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Meta-Analysis
. 2017 Aug 14;12(8):e0182942.
doi: 10.1371/journal.pone.0182942. eCollection 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

Péter Varjú  1   2 , Nelli Farkas  3 , Péter Hegyi  1   4   5 , András Garami  1 , Imre Szabó  4 , Anita Illés  4 , Margit Solymár  1 , Áron Vincze  4 , Márta Balaskó  1 , Gabriella Pár  4 , Judit Bajor  4 , Ákos Szűcs  6 , Orsolya Huszár  6 , Dániel Pécsi  1 , József Czimmer  4
Affiliations
Meta-Analysis

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

Péter Varjú et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart for the systematic literature search.
Fig 2
Fig 2. Forest plot of IBS-SSS DIMs, comparing pre- vs. post-intervention values within groups (low-FODMAP and control).
IBS-SSS = Irritable Bowel Syndrome Symptom Severity Score (0–500); DIM = Difference in Means; FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
Fig 3
Fig 3. Forest plot of IBS-SSS DIMs, comparing pre- and post-intervention values between groups (low-FODMAP vs. control).
IBS-SSS = Irritable Bowel Syndrome Symptom Severity Score (0–500); DIM = Difference in Means; FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
See this image and copyright information in PMC

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