TOPLINE:

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) reduced postprandial distress syndrome (PDS) symptoms in more than 70% of patients with functional dyspepsia (FD).

METHODOLOGY:

• Despite evidence that intragastric FODMAP infusion rapidly reproduces FD-like symptoms and that low-FODMAP diets benefit patients with irritable bowel syndrome (IBS), no prior studies established an effective dietary intervention for FD.
• Between July 2019 and March 2022, researchers in Belgium enrolled patients with FD to assess the impact of a low-FODMAP diet on symptom severity and duodenal mucosal permeability.
• All patients completed a 2-week run-in, followed by a 6-week low-FODMAP diet under dietitian guidance. Symptom severity and quality of life were assessed via standardized questionnaires, and endoscopies were conducted to assess duodenal mucosal integrity through transepithelial electrical resistance and dextran flux measurements.
• Diet responders then entered a 9-week blinded reintroduction phase testing FODMAP powders — fructans (20 g/d), fructose (60 g/d), galacto-oligosaccharides (12 g/d), lactose (60 g/d), mannitol (15 g/d), sorbitol (15 g/d), and glucose (30 g/d), with glucose as the control.
• The primary endpoint was improvement in PDS symptoms (early satiety, postprandial fullness, and bloating) tracked via the Leuven Postprandial Distress Scale (LPDS) daily diary.

TAKEAWAY:

• Among the 36 patients included (mean age, 39.8 years; 83% women), the majority (73%) experienced reduced symptoms.
• LPDS scores fell from 1.8 at baseline to 1.0 after the intervention (P < .001); other upper gastrointestinal symptoms, depression, somatic symptom disorder, and quality of life also improved with the low-FODMAP diet.
• Overall duodenal mucosal integrity did not change significantly, but individual changes in transepithelial electrical resistance positively correlated with PDS symptom reduction (correlation coefficient, 0.40; P = .04).
• During blinded reintroduction, 46% of patients experienced symptom triggers from at least one FODMAP, most commonly mannitol (23%); additionally, 27% reported worsened symptoms after consuming glucose powder.
• No significant differences in total LPDS scores or individual PDS symptoms were observed between patients with FD alone and FD with overlapping IBS.

IN PRACTICE:

“While the findings of the present study support the application of a low-FODMAP diet regardless of comorbid IBS in PDS patients, any role for restriction of glucose from the diet needs additional confirmatory studies,” the authors of the study wrote.

SOURCE:

The study was led by Karen Van den Houte, PhD, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium. It was published online in Gut.

LIMITATIONS:

Major limitations included the single-center design and open-label FODMAP restriction phase, small sample size, and a predominantly female cohort, which reflects typical FD demographics but may affect generalizability.

DISCLOSURES:

The study was funded by Universitaire Ziekenhuizen Leuven and KU Leuven. Several authors reported serving as scientific advisors for; receiving research support, funding, or travel or conference grants from; or serving on speakers bureaus for various pharmaceutical and biopharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.