title: The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study.
abstract: OBJECTIVE
  Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients.
  
  
  METHODS
  Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed.
  
  
  RESULTS
  Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 [95% confidence interval (CI) 2.01-25.0], bloating OR 8.71 (95% CI 2.76-27.5), flatulence OR 7.64 (95% CI 2.53-23.0) and diarrhoea OR 3.39 (95% CI 1.17-9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms.
  
  
  CONCLUSIONS
  The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet.
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: R H
authors.initials: RH
authors.lastname: de Roest
authors.forename: B R
authors.initials: BR
authors.lastname: Dobbs
authors.forename: B A
authors.initials: BA
authors.lastname: Chapman
authors.forename: B
authors.initials: B
authors.lastname: Batman
authors.forename: L A
authors.initials: LA
authors.lastname: O'Brien
authors.forename: J A
authors.initials: JA
authors.lastname: Leeper
authors.forename: C R
authors.initials: CR
authors.lastname: Hebblethwaite
authors.forename: R B
authors.initials: RB
authors.lastname: Gearry
mesh_terms: D015746:Abdominal Pain / Q000178:diet therapy / Q000209:etiology; D001944:Breath Tests; D003967:Diarrhea / Q000178:diet therapy / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000178:diet therapy / Q000209:etiology; D005632:Fructose / Q000493:pharmacokinetics; D005633:Fructose Intolerance / Q000150:complications / Q000178:diet therapy; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000209:etiology; D007785:Lactose / Q000493:pharmacokinetics; D007787:Lactose Intolerance / Q000150:complications / Q000178:diet therapy; D008286:Malabsorption Syndromes / Q000150:complications / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005632:Fructose; D007785:Lactose