A diet low in fermentable carbohydrates (FODMAPs) improves symptoms of irritable bowel syndrome (IBS) (Reference Staudacher and Whelan1). Although it is recommended patients receive advice on a low FODMAP diet by a dietitian (Reference O'Keeffe and Lomer2), this is labour-intensive and costly, highlighting the need for alternative effective education delivery methods. This study aimed to establish the feasibility of undertaking a trial that assesses the clinical and cost effectiveness of different education delivery methods (leaflets vs mobile application vs one-to-one consultation with a dietitian) of the low FODMAP diet.
Patients diagnosed with IBS, functional bloating or functional diarrhoea based upon the Rome IV criteria were recruited in this parallel group, 4-week, feasibility randomised controlled trial. Patients were randomised 1:1:1 to receive information about the low FODMAP diet using leaflets (leaflet), mobile application (app), or one-to-one consultation with a dietitian (dietitian). Feasibility outcomes included recruitment and retention rates, and acceptability of the interventions. Symptoms were assessed using the validated “adequate symptom relief” question and IBS-Symptom Scoring System (IBS-SSS). Analysis of variance was used to analyse continuous outcomes, and chi-squared test for categorical outcomes.
Fifty-one patients were randomised. Overall, recruitment rate was 2.4 patients/month and retention rates were 18/19 (95%) in the leaflet, 16/17 (94%) in the app and 14/15 (93%) in the dietitian group. A higher proportion of patients in the dietitian group (64%) strongly agreed they were “able to implement the low FODMAP diet” compared with the app (13%) and leaflet groups (6%; p = 0.008). More patients reported “adequate symptom relief” in the dietitian group (80%) compared to those in the leaflet group at follow up (39%, p = 0.026), but not compared to the app (63%). Although there was no significant difference in total IBS-SSS scores among the groups (p = 0.438), change in IBS-SSS from baseline was significantly greater in the dietitian group (-153 ± 90) compared to the leaflet group (-90 ± 56; p = 0.048), but not compared to the app (-120 ± 62). More patients in the leaflet group (83%) reported they would have preferred to have received a different education method compared with those in the app (44%) and dietitian groups (14%; p < 0.001).
To conclude, this feasibility study confirms that an adequately powered trial of the most clinically and cost-effective education delivery method for the low FODMAP diet is required. Preliminary evidence suggests that delivering low FODMAP diet advice through a one-to-one consultation with a dietitian improves functional bowel symptoms compared to leaflets, but not compared to the app.
