Medical treatment

Restrictive diets offer greater symptom reduction compared to medical treatment in patients with IBS



Nybacka S, et al. Abstract 684. Featured at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).

Disclosures: Nybacka does not report any relevant financial information.

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SAN DIEGO — Two restrictive diets were superior in reducing symptoms compared to optimized medical treatment alone in patients with irritable bowel syndrome, according to results presented at Digestive Disease Week 2022.

“There are several different treatment options that are effective in relieving IBS symptoms, and dietary treatment may indeed be encouraged as a first-line treatment option,” Sana NybackaRD, PhD, from the Department of Molecular and Clinical Medicine at the University of Gothenburg in Sweden, Healio told. “Our findings support current IBS treatment guidelines, where a positive IBS diagnosis is crucial for successful management of IBS and should be followed by general lifestyle intervention and dietary advice. Medical treatment should be guided by the patient’s symptom profile and preferences as a second-line treatment option.

Nybacka and colleagues randomly assigned 302 adult IBS patients, all of whom had at least moderate severity of IBS symptoms (IBS-SSS 175), to receive one of three treatment options for 4 weeks: a diet Low Total Carb (LCD); a diet combining low-fermentable oligo-, di- and monosaccharides and polyols (FODMAP) and traditional dietary advice (LFTD); or an optimized medical treatment strategy (OMT). Food was delivered to patients weekly.

Investigators based the OMT on the predominant IBS symptom and previous experience with IBS pharmacological agents and assessed the severity of IBS symptoms before and after the treatment period. The proportion of patients with a reduction in IBS-SSS of at least 50 served as the primary endpoint.

Of the randomized participants, 295 were included in the intention-to-treat (ITT) analysis and 272 completed the intervention period.

According to the researchers, all three interventions reduced the severity of IBS symptoms (P

The results of the ITT analysis demonstrated that 72% of patients in the LCD group met the primary endpoint, followed by 75% in the LFTD group and 58% in the OMT group (P = 0.025). Additionally, there was a greater proportion of responders after LCD and LFTD compared to OMT (P = 0.042, P = 0.012, respectively). Moreover, even with more stringent response criteria (reduction of IBS-SSS by 100 and 50%, respectively) and the proportion of patients with mild IBS symptoms (IBS-SSS

“However, we will need to analyze long-term follow-up data to ensure treatments are safe, effective and applicable to patients,” Nybacka said. “We will also need to elucidate the pre-treatment factors that can predict a positive treatment outcome, in order to give patients more personalized treatment.”