ReviewLow fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis
Section snippets
Background
Irritable bowel syndrome (IBS) describes a group of symptoms that include abdominal pain or discomfort and changes in bowel movement patterns and defecation. Although a correlation between pathophysiology and symptoms lacks for most cases, patients experience abdominal pain and a negative impact on their quality of life. IBS is the most common functional gastrointestinal (GI) disease [1] and a diagnosis of IBS is based on the Rome criteria [2].
Although nearly 60% of patients claim that certain
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses [6] and the recommendations by the Cochrane Collaboration [7] were followed.
Literature search
The literature search retrieved 179 records of which 113 non-duplicate records were screened and 105 records were excluded because they did not use an RCT design and/or a low FODMAP diet was not an intervention. One RCT was excluded because it used the low FODMAP diet only to wash out symptoms in the initial stage of the investigation on the effects of diets that were high or low in gluten [14]. Nine full-text articles on RCTs with a total of 596 subjects were included for the qualitative
Summary of evidence
In this systematic review of nine randomized trials, significant evidence for short-term benefits of diets that are low in FODMAPs was found for GI symptoms, abdominal pain, and quality of life in patients with IBS and no side effects were reported. Effects were robust against potential methodological bias.
Despite the evidence that supports LFD efficacy, more than 25% of patients with IBS do not improve on the diet [25]. This meta-analysis shows that adherence to LFD significantly improves GI
Conclusion
This meta-analysis found evidence that the low-FODMAP diet is effective to relieve symptoms and improve the quality of life of patients with IBS. Still, long-term outcomes and the safety of low-FODMAP diets remain to be investigated. Further studies are required to evaluate its long-term effects on gut microbiota, cost effectiveness, and efficacy compared with other modalities.
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Sources of support: No external funding was received for this review.
Conflicts of interest: The authors have declared that no competing interests exist.