Post by kickingfrog on Oct 17, 2016 10:35:34 GMT
FODMAP RESTRICTION OF A GLUTEN FREE DIET IN PATIENTS WITH COELIAC DISEASE: A RANDOMIZED, CONTROLLED CLINICAL STUDY
K. Nuland I. Strindmo G. Kahrs J. Hatlebakk
Introduction
20-30 % of coeliac patients on a gluten free diet still have irritable bowel syndrome (IBS) symptoms. A low FODMAP (fermentable oligo-, di-, monosaccharides and polyols) diet is effective to reduce symptoms in IBS patients.
Aims & Methods
We wanted to investigate the benefit from restricting the FODMAP content of the diet in patients With coeliac disease, who are sitll symptomatic on a gluten-free diet. 40 patients with coeliac disease and IBS symptoms confirmed by the Rome III-criteria and IBS-SSS (Symptom Severity Scale) were randomized and instructed by dieticians: Group A excluded all wheat starch and “traces of gluten” from their diet, Group B excluded FODMAPs as well as gluten. Symptoms on IBS-SSS were recorded at baseline, 3 and 6 weeks, as well as quality of life (SF-36). Four days prospective dietary intake records at baseline and 6 weeks, compliance and satisfaction after 6 weeks, and 1 month later. Dietist Net Free was used for FODMAP calculations. Statistics: paired T-tests and Wilcoxon's.
Results
20 patients were included in each group; A (18F/2M, age 39±15) and B (15F/5M, age 43±12). 42.5% had constipation, 27.5% diarrhoea and 30% both.
The mean total IBS-SSS score was significantly reduced: Group A from 260 to 204 (p=0.0022), group B from 263 to 145 (p<0.0001), p=0.0247, group B vs. A. In group A 10% reached remission, in Group B 25% (p=0.408). All subscales improved significantly in group B, but only abdominal pain severity in group A. SF-36 physical health score improved in group B (p= 0.0081), but not in group A. Patients in group B were significantly more satisfied with pain relief (p=0.0132), but it was also more challenging to follow their diet (p=0.0008).
Conclusion
Patients with coeliac disease and IBS-symptoms had significant improvement in abdominal symptoms and physical health from a low FODMAP diet for 6 weeks. A gluten free diet with reduced FODMAP content was more effective than a more strict gluten free diet, and should be offered to coeliac patients with refractory IBS-symptoms on a gluten free diet.
cslide.ctimeetingtech.com/ueg2016/confcal/person/Kaukinen
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K. Nuland I. Strindmo G. Kahrs J. Hatlebakk
Introduction
20-30 % of coeliac patients on a gluten free diet still have irritable bowel syndrome (IBS) symptoms. A low FODMAP (fermentable oligo-, di-, monosaccharides and polyols) diet is effective to reduce symptoms in IBS patients.
Aims & Methods
We wanted to investigate the benefit from restricting the FODMAP content of the diet in patients With coeliac disease, who are sitll symptomatic on a gluten-free diet. 40 patients with coeliac disease and IBS symptoms confirmed by the Rome III-criteria and IBS-SSS (Symptom Severity Scale) were randomized and instructed by dieticians: Group A excluded all wheat starch and “traces of gluten” from their diet, Group B excluded FODMAPs as well as gluten. Symptoms on IBS-SSS were recorded at baseline, 3 and 6 weeks, as well as quality of life (SF-36). Four days prospective dietary intake records at baseline and 6 weeks, compliance and satisfaction after 6 weeks, and 1 month later. Dietist Net Free was used for FODMAP calculations. Statistics: paired T-tests and Wilcoxon's.
Results
20 patients were included in each group; A (18F/2M, age 39±15) and B (15F/5M, age 43±12). 42.5% had constipation, 27.5% diarrhoea and 30% both.
The mean total IBS-SSS score was significantly reduced: Group A from 260 to 204 (p=0.0022), group B from 263 to 145 (p<0.0001), p=0.0247, group B vs. A. In group A 10% reached remission, in Group B 25% (p=0.408). All subscales improved significantly in group B, but only abdominal pain severity in group A. SF-36 physical health score improved in group B (p= 0.0081), but not in group A. Patients in group B were significantly more satisfied with pain relief (p=0.0132), but it was also more challenging to follow their diet (p=0.0008).
Conclusion
Patients with coeliac disease and IBS-symptoms had significant improvement in abdominal symptoms and physical health from a low FODMAP diet for 6 weeks. A gluten free diet with reduced FODMAP content was more effective than a more strict gluten free diet, and should be offered to coeliac patients with refractory IBS-symptoms on a gluten free diet.
cslide.ctimeetingtech.com/ueg2016/confcal/person/Kaukinen
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