Does a Low FODMAP Diet Help Patients With Celiac Disease?
Vanessa M. Shami, MD, FASGE, reviewing van Megen F, et al. Clin Gastroenterol Hepatol 2022 Jan 17.
The incidence of celiac disease has been increasing over time and is commonly encountered in GI practice. Although a gluten-free diet leads to pathologic disease remission, symptoms may persist in a subset of patients. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for patients with irritable bowel syndrome (IBS). However, its efficacy in patients with celiac disease is not well established. This randomized controlled trial, performed from October 2018 to August 2019, assessed the efficacy of a low FODMAP diet on alleviating symptoms in patients with treated celiac disease with ongoing GI symptoms.
Seventy patients with biopsy-proven celiac disease were enrolled in the study and randomized to a low FODMAP diet (n=34) or a control group (n=36). All 70 patients had persistent gastrointestinal symptoms, defined by a score ≥30 on the IBS version of the Gastrointestinal Symptom Rating Scale (GSRS-IBS), gluten-free diet adherence ≥12 months, as well as serological and biopsy-proven remission. GSRS-IBS was recorded at baseline and weeks 1 to 4, and the Celiac Symptom Index (CSI) score was recorded at baseline and week 4.
GSRS-IBS total scores differed significantly between the groups (P<0.001 for interaction) starting as soon as one week (mean difference [95% confidence interval/CI] of intervention vs control (-8.2 [-11.5, -5.0]) and persisting through week 4 (-10.8 [-14.8, -6.8]). Additionally, the intervention group experienced significant improvements in pain, bloating, diarrhea, and satiety (P≤0.04 for interaction) but not constipation (P=0.43 for interaction). CSI was significantly lower in the intervention group versus the control group at week 4 (mean difference, -5.8; 95% CI [-9.6, -2.0]).
COMMENTA low FODMAP diet should be recommended to patients with celiac disease who have followed a strict gluten-free diet and have biopsy-proven remission yet still have persistent symptoms. Although this seems like an easy intervention, it takes further commitment from patients who already are diet-restricted.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
van Megen F, Skodje GI, Lergenmuller S, et al. A low FODMAP diet reduces symptoms in treated celiac patients with ongoing symptoms – a randomized controlled trial. Clin Gastroenterol Hepatol 2022 Jan 17. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.01.011)
