An algorithm for differentiating food antigen-related gastrointestinal symptoms.

Kamran Rostami, Justine Bold, Jafer Ismail Ali, Alison Parr, Walburga Dieterich, Yurdagül Zopf, Aung Htoo, Mohammad Rostami-Nejad, Mihai Danciu

Journal: Gastroenterology and hepatology from bed to bench 2021;14(1):8-16

PMID: 33868604

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Plain Language Summary

Irritable bowel syndrome (IBS) is a collection of gastrointestinal symptoms. Due to multiple etiologies, the pathogenesis of IBS is poorly understood. The aim of this audit was to assess the outcomes achieved using a lactose and gluten-free diet clinical intervention in patients traditionally diagnosed with IBS. This study was an audit of outcomes from the records of 149 patients presenting with IBS symptoms at secondary and tertiary Gastroenterology outpatients in two UK hospitals. This audit has demonstrated that more than 70% of patients presenting with IBS symptoms improved by following a diet eliminating lactose and gluten containing grains (improvement for >30% in their symptoms). The success of the elimination diet did not seem to be correlated with the body mass index (BMI). The best outcome was recorded in patients with normal BMI and also in the overweight group. Patients with higher BMI >30 or low below 18 also responded well to nutrition therapy. In conclusion, multidisciplinary team management and implementation of detailed nutrition therapy using the audit algorithm might prove to be both cost effective and efficacious a treatment option in IBS.

Abstract

AIM

The aim of this clinical audit was to assess patient-reported outcomes on the effect of dietary intervention, to enhance our understanding of possible treatment options in irritable bowel syndrome (IBS).

BACKGROUND

A large number of food-related gastro-intestinal disorders have been attributed to IBS for decades.

METHODS

Patient-reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Patients all presented with symptoms fulfilling Rome III-IV criteria for IBS had negative coeliac serology and did not have other gastrointestinal (GI) conditions. A modified version of a low FODMAP diet had been recommended (gluten and lactose free diet (G/LFD)) and was implemented for 6 weeks. Outcomes and dietary adherence were recorded during outpatient's consultations.

RESULTS

A total of 134 patients complied with the diet optimally. The majority had an improvement rate >70% and continued with the diet. Fifty-three percent became completely or almost asymptomatic, while 27.6% had a poor response to the diet (scoring < 30%) to G/LFD. The improvement was excellent in patients with normal BMI and good in overweight and obese and where BMI <18. Over 50% did not require any follow-up within 12 months.

CONCLUSION

Although it is unclear whether symptoms are triggered by gluten, fructans or lactose, elimination of gluten and lactose proved to be an effective treatment in patients with IBS. Multidisciplinary team management and implementation of detailed nutrition therapy using the audit algorithm might prove to be both cost effective and efficacious a treatment option in IBS.

Address: Department of Gastroenterology, MidCentral DHB, Palmerston North, New Zealand.; Department of Gastroenterology, Milton Keynes University Hospital NHS Trust, UK.; The School of Allied Health and Community, University of Worcester, Worcester, UK.; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff UK.; Department of Gastroenterology, Milton Keynes University Hospital NHS Trust, UK.; Salford Community Leisure, Manchester, UK.; Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Hector Centre of Excellence for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.; Department of Gastroenterology, MidCentral DHB, Palmerston North, New Zealand.; Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania.