Goyal Omesh, Batta Shaveta, Nohria Sahil, Kishore Harsh, Goyal Prerna, Sehgal Rishabh, Sood Ajit
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Dietetics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Gastroenterol Hepatol. 2021 Aug;36(8):2107-2115. doi: 10.1111/jgh.15410. Epub 2021 Feb 4.
Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet improves irritable bowel syndrome (IBS) symptoms. Data on long-term "modified" FODMAP diet are emerging. We aimed to assess efficacy and acceptability of short-term "strict" low FODMAP diet (LFD) and long-term "modified" FODMAP diet in patients with diarrhea-predominant IBS (IBS-D).
This prospective randomized trial included patients with IBS-D (Rome IV) and IBS severity scoring system (IBS-SSS) ≥ 175. In phase I (4 weeks), patients were randomized to strict LFD and traditional dietary advice (TDA) groups. From 4 to 16 weeks, LFD group was advised systematic reintroduction of FODMAPs ("modified" FODMAP diet). Response was defined as > 50-point reduction in IBS-SSS.
Of the total 166 patients with IBS-D screened, 101 (mean age 41.9 ± 17.1 years, 58% male) were randomized to LFD (n = 52) and TDA (n = 49) groups. Both at 4 and 16 weeks, total IBS-SSS and IBS quality of life score reduced significantly in both groups, but there was significantly greater reduction in LFD group. By intention-to-treat analysis, responders in LFD group were significantly higher than TDA group (4 weeks-62.7% [32/51] vs 40.8% [20/49], respectively, P = 0.0448; 16 weeks-52.9% [27/51] vs 30.6% [15/49], respectively; P = 0.0274). Compliance to LFD was 93% at 4 weeks and 64% at 16 weeks. Energy, carbohydrate, fat, and fiber intake showed reduction in LFD group at 4 weeks, which improved till 16 weeks.
Strict LFD for short-term and "modified" LFD for long term in IBS-D patients is acceptable and leads to significant improvement in symptoms and quality of life.
低可发酵寡糖、双糖、单糖和多元醇（FODMAP）饮食可改善肠易激综合征（IBS）症状。关于长期“改良”FODMAP饮食的数据正在不断涌现。我们旨在评估短期“严格”低FODMAP饮食（LFD）和长期“改良”FODMAP饮食对腹泻型肠易激综合征（IBS-D）患者的疗效和可接受性。
这项前瞻性随机试验纳入了符合罗马IV标准且肠易激综合征严重程度评分系统（IBS-SSS）≥175的IBS-D患者。在第一阶段（4周），患者被随机分为严格LFD组和传统饮食建议（TDA）组。从第4周到第16周，建议LFD组系统性重新引入FODMAPs（“改良”FODMAP饮食）。反应定义为IBS-SSS降低>50分。
在总共166例接受筛查的IBS-D患者中，101例（平均年龄41.9±17.1岁，58%为男性）被随机分为LFD组（n=52）和TDA组（n=49）。在第4周和第16周时，两组的IBS-SSS总分和IBS生活质量评分均显著降低，但LFD组降低更为显著。通过意向性分析，LFD组的反应者显著高于TDA组（第4周分别为62.7%[32/51]和40.8%[20/49]，P=0.0448；第16周分别为52.9%[27/51]和30.6%[15/49]；P=0.0274）。LFD组第4周的依从率为93%，第16周为64%。LFD组在第4周时能量、碳水化合物、脂肪和纤维摄入量减少，至第16周时有所改善。
IBS-D患者短期采用严格LFD，长期采用“改良”LFD是可接受的，且可显著改善症状和生活质量。
