S525 The Low FODMAP Diet Improves Abdominal and Overall Symptoms in Patients With All Subtypes of Irritable Bowel Syndrome

Abstract

Introduction: There is substantial evidence that a diet low in fermenTable oligo-, di-, monosaccharides, and polyols (FODMAPs) improves symptoms in patients with Irritable Bowel Syndrome and diarrhea (IBS-D). Though the low-FODMAP diet is increasingly used in patients with IBS and constipation (IBS-C) or mixed bowel habits (IBS-M), there is little data to support this practice. We aim to compare the real-world effectiveness of a low-FODMAP diet in patients with IBS-D, IBS-C, and IBS-M. Methods: Utilizing a commercially available meal procurement service which prepares and delivers meals certified low in FODMAP content (Modify Health, Atlanta, GA), patients with suspected IBS met with a registered dietitian and completed the IBS symptom severity scale (IBS-SSS) questionnaire before starting the low-FODMAP diet and after the restriction phase of the diet plan. A decrease in IBS-SSS score of >100 was defined as a responder. Results: 403 IBS patients filled out baseline and post-elimination IBS-SSS surveys. 26% of patients were referred by a GI specialist; the rest were self-referrals. 193 (48%) patients had severe IBS (IBS-SSS > 300) prior to the intervention. IBS-D patients had a 71% improvement in pain, 56% improvement in bloating, and 55% improvement in bowel movement satisfaction. 77% of IBS-D patients had improvement in total IBS-SSS >100. IBS-C patients had a 69% improvement in pain, 49% improvement in bloating, and 42% improvement in bowel movement satisfaction. 67% of IBS-C patients had improvements in IBS-SSS >100. IBS-M patients had 85% improvement in pain, 55% improvement in bloating, and 53% improvement in bowel movement satisfaction. 72% of IBS-M patients had improvement in total IBS-SSS >100. Those who used the commercial meals for "all" of the restriction phase had a mean IBS-SSS improvement of 174, and mean quality of life (QOL) improvement of 40%, while those who used the commercial meals for "some" of the elimination phase had mean IBS-SSS improvement of 153, and mean QOL improvement of 33% (p=0.059 and 0.03, respectively). (Table) Conclusion: This data supports the effectiveness of a low-FODMAP diet for all IBS subtypes, including IBS-C and IBS-M. Patients who obtained prepared low-FODMAP meals during the entire restriction phase experienced greater benefits than those who only obtained meals for a portion of the restriction phase. Table 1. - Improvement in IBS-SSS Categories by IBS-Subtype IBS Subtype Total Number of Patients IBS-SSS (Mean % Improvement) Pain (Mean % Improvement) Bloating (Mean % Improvement) BM Satisfaction (Mean % Improvement) % Improvement in IBS-SSS >100 IBS-D 87 59 (p< 0.001) 72 56 56 77 IBS-C 73 50 (p< 0.001) 70 49 42 67 IBS-M 91 56 (p< 0.001) 73 55 53 73