Tolerability of FODMAP – reduced diet in irritable bowel syndrome – efficacy, adherence, and body weight course

Abstract

Background FODMAP reduced diet (fermentable oligo-, di-, monosaccharide, and polyols) belongs to the established therapy strategies in irritable bowel syndrome (IBS). However, disadvantages of this diet are significant and may lead to weight loss and insufficient patient adherence. Reports from Germany are not available yet.

Material and methods In a prospective study, 93 patients with IBS according to Rom III were investigated. Sixty-three patients were recruited for the study and received standardized investigation, informed consent, and structured dietary instructions about the FODMAP reduced diet. Patients complaints were documented by a validated questionnaire and a standardized Lickert scale before and 8 weeks after the start of the diet. Stool characteristics were documented by the Bristol stool form scale.

Results Patients adherence was low because 30 patients (47 %) stopped the diet. Of the remaining 33 patients, 36 % (n = 12) developed significant weight loss during the FODMAP therapy. Patients completing the study reported significant global improvement of symptoms in 79 % of cases (abdominal pain 85 %, meteorism 79 %, flatulence 69 %, borbogymi 69 %, nausea 46 %, fatigue 69 %). In addition, the severity of symptoms was significantly reduced. Fourteen patients developed changes of their stool characteristics according to the Bristol stool form scale, 11 of whom improved diarrhea and 3 improved constipation.

Conclusion FODMAP reduced diet is an efficient therapy in IBS. However, adherence of the patients is poor and the therapy bears the risk of significant weight loss.

Zusammenfassung

Hintergrund Die FODMAP-reduzierte Kost (fermentierbare Oligo-, Di-, Monosaccharide und Polyole) gehört zur etablierten Therapiestrategie beim Reizdarmsyndrom (IBS). Die Nachteile dieser Diät sind allerdings gravierend und können zum Gewichtsverlust und zur mangelnden Patientenadhärenz führen. Zahlen in Deutschland liegen allerdings hierüber nicht vor.

Patienten und Methoden In einer prospektiven Studie wurden 93 Patienten mit IBS nach Rom-III-Kriterien untersucht. 63 Patienten konnten für die Studie rekrutiert werden. Es wurde eine standardisierte Untersuchung, Aufklärung und FODMAP-Ernährungsberatung mit schriftlichem Informationsmaterial durchgeführt. Die Beschwerden wurden anhand validierter Fragebögen und einer standardisierten Lickert-Skala vor und 8 Wochen nach Beginn der Ernährungstherapie erfasst. Die Stuhleigenschaften wurden anhand der Bristol-stool-form-Skala dokumentiert.

Ergebnisse Die Patientenadhärenz war gering, da 30 Patienten (47 %) die Therapie frühzeitig beendeten. Von den 33 verbliebenen Patienten entwickelten 36 % (n = 12) einen signifikanten Gewichtsverlust unter FODMAP-Diät. Die Patienten gaben in 79 % eine signifikante globale Besserung ihrer Beschwerden (Bauchschmerzen 85 %, Blähungen 73 %, Flatulenz 69 %, Borbogymi 69 %, Übelkeit 46 %, Fatigue 69 %) an. Ebenfalls war die Schwere der Symptome signifikant reduziert. 14 Patienten entwickelten eine Veränderung ihres Stuhlverhaltens mit einer Verbesserung der durchfälligen Stühle bei 11 Patienten und der Verstopfung in 3 Fällen.

Schlussfolgerung Die FODMAP-reduzierte Kost ist eine effektive Therapie bei IBS. Allerdings ist die Patientenadhärenz gering und die Therapie kann einen signifikanten Gewichtsverlust erzeugen.

Key words

FODMAP - irritable bowel syndrome - IBS

Schlüsselwörter

FODMAP - irritable bowel syndrome - IBS - Reizdarmsyndrom

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