelweis University, Budapest, Hungary.First Department of Surgery, Semmelweis University, Budapest, Hungary.Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28806407

Citation

Varjú, Péter, et al. "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." PloS One, vol. 12, no. 8, 2017, pp. e0182942.
Varjú P, Farkas N, Hegyi P, et al. 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. PLoS ONE. 2017;12(8):e0182942.
Varjú, P., Farkas, N., Hegyi, P., Garami, A., Szabó, I., Illés, A., Solymár, M., Vincze, Á., Balaskó, M., Pár, G., Bajor, J., Szűcs, Á., Huszár, O., Pécsi, D., & Czimmer, J. (2017). 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. PloS One, 12(8), e0182942. https://doi.org/10.1371/journal.pone.0182942
Varjú P, et al. 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. PLoS ONE. 2017;12(8):e0182942. PubMed PMID: 28806407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Varjú,Péter, AU - Farkas,Nelli, AU - Hegyi,Péter, AU - Garami,András, AU - Szabó,Imre, AU - Illés,Anita, AU - Solymár,Margit, AU - Vincze,Áron, AU - Balaskó,Márta, AU - Pár,Gabriella, AU - Bajor,Judit, AU - Szűcs,Ákos, AU - Huszár,Orsolya, AU - Pécsi,Dániel, AU - Czimmer,József, Y1 - 2017/08/14/ PY - 2017/04/19/received PY - 2017/07/27/accepted PY - 2017/8/15/entrez PY - 2017/8/15/pubmed PY - 2017/10/11/medline SP - e0182942 EP - e0182942 JF - PloS one JO - PLoS ONE VL - 12 IS - 8 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28806407/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_ L2 - http://dx.plos.org/10.1371/journal.pone.0182942 DB - PRIME DP - Unbound Medicine ER -