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Exploring Gut Microbiota Composition as an Indicator of Clinical Response to Dietary FODMAP Restriction in Patients with Irritable Bowel Syndrome

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Abstract

Background

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may relieve symptoms of irritable bowel syndrome (IBS). However, nutritional counseling is resource-demanding and not all patients will benefit.

Aims

To explore whether gut microbial composition may identify symptom response to a low-FODMAP diet in patients with IBS.

Methods

Patients were recruited consecutively to participate in a 4-week FODMAP-restricted diet. Response to diet was defined as ≥ 50% decrease in IBS symptom severity scores (IBS-SSS) compared to baseline. Fecal microbiota were analyzed by a commercially available method (the GA-map™ Dysbiosis Test), assessing 54 bacterial markers targeting more than 300 bacteria at different taxonomic levels.

Results

Sixty-one patients (54 F; 7 M) were included: 32 (29 F; 3 M) classified as responders and 29 (25 F; 4 M) as non-responders. Ten of the 54 bacterial markers differed significantly between responders and non-responders. Based on median values (used as cutoff) of responders for these 10 bacterial markers, we constructed a Response Index (RI): Each patient was given a point when the value for each selected bacterial marker differed from the cutoff. These points were summed up, giving an RI from 0 to 10. Patients with RI > 3 were 5 times more likely to respond (OR = 5.05, 95% CI [1.58; 16.10]), and the probability to respond was 83.4%, 95% CI [61.2–94%].

Conclusions

Gut microbial composition, assessed by using a new RI, may constitute a tool to identify patients that are likely to respond to dietary FODMAP restriction.

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Acknowledgments

The work of the clinical dietician (TK) and the microbial DNA analyses were funded by Genetic Analysis AS, Oslo, Norway. Otherwise, the study was funded by Lovisenberg Diaconal Hospital, Oslo, Norway.

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Authors and Affiliations

  1. Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Lovisenberggata 21, 0440, Oslo, Norway

    Jørgen Valeur

  2. Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway

    Milada Cvancarova Småstuen

  3. Department of Clinical Nutrition, Lovisenberg Diaconal Hospital, Oslo, Norway

    Torunn Knudsen

  4. Department of Clinical Medicine, Center for Nutrition, University of Bergen, Bergen, Norway

    Gülen Arslan Lied

  5. Department of Medicine, Section of Gastroenterology, Haukeland University Hospital, Bergen, Norway

    Gülen Arslan Lied

  6. Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway

    Arne Gustav Røseth

Authors
  1. Jørgen Valeur
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  2. Milada Cvancarova Småstuen
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  3. Torunn Knudsen
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  4. Gülen Arslan Lied
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  5. Arne Gustav Røseth
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Contributions

JV conceived and designed the study, performed the data collection, and wrote the manuscript. MCS performed the statistical analyses and wrote the manuscript. TK guided the patients throughout the dietary intervention. GAL interpreted the data and contributed to critical revision. AR conceived and designed the study, and recruited the patients. All authors reviewed and approved the final version of the manuscript to be published.

Corresponding author

Correspondence to Jørgen Valeur.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the Regional Committee for Medical Research Ethics (REK Sør-Øst, Reference No. 2013/454) and with the 1964 Helsinki Declaration and its later amendments.

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Valeur, J., Småstuen, M.C., Knudsen, T. et al. Exploring Gut Microbiota Composition as an Indicator of Clinical Response to Dietary FODMAP Restriction in Patients with Irritable Bowel Syndrome. Dig Dis Sci 63, 429–436 (2018). https://doi.org/10.1007/s10620-017-4893-3

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  • DOI: https://doi.org/10.1007/s10620-017-4893-3

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