Low FODMAP diet improves symptoms in functional dyspepsia
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A low FODMAP diet improved predominant meal-related postprandial distress syndrome symptoms among patients with functional dyspepsia, according to a presentation at UEG Week Virtual.
“Functional dyspepsia is very prevalent with a prevalence of 7.2% worldwide and is divided into PDS, postprandial distress syndrome, and EPS, epigastric pain syndrome. Current treatment options for functional dyspepsia are based on initial therapy with acid suppressive drugs for EPS and prokinetic drugs for PDS, although the overall efficacy of treatment options is often very limited,” Karen Van den Houte, PhD, researcher at KU Leuven in Leuven, Belgium, said. “The pathophysiology of functional dyspepsia is very weak and remains poorly understood. Recent studies showed an increased duodenal mucosal permeability and loss of tight junction molecule expression as key players. As a trigger for these changes, adverse reactions to nutrients may play a role.”
To investigate the effect of a low FODMAP diet on duodenal mucosal integrity and meal-related PDS symptom severity, researchers evaluated 25 patients (mean age, 41 years; 81% women) with functional dyspepsia who followed a strict diet for 6 weeks. Throughout the study duration, they calculated symptom severity scores for early satiation, postprandial fullness and abdominal bloating from validated Leuven PDS (LPDS) daily diary entries; depression and somatization were also monitored at week 2, week 4, week 6 and weekly during a reintroduction period using PAGI-SYM and PHQ questionnaires. Patients underwent endoscopy with duodenal biopsy prior to and following adhering to their dietary plan.
Patients who demonstrated clinically meaningful improvement underwent a blinded reintroduction phase during which researchers evaluated FODMAP triggers over 1-week periods.
Compared with baseline measures, researchers observed improvements in LPDS (62% response; P < .0001) at week 2 (1.7 vs. 1.1), week 4 (1.7 vs. 0.9) and week 6 (1.7 vs. 0.8) as well as improved individual scores for postprandial fullness, early satiation and bloating. Further observation yielded improvements to PASI-SYM score (21.6 vs. 40.3; P > .0001), somatization score (11.8 vs. 13.5; P = .03) and depression measures (5.7 vs. 8.8; P = .0001). Symptom improvement correlated with increased transepithelial electrical resistance across the duodenal mucosa (23.9 vs. 26; P = .045).
During the reintroduction phase, researchers noted an average of 1.2 triggering FODMAPs per patient. Mannitol (29%) and galacto-oligosaccharides (29%) were the most triggering FODMAPs followed by fructans (21%), sorbitol (14%), fructose (14%) and lactose (12%). Fructose intake correlated with worsened somatization (8.1; P = .03) and depression (4.9; P = .05).
“A low FODMAP diet improved symptoms of PDS in functional dyspepsia patients and also improved somatization and depression. It was associated with restored mucosal integrity. We did not find significant difference for the gastric emptying time,” Van den Houte concluded. “During reintroduction, a highly individualized pattern was seen.”
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Van den Houte K. Abstract OP004. Presented at: UEG Week; Oct. 3-5, 2021 (virtual meeting).
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