Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jodi Freeman

Abstract

Abstract

Introduction: Irritable bowel syndrome (IBS) is a chronic disorder that affects the gastrointestinal system (GI) and is associated with abdominal pain and changes in bowel movements – diarrhea and/or constipation – without an organic cause, however, most people suffering from IBS agree that certain foods can be a trigger to their GI symptoms. The standard first-line dietary interventions for IBS are healthy eating and lifestyle changes. Once these diets are associated with failure, more intense therapies are necessary. Therefore, this review analyzes the use of a low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet (I) for management of symptoms of IBS-D/ IBS-C and quality of life (O) in adults (≥ 18 years old) with Irritable Bowel Syndrome (P) comparable to other dietary guidelines or restrictions (C).

Methods: A literature search was conducted through Clinical Key and PubMed in October 2018. A total of seven articles consisting of randomized control trials (RCT) were selected based on publication date, intervention technique, sample population, and outcome measures. These articles were later compared based on their study design, results, and statistical relevance.

Results: There is statistical evidence that patients over the age of 18 have a modest improvement in symptom reduction and quality of life with a low FODMAP diet. However, the evidence collected was not strong enough to confirm the efficacy of a low FODMAP diet as an alternative treatment for IBS across all populations. Four articles compared low FODMAP diets to high FODMAP, mNICE, and traditional IBS diets. These found significantly greater improvement in IBS-Symptom Severity Score (IBS-SSS) and quality of life when compared to the control group. These results didn’t provide any follow-up data. The three remaining studies compared gluten-free diet (GFD) to gluten-containing diet (GCD) or their HLA-DQ2/8 genotype status and similarly found statistically significant improvement in IBS-SSS and quality of life when compared to the control group. Only one of these studies provided follow-up data, but the results remained positive at 18 months.

Discussion: While significant positive results were found in each of the articles, improvements are modest and at this time cannot be confirmed as potentially a sole alternative to other dietary guidelines or restrictions. A limited sample population and lack of long-term data prevent the findings from achieving both statistical power and clinical significance. Most of the studies also used similar outcome measures to facilitate comparison of improvement of symptoms of IBS-D/IBS-C and quality of life. As a result, the efficacy of a low FODMAP diet as an alternative to other dietary guidelines or restrictions cannot be confirmed despite many positive findings.

Conclusion: While the seven studies selected for review found significant improvement in IBS symptoms and quality of life following a low FODMAP diet, there is not yet enough evidence to confirm that a low FODMAP diet is equally as effective or superior to other dietary guidelines or restrictions. Patients and providers may consider a low FODMAP diet as an alternative treatment option for those who failed conservative treatment with the standard dietary recommendations and lifestyle modifications. Future research is warranted to further explore low FODMAP and a GFD dietary intervention and to eliminate the limitations of the current studies.

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The Effects of a Low FODMAP Diet Compared to Other Diet Guidelines in Patients Over 18 with IBS

Abstract

Introduction: Irritable bowel syndrome (IBS) is a chronic disorder that affects the gastrointestinal system (GI) and is associated with abdominal pain and changes in bowel movements – diarrhea and/or constipation – without an organic cause, however, most people suffering from IBS agree that certain foods can be a trigger to their GI symptoms. The standard first-line dietary interventions for IBS are healthy eating and lifestyle changes. Once these diets are associated with failure, more intense therapies are necessary. Therefore, this review analyzes the use of a low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet (I) for management of symptoms of IBS-D/ IBS-C and quality of life (O) in adults (≥ 18 years old) with Irritable Bowel Syndrome (P) comparable to other dietary guidelines or restrictions (C).

Methods: A literature search was conducted through Clinical Key and PubMed in October 2018. A total of seven articles consisting of randomized control trials (RCT) were selected based on publication date, intervention technique, sample population, and outcome measures. These articles were later compared based on their study design, results, and statistical relevance.

Results: There is statistical evidence that patients over the age of 18 have a modest improvement in symptom reduction and quality of life with a low FODMAP diet. However, the evidence collected was not strong enough to confirm the efficacy of a low FODMAP diet as an alternative treatment for IBS across all populations. Four articles compared low FODMAP diets to high FODMAP, mNICE, and traditional IBS diets. These found significantly greater improvement in IBS-Symptom Severity Score (IBS-SSS) and quality of life when compared to the control group. These results didn’t provide any follow-up data. The three remaining studies compared gluten-free diet (GFD) to gluten-containing diet (GCD) or their HLA-DQ2/8 genotype status and similarly found statistically significant improvement in IBS-SSS and quality of life when compared to the control group. Only one of these studies provided follow-up data, but the results remained positive at 18 months.

Discussion: While significant positive results were found in each of the articles, improvements are modest and at this time cannot be confirmed as potentially a sole alternative to other dietary guidelines or restrictions. A limited sample population and lack of long-term data prevent the findings from achieving both statistical power and clinical significance. Most of the studies also used similar outcome measures to facilitate comparison of improvement of symptoms of IBS-D/IBS-C and quality of life. As a result, the efficacy of a low FODMAP diet as an alternative to other dietary guidelines or restrictions cannot be confirmed despite many positive findings.

Conclusion: While the seven studies selected for review found significant improvement in IBS symptoms and quality of life following a low FODMAP diet, there is not yet enough evidence to confirm that a low FODMAP diet is equally as effective or superior to other dietary guidelines or restrictions. Patients and providers may consider a low FODMAP diet as an alternative treatment option for those who failed conservative treatment with the standard dietary recommendations and lifestyle modifications. Future research is warranted to further explore low FODMAP and a GFD dietary intervention and to eliminate the limitations of the current studies.

 
 

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