DDW 2021 | Low FODMAP diet, the first-line treatment option for irritable bowel syndrome?

Introduction In primary care, general practitioners (GPs) have a high degree of uncertainty in the diagnosis and treatment of irritable bowel syndrome (IBS), and the curative effects of currently available treatments are limited.

In Europe, muscle-stimulating agents (such as otilonium bromide, OB) are often used to treat IBS.

Recently, in terms of specialty health care, the low-FODMAP diet guided by experienced dietitians has shown significant symptom improvement in IBS patients, but its application in primary care remains to be explored.

The purpose of this study was to evaluate the intervention effect of a low-FODMAP diet (D) implemented through a smartphone application on the symptoms, quality of life and psychosocial comorbidities of patients with IBS compared with OB.

Research Methods In this clinical trial, 69 GP recruited 470 patients with IBS who were randomly assigned to the OB group (60 mg tid) or the low FODMAP diet group (D).

The treatment was 8 weeks, and the follow-up lasted up to 6 months.

Patients who meet Rome IV criteria are defined as Rome +.

The numerical score (bootstrapped t-test) and the proportion of responders (≥50 improvement, ChiSquare) were used to compare the changes in the IBS symptom severity score (IBS-SSS) between the two treatment groups.

In addition, the effects of treatment on patient quality of life (IBSQoL), anxiety (GAD), depression and somatization (PHQ15) were also discussed.

Results of the study 453 primary care IBS patients (41 ± 15 years, 76% F, 71% Rome +) were randomly assigned to the OB group (n = 231, 41 ± 15 years, 75% F) or the low FODMAP diet group (n = 227 ,41±15y, 75%F).

The response rate of the diet group (71%) was significantly higher than that of OB (61%, p=0.
03), which was more pronounced in Rome+ patients (77 vs 62%, p=0.
005).

During the follow-up period, the diet group maintained a higher response rate (74 vs 58%, p <0.
001).

Over time, the average IBS-SSS of the two groups of patients improved significantly (OB 267 ± 100 vs 170 ± 109, p <0.
001; D 267 ± 96 vs 188 ± 109, p <0.
001), but the diet group improved more Obvious (p = 0.
02).

IBSQoL (OB -7.
34, p <0.
001 vs D -8.
07, p <0.
001), GAD (OB -0.
99, p <0.
001 vs D -1.
19, p <0.
001), depression (OB -1.
09, p <0.
001) of the two groups of patients Both 0.
001 vs D -1.
36, p <0.
001) and PHQ15 (OB -1.
31, p <0.
001 vs D -1.
80, p <0.
001) both improved significantly, but there was no significant difference in the improvement between the two groups.

Summary This study shows that in primary care IBS, diet intervention based on smartphone applications is better than standard medication in improving the severity of symptoms, and can achieve clinically significant responses at the end of treatment and during follow-up.

Both treatments improved the patient's quality of life and psychosocial comorbidities.

App-based dietary interventions should be considered as first-line treatment options for IBS in primary care.

References: Carbone F, Van Den Houte K, Besard L, et al.
THE DOMINO STUDY: DIET OR MEDICATION IN PRIMARY CARE IBS.
DDW Abstract 512.