Efficacy and safety of a Low-FODMAP combined with gluten-free diet in adult irritable bowel syndrome: a systematic review and meta-analysis

Abstract

Abstract Background: Irritable Bowel Syndrome (IBS) is a prevalent gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits. A Low-FODMAP diet combined with a gluten-free diet (LF-GFD) has been proposed as a potential treatment approach. Objective: This study aimed to investigate the application of a low-FODMAP combined with gluten-free diet (LF-GFD) in patients with irritable bowel syndrome (IBS). Methods: Clinical studies that evaluated the intervention of LF-GFD in the treatment of IBS patients were identified through strict inclusion and exclusion criteria from online databases. The outcomes assessed the efficacy of LF-GFD in IBS patients using the following measures: Visual Analog Scale (VAS) for bloating and pain, IBS Symptom Severity Scale (IBS-SSS), and IBS Quality of Life (IBS-QoL) scores. Additionally, the psychological intervention effect of LF-GFD on IBS patients was evaluated using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). Results: 4 RCTs and 4 cohort studies were included which involving 437 patients (221 patients with LF-GFD diet and 216 with GFD). The pooled results showed LF-GFD Alleviated the VAS bloating scores (RR=-0.58, 95%CI: -0.92--0.23, P=0.0010, I2=83%) and VAS pain scores (RR=-0.42, 95%CI: -0.66--0.19, P=0.005, I2=58%). Besides that, LF-GFD showed significant improvement of IBS-SSS (MD=-1.42, 95%CI: -2.74--0.10, P=0.03, I2=24%) scores and IBS-QoL scores (MD=3.75, 95%CI: 0.98-6.53, P=0.008, I2=33%). Furthermore, SDS (MD=-2.56, 95%CI: -3.38--1.74, P<0.00001, I2=65%) and SAS(MD=-4.30, 95%CI: -6.53--2.24, P<0.0001, I2=0%) scores were significantly decreased in LF-GFD group compared to GFD group. Conclusion: LF-GFD intervention effectively improves clinical symptoms and alleviates anxiety and depression in patients with irritable bowel syndrome.