Low FODMAPs Diet in Gastrointestinal Disorders
Low FODMAPs Diet in Gastrointestinal Disorders
Recent studies have shown that FODMAPs (Fermentable Oligosaccharides, Disaccharides,
 Monosaccharides, and Polyols) free diet is efficient in subjects with Irritable Bowel
 Syndrome (IBS). Patients with Inflammatory Bowel Diseases (IBD) and celiac disease (CD) can
 experience functional gastrointestinal symptoms not related to inflammation, but data about
 the use of low FODMAPs diet in these settings are still scarce. The aim of the present study
 was to evaluate the usefulness of a low FODMAPs diet in patients with IBS, non-active IBD and
 CD on strict gluten-free diet (GFD). A low FODMAPs diet could be a valid option to contrast
 abdominal symptoms in patients with IBS, non-active IBD and CD on GFD, thus improving the
 quality of life and the social relations.
Recurrent gastrointestinal symptoms (bloating, constipation, abdominal pain, diarrhea and
 flatulence) often interfere with patients' quality of life (QoL) and daily activities. These
 symptoms have been noted in various diseases such as irritable bowel syndrome (IBS), celiac
 disease (CD) and inflammatory bowel diseases (IBD). IBS is the most common diagnosis made by
 gastroenterologists and affects up to 15% of the population. About 60% of patients with IBS
 claims that certain foods can exacerbate their symptoms, so pharmacological treatment is
 often accompanied by dietary measures. Very recently, a diet for the management of functional
 symptoms associated with IBS has been developed: the low FODMAPs diet. FODMAPs (Fermentable,
 Oligo-, Di-, Mono-saccharides And Polyols) is a collective term that indicates a family of
 poorly absorbed short-chain carbohydrates. The low FODMAPs diet is a relatively novel area of
 interest and the majority of studies have been performed in patients with IBS; most of them
 showed that limiting FODMAPs led to an improvement of intestinal symptoms. Patients with
 Crohn's disease (CrD) and ulcerative colitis (UC) often experience symptoms related to
 concomitant functional disease, such as bloating, abdominal pain and flatulence, in the
 absence of active inflammation. These symptoms are less likely to respond to the common
 anti-inflammatory drugs and it is important to recognize them, in order to avoid
 inappropriate therapy and improve QoL. In effect, the cause of these symptoms is related to
 altered function of the gut and the enteric nervous system, rather than to the inflammatory
 activity of disease. In these patients, carbohydrate malabsorption has been considered a
 candidate mechanism by which the diet can induce gut symptoms: lactose and fructose
 malabsorption has been recognized as a potential cause of symptoms due to the high osmotic
 activity and fermentability of malabsorbed lactose.

 The management of this condition could benefit of a dietary intervention, but data regarding
 the effect of a low FODMAPs diet in IBD are limited.

 Also in coeliac patients, despite a lifelong GFD, some abdominal symptoms such as flatulence,
 bloating, diarrhea and abdominal pain can persist. However data regarding the effect of a low
 FODMAPs diet in these subjects are still scarce.

 On the basis of these considerations, the aim of this study was to evaluate the clinical
 impact of a low FODMAPs diet in patients with IBS, CD on GFD and IBD in remission.

 Each subject who respected the inclusion criteria was enrolled in the study and was submitted
 to a diet low in FODMAPs content, after filling out questionnaires on quality of life and
 symptoms (IBS-SSS and SF-36) (T0).

 The IBS-SSS questionnaire consists of 5 questions on: the severity and frequency of abdominal
 pain, the severity of the bloating, the level of satisfaction in bowel habits and quality of
 life. Patients give an estimate from 0 to 100 and the results of each question are summed to
 obtain the final score (theoretical range of 0-500, with a higher score indicating worse
 condition). Previous studies have established that scores below 175 represents mild IBS
 symptoms, 175-300 represents moderate severity, and scores above 300 represent severe IBS.

 The SF-36 is a questionnaire on the patient's state of health consisting of 36 questions
 related to eight health domains: AF-physical activity (10 questions), RP-role limitations due
 to physical health (4 questions) and RE-role limitations due to emotional problems (3
 questions), BP-physical pain (2 questions), GH-perception of general health (5 questions),
 VT-vitality (4 questions), SF-social activities (2 questions), MH-mental health (5 questions)
 and a single question about the change in health status. All SF-36 questions, except one, are
 referred to a previous four-week period of the compilation of questionnaire. The eight-scaled
 scores are the weighted sums of the questions in their section. Each scale is directly
 transformed into a 0-100 scale on the assumption that each question carries equal weight: the
 lower the score the more disability; the higher the score the less disability.

 After the administration of the questionnaires and the collection of anthropometric
 measurements (weight and height), patients were put on a low FODMAPs diet (T0). Each regimen
 was specific for the patient's energy requirement (calculated by BMI) and for its content in
 FODMAPs, realized in conformity with the food reference tables. This low FODMAPs diet was
 prescribed by a dietitian for 12 weeks and patients were instructed to eat according to their
 appetite, received a summary diagram with substances to be taken and those to be avoided and
 were educated to interpret food labels/ingredients lists.

 In order to cover the needs of micro and macronutrients, the administered dietary patterns
 maintained the contents of oligosaccharides, fructose and polyols not more than 0.5 g.

 The questionnaires and the clinical evaluation of the patients were repeated one month (T1)
 and three months (T3) after the beginning of the diet.
Inclusion Criteria:

 -  IBS patients

 -  IBD patients in remission

 -  Coeliac patients on gluten free diet

 Exclusion Criteria:

 -  Active IBD

 -  Coeliac patients non compliant to gluten free diet