Adult celiac disease with persistent IBS-type symptoms: a pilot study of an adjuvant FODMAP diet

Gastroenterol Hepatol Bed Bench. 2021 Fall;14(4):304-310.


Aim: This pilot study assessed the benefits of an adjuvant low FODMAP diet (LFD) in adult CD patients established on GFD who had a normal remission biopsy.

Background: Patients with biopsy-proven adult celiac disease (CD) may have on-going gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). Functional gut symptoms, including irritable bowel syndrome (IBS), is one cause of persistent symptoms in CD patients.

Methods: Twenty-five adult CD patients who were adherent to the GFD were recruited. These patients had histologically normal villi on their remission biopsy. A specialist dietitian then offered an adjuvant LFD. Symptom response was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) from baseline to follow up.

Results: Of the 25 CD patients in remission with concurrent IBS, 9 did not wish to pursue the LFD, and 1 had incomplete data. Fifteen patients completed a minimum of four weeks on the LFD (mean age 44 ± 17.3; range 43.2 years; median duration of CD follow-up 7.2 years). Global relief of gut symptoms was reported by 8/15 patients (53% p = 0.007). Significant reductions in abdominal pain (p <0.01), distension (p < 0.02), and flatulence (p <0.01) were demonstrated.

Conclusion: This is the first study to demonstrate that an adjunct LFD is an effective dietary treatment for concurrent IBS in adult CD patients with biopsy-confirmed remission. Such patients should be seen by a specialist dietitian to ensure nutritional adequacy and appropriate reintroduction of FODMAP-containing foods.

Keywords: Celiac disease; Diet; Gluten-free; Irritable bowel syndrome.