Effectiveness of the low-FODMAP diet in improving non-celiac gluten sensitivity: a systematic review

Non-celiac gluten sensitivity is characterised by the presence of gastrointestinal and extraintestinal symptoms following gluten ingestion. Recent studies suggested an association between non-celiac gluten sensitivity and the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP). This systematic review aimed to examine literature evidence on the relationship between non-celiac gluten sensitivity and FODMAP intake. A comprehensive search was carried out for randomised clinical trials addressing gastrointestinal symptoms as the primary outcome, published between 2010 and 2020 in Portuguese, English or Spanish, and indexed in Scopus, PubMed, SciELO, Cochrane Library, CINAHL, Embase or VHL (LILACS) databases. The systematic review was performed using the population, intervention, comparison and outcome (PICO) framework. A total of 1133 articles were retrieved for further assessment. Three articles were selected for systematic review, one of which included two interventions with different periods and assessments. Quality of evidence was assessed according to the GRADE protocol. The selected articles used different instruments to measure gastrointestinal symptoms and quality of life, hindering comparison of data. Clinical trials identified an association between decreased gastrointestinal symptoms and FODMAP restriction. There are few studies on the topic, and those available used different instruments to assess gastrointestinal symptoms and quality of life. Nevertheless, current evidence supports the gluten-free diet still represents first-line therapy. However, a FODMAP restriction can decrease gastrointestinal symptoms in individuals with non-celiac gluten sensitivity. Further research is needed to confirm this finding.