Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2022;20(10):2258–66.e3
A low FODMAP diet reduces symptoms in treated celiac patients with ongoing symptoms – A randomized controlled trial
Background and aims: A gluten-free diet (GFD) usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). The authors have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients.
Methods: A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)-IBS version score of 30 or higher, GFD adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP-GFD (intervention) or usual GFD (control). The GSRS-IBS score was recorded at baseline and at weeks 1–4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance.
Results: The authors included 34 participants in the intervention group and 36 in the control group. Time development of GSRS-IBS total scores differed significantly between the groups (pinteraction < 0.001), evident after 1 week (mean difference in intervention vs. control, -8.2; 95% confidence interval [CI]: -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs. control, -10.8; 95% CI: -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (pinteraction ≤ 0.04), but not constipation (pinteraction = 0.43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/day; 95% CI: 6.7–9.3 g/day). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI: -9.6 to -2.0).
Conclusions: A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease-specific health, and should be considered for the management of persistent symptoms in celiac disease.