Background & Aims

A gluten-free diet usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). We have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients.

Methods

A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP–gluten-free diet (intervention) or usual gluten-free diet (control). The GSRS-IBS score was recorded at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance.

Results

We included 34 participants in the intervention group and 36 in the control group. Time development of GSRS–IBS total scores differed significantly between the groups (P_interaction < .001), evident after 1 week (mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (P_interaction ≤ .04), but not constipation (P_interaction = .43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/d; 95% CI, 6.7–9.3 g/d). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI, -9.6 to -2.0).

Conclusions

A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease–specific health, and should be considered for the management of persistent symptoms in celiac disease. ClinicalTrials.gov: NCT03678935.

中文翻译：

---

低 FODMAP 饮食可减轻经治疗的持续症状的乳糜泻患者的症状——一项随机对照试验

背景与目标

无麸质饮食通常会导致乳糜泻的粘膜缓解，但持续症状很常见。低发酵低聚糖、双糖、单糖和多元醇 (FODMAP) 饮食是肠易激综合征 (IBS) 的既定治疗方法。我们评估了适度低 FODMAP 饮食对接受治疗的乳糜泻患者持续症状的疗效。

方法

2018 年至 2019 年对 70 名经活检证实患有乳糜泻的成年人进行了一项随机对照试验。纳入标准如下：由胃肠道症状评定量表 (GSRS)-IBS 版本得分 30 或更高定义的持续胃肠道症状，坚持无麸质饮食 12 个月或更长时间，以及血清学和粘膜缓解。参与者被随机分配到低 FODMAP 无麸质饮食（干预）或常规无麸质饮食（对照）。在基线和第 1 至 4 周记录 GSRS-IBS 评分，并在基线和第 4 周记录腹腔症状指数。统计数据包括重复数据的边际模型和协方差分析。

结果

我们在干预组中纳入了 34 名参与者，在对照组中纳入了 36 名参与者。GSRS-IBS 总分的时间发展在各组之间存在显着差异（P_相互作用<.001），1 周后明显（干预与对照组的平均差异，-8.2；95% CI，-11.5 至 -5.0）并持续一周4（干预与对照的平均差异，-10.8；95% CI，-14.8 至 -6.8）。此外，疼痛、腹胀、腹泻和饱腹感（ P_相互作用≤ .04）维度得分显着较低，但便秘（P_相互作用 = .43）。干预期间的 FODMAP 摄入量适度偏低（平均 8.1 g/d；95% CI，6.7–9.3 g/d）。第 4 周时干预组的腹腔症状指数显着降低（平均差，-5.8；95% CI，-9.6 至 -2.0）。

结论

短期中等低 FODMAP 饮食可显着减少胃肠道症状并增加乳糜泻特异性健康，应考虑用于乳糜泻持续症状的管理。ClinicalTrials.gov：NCT03678935。