Department of Gastroenterology/Hepatology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, St.Gallen, 9007, Switzerland.
Department of Internal Medicine, Spital Männedorf, Asylstrasse 10, Männedorf, 8708, Switzerland.
Clin Nutr ESPEN. 2020 Dec;40:83-89. doi: 10.1016/j.clnesp.2020.09.020. Epub 2020 Oct 6.
A low FODMAP diet (LFD) has become a standard treatment in irritable bowel syndrome (IBS) patients. Compliant adherence to a LFD is challenging. We investigated the effect of a LFD compared to a less restrictive low lactose diet (LLD) in a randomized cross-over trial with IBS patients.
Twenty-nine IBS patients were randomly assigned to two groups. After a run-in phase of 14 days, patients received 21 days of either a LFD or LLD. This intervention was followed by a washout period of 21 days before crossing over to the alternate diet. Dietician led diet instruction was given continuously. An IBS Severity Scoring System (IBS-SSS) was filled in at the end of each study period. To enhance study adherence, daily symptoms were assessed using a Visual Analog Scale (VAS).
IBS patients, irrespective of lactase deficiency, had a significantly reduced IBS-SSS score after both diets (LFD p = 0.002, LLD p = 0.007) without significant difference. On both diets, patients reported that IBS had less impact on their daily life compared to the time before the study (p < 0.01). On daily assessment, IBS patients on LFD reported significantly less abdominal pain (median VAS difference to baseline -0.8 (-2.8 to 2.7, p = 0.03) and less bloating (-0.5 (-4.1 to 3.4, p = 0.02) than patients on the LLD.
Both diets improved the overall IBS severity significantly and patients' preference of the two diets was similar. LFD but not LLD effectively reduced pain and bloating in patients with IBS.
低 FODMAP 饮食（LFD）已成为肠易激综合征（IBS）患者的标准治疗方法。但患者通常难以坚持这种饮食。我们在一项随机交叉试验中比较了 LFD 和限制较少的低乳糖饮食（LLD）在 IBS 患者中的效果。
29 名 IBS 患者被随机分为两组。在为期 14 天的适应期后，患者分别接受 21 天的 LFD 或 LLD。在此干预之后，经过 21 天的洗脱期，患者再交叉至另一饮食。由营养师进行连续的饮食指导。在每个研究阶段结束时填写肠易激综合征严重程度评分系统（IBS-SSS）。为了增强研究的依从性，使用视觉模拟量表（VAS）每天评估症状。
无论乳糖酶缺乏与否，IBS 患者在两种饮食后 IBS-SSS 评分均显著降低（LFD p=0.002，LLD p=0.007），但无显著差异。在两种饮食中，患者均报告称与研究前相比，IBS 对日常生活的影响较小（p<0.01）。在每天的评估中，LFD 组患者报告的腹痛明显少于 LLD 组（与基线相比的 VAS 差值中位数为-0.8（-2.8 至 2.7，p=0.03），腹胀也更少（-0.5（-4.1 至 3.4，p=0.02）。
两种饮食均显著改善了 IBS 的整体严重程度，且患者对两种饮食的偏好相似。LFD 可有效减轻 IBS 患者的疼痛和腹胀，而 LLD 则无效。
