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Aliment Pharmacol Ther. 2015 Jun;41(12):1256-70. doi: 10.1111/apt.13167. Epub 2015 Apr 22.

Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome.

Author information

1
Section of Gastroenterology/Hepatology, Department of Internal Medicine, Georgia Regents University, Augusta, GA, USA.
2
Food and Nutrition Department, Georgia Regents University, Augusta, GA, USA.

Erratum in

Abstract

BACKGROUND:

Dietary fibre supplements have been advocated for the management of chronic constipation (CC) and irritable bowel syndrome (IBS). Recently, a fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) restricted diet has been recommended for IBS.

AIM:

To systematically examine recent evidence for dietary interventions with fibre in CC and IBS and FODMAP-restricted diet in IBS, and provide recommendations.

METHODS:

We searched PUBMED, MEDLINE, OVID and COCHRANE databases from 2004 to 2014. Published studies in adults with CC and IBS and constipation-predominant IBS (IBS-C) that compared fibre with placebo/alternative and FODMAP-restricted diet with alternative were included.

RESULTS:

Of 550 potentially eligible clinical trials on fibre, 11 studies were found and of 23 potentially eligible studies on FODMAPs, six were found. A meta-analysis was not performed due to heterogeneity and methodological quality. Fibre was beneficial in 5/7 studies in CC and 3/3 studies in IBS-C. FODMAP-restricted diet improved overall IBS symptoms in 4/4 and IBS-C symptoms in 1/3 studies and three studies did not meet inclusion criteria. There were significant disparities in subject selection, interventions and outcome assessments in both fibre and FODMAPs studies.

CONCLUSIONS:

Fibre supplementation is beneficial in mild to moderate CC and IBS-C, although larger, more rigorous and long-term RCTs are needed (Fair evidence-Level II, Grade B). Although the FODMAP-restricted diet may be effective in short-term management of selected patients with IBS (Fair evidence-Level II, Grade C) and IBS-C (Poor evidence-Level III, Grade C), more rigorous trials are needed to establish long-term efficacy and safety, particularly on colonic health and microbiome.

PMID:
25903636
DOI:
10.1111/apt.13167
[Indexed for MEDLINE]
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