Gastroenterology. 2024 Feb 22:S00165085(24)001707. doi:10.1053/j.gastro.2024.02.008.Online ahead of print.

K Van den Houte ¹, E Colomier ², K Routhiaux ¹, Z Mariën ¹, J Schol ¹, J Van den Bergh ³, J Vanderstappen ³, N Pauwels ³, A Joos ³, J Arts ⁴, Ph Caenepeel ⁵, F De Clerck ⁶, C Matthys ⁷, A Meulemans ⁷, M Jones ⁸, T Vanuytsel ⁹, F Carbone ⁹, J Tack ¹⁰

Author information

¹Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium.

²Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

³Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.

⁴Department of Gastroenterology, Algemeen Ziekenhuis Sint Lucas, Brugge, Belgium.

⁵Department of Gastroenterology, Hospital Oost-Limburg, Genk, Belgium.

⁶Department of Gastroenterology, AZ Sint-Lucas, Gent, Belgium.

⁷Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism KU Leuven, Leuven, Belgium.

⁸School of Psychological Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, NSW, Australia.

⁹Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium.

¹⁰Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium. Electronic address: jan.tack@kuleuven.be.

Abstract

Background and aims: The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in Irritable Bowel Syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP-powders to objectively identify triggers and evaluated the effect on symptoms, quality of life (QoL), and psychosocial co-morbidities.

Methods: Responders to a 6-week low-FODMAP diet, defined by a drop in IBS-symptom severity score (IBS-SSS) compared to baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP-trigger. Patients completed daily symptom diaries and questionnaires for QoL and psychosocial co-morbidities.

Results: In 117 recruited IBS patients, IBS-SSS improved significantly after the elimination period compared to baseline (150±116 vs 301±97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5±2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides and day 3 for lactose.

Conclusion: We confirmed the significant benefit of the low-FODMAP diet in tertiary care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP-triggers; Clinicaltrial.gov number: NCT04373304.