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Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet vs Traditional Dietary Advice in
Mohamed G Shiha1, Rachel L Buckle2, Christian C Shaw2
1Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
Background & Aims:
Postprandial distress syndrome affects 80% of individuals with functional dyspepsia, yet evidence-based dietary management strategies remain poorly defined. This United Kingdom-based, single-center, randomized trial compared traditional dietary advice with a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet in postprandial distress syndrome.
Methods:
Participants with postprandial distress syndrome received dietary education on traditional dietary advice (ie, small, frequent meals with reduction of caffeine, alcohol, carbonated beverages, and high-fat, processed, or spicy foods) or a low FODMAP diet. Questionnaires were completed at baseline and over 6 weeks, including the Leuven Postprandial Distress Scale, which was used to determine the primary endpoint of clinically meaningful reductions in the postprandial distress syndrome subscale of the Leuven Postprandial Distress Scale (≥0.5 points and ≥0.7 points). Secondary endpoints included individual changes to the Leuven Postprandial Distress Scale, changes in the overall Gastrointestinal Symptom Rating Scale and Nepean Dyspepsia Index for quality of life, and self-reported adequate relief of dyspeptic symptoms (≥50% of the time during weeks 4-6).
Results:
A total of 60 patients with postprandial distress syndrome underwent randomization; 31 were assigned to the low FODMAP diet and 29 to the traditional dietary advice group. Baseline characteristics were similar between groups, with mean age 39.6 years, 78% female, 78% white, and coexistent irritable bowel syndrome in 63%. For the primary endpoint, a ≥0.5-point reduction in postprandial distress syndrome subscale was achieved by 61.3% with the low FODMAP diet vs 37.9% with traditional dietary advice (P = .04), while a ≥0.7-point reduction was achieved by 61.3% with the low FODMAP diet vs 20.7% with traditional dietary advice (P < .001). The low FODMAP diet group demonstrated significantly greater improvements in individual Leuven Postprandial Distress Scale symptoms, overall quality of life, and overall gastrointestinal symptoms compared with traditional dietary advice. Adequate relief of dyspepsia was self-reported by 71.0% with the low FODMAP diet vs 34.5% with traditional dietary advice (P = .005).
Conclusions:
A low FODMAP diet was superior to traditional dietary advice for achieving symptom relief and quality of life improvement in postprandial distress syndrome.
Clinicaltrials:
gov, Number: NCT05810168.
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