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MNT: Gastrointestinal Disorders (2015

Citation:
Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010; 25 (2): 252-258. PubMed ID: 20136989
 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:
  • The purpose of this review is to describe the theoretical basis for the low FODMAP diet as an approach to the management of patients with functional gastrointestinal symptoms
  • The acronym FODMAP, fermentable oligo-, di- and monosaccharides and polyols, was coined to describe a previously unrelated group of short-chain carbohydrates and sugar alcohols. The term FODMAPs has been registered by the authors as a trademark.
Inclusion Criteria:
Articles that describe the nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet were included in this review.
Exclusion Criteria:
Not described.
Description of Study Protocol:

Search procedures for this review were not described.

Data Collection Summary:

This review did not describe what information was abstracted from articles, how information was combined or what analytic methods were used. 

Description of Actual Data Sample:

This review did not describe how many articles were identified or included, what types of studies were reviewed, sample size of studies or characteristics of study participants.

Summary of Results:

Key Findings

  • FODMAPs lead to luminal distension, which is the genesis of many functional gut symptoms
  • The following properties and characteristics of FODMAPs are associated with luminal distension:
    • Poorly absorbed in the small intestine
    • Small and therefore osmotically active molecules
    • Rapidly fermented by bacteria
    • Favor production of hydrogen over methane.
  • The global restriction of FODMAPs (as opposed to the restriction of individual FODMAPs) reduces functional gut symptoms. The low FODMAP diet provides relief of symptoms in about 75% of patients, with little benefit in some patients.
  • The diet has a high compliance rate
  • The low FODMAP diet has only been evaluated as a dietitian-delivered diet
  • Testing of tolerance is a vital stage of the dietetic process to ensure maximum variety in the diet.
Author Conclusion:
The low FODMAP diet provides an effective approach to the management of patients with functional gastrointestinal symptoms. The evidence base is now sufficiently strong to recommend its widespread application.
Funding Source:
Not-for-profit
National Health & Medical Research Council of Australia, Eva and Les Erdi Foundation, and Sir Robert Menzies Memorial Research Scholarship in the Allied Health Sciences
Other non-profit:
Reviewer Comments:
  • Search strategy not described
  • Study selection methods not described. Unclear how many studies are included in review.
  • Quality and validity of studies included not discussed
  • Specific treatments/interventions not described. It is unclear if treatments were similar enough to be combined.
  • Processes for data abstraction, synthesis and analysis not described
  • Results from studies are not clearly presented
  • Limitations of the review are not discussed
  • One author has published several cookbooks directed towards issues of celiac disease and low FODMAP diet.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? ???