Low FODMAP diet appears to work for upper and lower GI symptoms

A low FODMAP diet is more effective for improving functional dyspepsia symptoms than standard dietary advice, according to Australian research.

It suggests the low FODMAP diet may influence upper GI symptoms in addition to its known impact on lower gastrointestinal symptoms.

The observational study at the Princess Alexandra Hospital in Brisbane compared symptoms in 40 patients who received a low FODMAP advice and 19 who received standard dietary advice.

Most patients (81%) had co-existing functional dyspepsia and IBS.

Among the findings, the study found a higher proportion of “responders” (≥30% reduction in Structured Assessment of Gastrointestinal Symptom Scale (SAGIS) epigastric domain score at the follow-up visit) in the low FODMAP dietary group compared with the standard diet group (50% v 16%, p-0.012).

“Reduction in postprandial pain and bloating, symptoms both included in the SAGIS epigastric domain, was significantly greater in the low FODMAP dietary advice group compared with the standard advice group after adjusting for baseline differences (p < 0.05).”

“Reduction in excessive belching was also significantly greater in the low FODMAP dietary advice group compared with standard dietary advice (p < 0.05); however, change in all other individual symptoms was not different between groups,” the study said.

The change in total SAGIS score between baseline and follow-up, as a measure of improvement in overall gastrointestinal symptoms, was also greater in the low FODMAP dietary advice group compared with standard dietary advice (p = 0.026).

The study, published in Neurogastroenterology & Motility, said there were a number of ways in which a low FODMAP diet could help reduce symptoms in functional dyspepsia.

For example, a low FODMAP diet would limit small intestinal water, decrease stimulation of mechanoreceptors, and ultimately reduce functional dyspepsia symptoms such as epigastric pain, postprandial fullness, and bloating.

In addition, a low FODMAP diet may improve symptoms by enhancing gastrointestinal epithelial integrity and reducing immune activation.

The researchers said their results showed standard dietary advice still held some value in the clinical setting.

“There is a critical need for high-quality randomised controlled trials in people with and without comorbid IBS to substantiate these findings.”

“Future research examining symptom response in those with FD and coexisting IBS versus FD alone would help delineate whether the presence of IBS is important for clinical response to a low FODMAP diet.”

“Trials of other dietary approaches are also necessary to enable development of much needed dietetic guidelines to support clinical decision-making and reduce symptom burden in people with FD.”

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