番茄社区

A randomized controlled trial presented at the Digestive Disease Week (DDW) annual meeting looked at the effects of a diet low in FODMAPs (fermentable oligo-, di-, monosaccharides, and polyols) versus traditional dietary advice for patients with irritable bowel syndrome (IBS).

In this exclusive 番茄社区 video, study author Hans Törnblom, MD, PhD, of the University of Gothenburg in Sweden, discusses the study's findings.

Following is a transcript of his remarks:

This study is related to diet therapy in IBS. We all know that -- patients and ourselves know that -- diet seems to be able to improve, reduce symptoms in IBS. But we have problems in deciding which patients will fare best from which type of diet advice.

So, what we have done this time is actually form a study where we compare three different treatment options. Two of them are diet advice, and one is an optimized medical treatment to have something else than diet advice to compare with. And this is quite uncommon; I would say it's a unique study from that point of view.

And what we have been comparing is the low FODMAP diet, which most people interested in IBS nowadays are well aware of. It's certain carbohydrates, where we have limited or no ability to absorb them from the gut, which creates fermentation and osmotic effects in the bowel, particularly in the colon. And in patients with IBS that has a different sensory function, this type of fermentation might produce symptoms like abdominal pain, gas, bloating, or poor bowel habits -- the core symptoms.

What we have compared this diet with is a more restrictive, low-carbohydrate diet in general, which means that we have a higher fat and protein content to compensate for the loss of calories in this diet. And as a third treatment option, myself and three more colleagues of mine have been [studying] the third treatment arm, trying to optimize the medical treatment according to the predominant GI symptom. And this is, I think, what most clinicians recognize as a common way to treat IBS patients. Giving those with troubles with constipation something that will improve the constipation, with diarrhea, something that reduces diarrhea, etc.

And we randomized patients with IBS defined by the Rome IV criteria within equal randomization blocks into one of those treatments for 4 weeks. It's difficult to have diet treatment going on for more than 4 weeks, if you want to make sure that as many patients as possible are following your advice. In order to have an opportunity to adapt to a low FODMAP diet, a low-carb diet, and also for medical treatment, all the treatments were for free. And when it comes to the diet, the food was also free and it was delivered by home delivery service once a week. And we have produced cookbooks and suggestions on what to eat and which days to eat it. And also in those who needed more food than we provided, we suggested which types of snacks they can use in order to still adhere to the diet.

And after 4 weeks, both before and after the study period, we measured IBS symptoms by a scale called the IBS Severity Scoring System -- maximum score is 500, if you have a score less than 75, you're in remission. Most studies include patients with moderate to severe symptoms as we have done, which means that they have a score of at least 175. And on average, our patients had a little bit more than 300 in this score before the study. All three treatment groups improved their symptoms, which was what we expected beforehand, that all treatment groups should improve their symptoms.

Our hypothesis was actually that the low FODMAP diet would do best. But what we saw was that both diet treatment options, you can say that three out of four patients had what we can define as a significant reduction in the symptom score. And two out of three patients in the optimized medical treatment had a significant reduction in symptoms. So, you can tell that all three interventions were effective, but it seems like dietary treatment options are more effective than medical treatment.

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