An algorithm for differentiating food antigen related gastrointestinal symptoms

Background: A large number of food related gastro-intestinal disorders have been attributed to Irritable Bowel Syndrome (IBS) for decades. Discovery of food sensitivities and a high rate of symptomatic response to a low FODMAP diet (fermentable oligo-, di-, monosaccharides and polyols) has revolutionized the treatment of IBS. The aim of this clinical audit was to assess patient reported outcomes on the effect of dietary intervention in managing this group of patients to enhance our understanding of possible treatment options in IBS. Methods: Patient reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Patients all presented with symptoms fulfilling Rome III-IV criteria for IBS, had negative coeliac serology and did not have other gastrointestinal(GI) conditions. A modified version of a low FODMAP diet had been recommended (gluten and lactose free diet (G/LFD)) and was implemented for 6 weeks. Outcomes and dietary adherence were recorded during outpatient’s consultations. Out of 149 patients records, there was complete data for 134 patients. Results: 134 patients complied with the diet optimally. Ages ranged from 8 to 85 years, with mean age of 46.41± 17.388 years. Patients were predominantly female 109 (81.34%) in comparison to male 25 (18.66%). The majority had an improvement rate >70% and continued with the diet. 53% became completely or almost asymptomatic, while 27.6% had a poor response to the diet (scoring < 30%) to G/LFD. The improvement was excellent in patients with normal BMI and good in overweight, obese and where BMI <18. Over 50% didn’t require any follow-up within 12 months. Conclusions: Although, it is unclear whether symptoms are triggered by gluten, fructans or lactose, the elimination of gluten and lactose proved to be an effective treatment in these patients with IBS. Multidisciplinary team management and implementation of detailed nutrition therapy using the algorithm developed as a result of this audit might prove to be both a cost effective and efficacious treatment option in IBS, that is also easier for patients to implement than a full FODMAP exclusion and so is an area recommended for further research. Keywords: Non-coeliac gluten sensitivity (NCGS), gluten, fructans, amylase trypsin inhibitors, FODMAP, lactose intolerance, irritable bowel syndrome