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

Patients with biopsy proven adult celiac disease (CD) may have on-going gastrointestinal symptoms despite adherence to the gluten-free diet (GFD). Functional gut symptoms including Irritable Bowel Syndrome (IBS) is one cause of persisting symptoms in CD patients. This pilot study assessed the benefit of an adjuvant low FODMAP diet (LFD) in adult CD patients established on GFD who had a normal remission biopsy. 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 patients did not wish to pursue the LFD, 1 patient had incomplete data. Fifteen patients completed a minimum of four weeks on the LFD (mean age 44 ± 17.3; median duration of follow-up 7.2 years; range 43.2 years). Global symptom 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. Conclusions This is the first study to demonstrate 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.