A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease

Objective: The aim of this study was to assess the safety and efficacy of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) in patients with inflammatory bowel disease (IBD). Methods: An LFD is associated with symptom improvement in patients with functional intestinal disorders, although its safety and efficacy has not been characterized in patients with IBD. Fifty-five patients with IBD in remission or with mild disease activity were randomized to a 6-wk LFD or standard diet (SD). Disease activity (Harvey–Bradshaw index [HBi], partial Mayo score), fecal calprotectin, and disease-specific quality of life (IBD-Q) were assessed at baseline and at the end of dietary intervention. Results: After the 6-wk dietary intervention, median HBi decreased in the LFD (4; IQR, 3–5 versus 3; IQR, 2–3; P = 0.024) but not in the SD (3; IQR, 3–3 versus 3; IQR, 2–4), whereas Mayo scores were numerically decreased in the LFD group and unmodified in the SD group. Median calprotectin decreased in the LFD (76.6 mg/kg; IQR, 50–286.3 versus 50 mg/kg; IQR, 50.6–81; P = 0.004) but not in the SD group (91 mg/kg; IQR, 50.6–143.6 versus 87 mg/kg; IQR, 50–235.6). Lastly, we observed a barely significant increase in median IBD-Q in the LFD group (166; IQR, 139–182 versus 177; IQR, 155–188; P = 0.05) and no modification in the SD group (181; IQR, 153–197 versus 166; IQR, 153–200). Conclusions: A short-term, LFD is safe for patients with IBD, and is associated with an amelioration of fecal inflammatory markers and quality of life even in patients with mainly quiescent disease.