Low FODMAP diet promising in management of persistent symptoms in coeliac disease

For treated patients with coeliac disease (CD) who are experiencing persistent symptoms, a short-term diet with moderately low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) helps reduce gastrointestinal (GI) symptoms and improve CD-specific health, as suggested in a study.

The study included 70 adults (mean age 45 years, 84.3 percent female) with biopsy-proven CD with persistent gastrointestinal symptoms defined by Gastrointestinal Symptom Rating Scale-IBS version (GSRS-IBS) score≥ 30, gluten-free diet adherence ≥12 months, and serological and mucosal remission. They were randomized to receive low FODMAP-gluten-free diet (intervention, n=34) or usual gluten-free diet (control, n=36) for 4 weeks.

The primary outcome was change in GI symptoms, with the GSRS-IBS assessed at baseline and weeks 1–4. Celiac Symptom Index (CSI) and fatigue (Chalder Fatigue Questionnaire [CFQ]), and FODMAP intake were also evaluated.

The median duration of CD was 7.9 years in the intervention group and 6.7 years in the control group. All participants had normal CD serology (median anti-TG2 IgA 0.5 U/mL, median anti-DGP IgG 2.5 U), and normalized duodenal biopsy (Marsh 0–1). Overall, dietary adherence was good to excellent.

GI symptoms improved markedly in the intervention group relative to the control group, with the difference evident at week 1 (mean difference [MD], –8.2, 95 percent confidence interval [CI], –11.5 to –5.0) and persisting through week 4 (MD, –10.8, 95 percent CI, –14.8 to –6.8). There was significant time-group interaction for GSRS-IBS total score (p_interaction<0.001).

Moreover, the intervention was associated with significantly lower scores for the dimensions pain, bloating, diarrhoea, and satiety (p_interaction≤0.04), but not constipation (p_interaction=0.43).

At week 4, CSI was significantly lower in the intervention vs control group (MD, –5.8, 95 percent CI, –9.6 to –2.0). FODMAP intake during the intervention was moderately low (mean, 8.1 g/day, 95 percent CI, 6.7–9.3).

The findings highlight the potential of a short-term moderately low FODMAP diet for the management of persistent symptoms in CD.