Effects of a Low FODMAP Diet in Inflammatory Bowel Disease and Patient Experiences: A Mixed Methods Systematic Literature Review and Meta-Analysis

Introduction

A low FODMAP diet reduces symptoms of irritable bowel syndrome (IBS), but its impact on inflammatory bowel disease (IBD) is less established. This systematic review aimed to: (1) assess the effect of a low FODMAP diet in IBD and (2) understand patient experiences when implementing the low FODMAP diet.

Methods

Four databases (Medline, Embase, CINAHL and CENTRAL) were systematically searched. RCTs evaluating a low FODMAP diet in IBD on disease activity, inflammatory markers, gastrointestinal symptoms, and quality of life (QoL), and qualitative studies reporting patient experiences of low FODMAP interventions (in either IBS or IBD), were included. Outcome data were meta-analysed as standardised mean differences or odds ratios. Qualitative data underwent content analysis using the Health Belief Model.

Results

Five RCTs (n = 224) and two qualitative studies (n = 30 IBS patients, no studies in IBD) were included. Compared with controls, there was no effect of a low FODMAP diet on disease activity (Crohn's disease: SMD −0.33; −0.77, 0.11; ulcerative colitis: SMD −0.31; −0.78, 0.15) or faecal calprotectin (SMD −0.20; −0.49, 0.09), but lower severity of global IBS symptoms (SMD −0.56; −0.90, 0.23) and higher QoL scores (SMD 0.43; 0.05, 0.81) at end of intervention. Patients with IBS described implementation as burdensome (Severity, Barriers), inadequate professional support (Susceptibility) and found it difficult to interpret information (Susceptibility, Barriers). Meal plans and recipes (Cue to action and Self-efficacy) gained through dietitian-led information sessions were valued (Benefits).

Conclusions

A low FODMAP diet does not impact IBD disease activity and inflammation markers, but leads to improved gastrointestinal symptoms compared with controls. The diet should be considered for improving functional gastrointestinal symptoms, but not an IBD treatment. There are minimal studies about patient experiences implementing the low FODMAP diet, all in IBS. Future research should assess patient experiences of low FODMAP diet implementation, specific to IBD.

Summary

• A low FODMAP diet reduces symptoms of irritable bowel syndrome (IBS), but its impact on inflammatory bowel disease (IBD) is unclear.
• These findings highlight the potential benefit of a low FODMAP diet for managing gastrointestinal symptoms and improving quality of life in patients with IBD experiencing IBS symptoms.
• Social challenges, the burden of implementation and the lack of tailored support were major barriers to following a low FODMAP diet in IBS, but there were no studies of patient experience in IBD.

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