In a primary care-based trial, the diet was moderately more effective than antispasmodic medication.

A diet low in FODMAPs (i.e. Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) improved symptoms of irritable bowel syndrome (IBS) in small clinical trials with dietitian involvement in specialty practices (Gastroenterology 2014; 146: 67-75), but this diet is not easy to adhere to, and its effectiveness in primary care settings is unclear.

In this pragmatic, eight-week trial from Belgium, researchers randomised 459 patients with IBS – clinically diagnosed in primary care practices – to either a low-FODMAP diet or to otilonium bromide (an antispasmodic drug taken thrice daily). The diet intervention – delivered through a smartphone or tablet application – was a FODMAP-lowering diet rather than a strict low-FODMAP diet. Patients with either constipation- predominant or diarrhoea-predominant IBS were included.

At eight weeks, the primary outcome (improvement of 50 points or more on a 500-point standardised IBS symptom scale) had occurred significantly more often in the diet group than in the medication group (71% vs 61%). The results were similar regardless of stool-pattern subtype.

Comment: A majority of patients improved in both groups, but the FODMAP-lowering dietary intervention was somewhat more effective than medication. Because so many foods are potentially excluded in this diet, professional guidance makes sense for patients with access to a dietitian. However, FODMAP-lowering advice is freely available through various websites and apps, and I’ve had several patients with IBS who have used such resources successfully.
ALLAN S. BRETT, MD
Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Carbone F, et al. Diet or medication in primary care patients with IBS: the DOMINO study – a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut 2022; 71: 2226-2232.

This summary is taken from the following Journal Watch title: Gastroenterology.