A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms–A Randomized Controlled Trial

Frida Van Megen,Gry I Skodje,Simon Lergenmuller,Stephanie Zühlke,Lars Aabakken,Marit B Veierød,Christine Henriksen,Knut E.A Lundin

doi:10.1016/j.cgh.2022.01.011

Abstract

A gluten-free diet usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). We have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients. A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)-IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP-gluten-free diet (intervention) or usual gluten-free diet (control). The GSRS-IBS score was recorded at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance. We included 34 participants in the intervention group and 36 in the control group. Time development of GSRS-IBS total scores differed significantly between the groups (Pinteraction < .001), evident after 1 week (mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (Pinteraction ≤ .04), but not constipation (Pinteraction= .43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/d; 95% CI, 6.7-9.3 g/d). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI, -9.6 to -2.0). A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease-specific health, and should be considered for the management of persistent symptoms in celiac disease. gov: NCT03678935.

Highlights

Many well-treated celiac patients in mucosal remission suffer from ongoing symptoms despite following a strict gluten-free diet, and treatment options are needed
Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)–irritable bowel syndrome (IBS) version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission
The Celiac Symptom Index was significantly lower in the intervention group at week 4

Summary

Methods

A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsyproven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Statistics included marginal models for repeated data and analyses of covariance. Inclusion criteria were persistent GI symptoms, defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version[15] score of 30 or higher, age 18 to 75 years, biopsy-verified diagnosis of CeD or serologyverified CeD during childhood/adolescence,[16] glutenfree diet for at least 12 months, normal CeD serology No. What You Need to Know. Change in GSRS–IBS score was analyzed with a marginal model for repeated measures, including all time points and taking baseline differences into account.[19]. To evaluate the impact of potential departures from normality, changes in GSRS–IBS score were analyzed using a log-transformation of the scores

Results

Discussion

Conclusion