Low FODMAPS diet is better than an oral spasmolytic for irritable bowel syndrome (NNT = 7 – 9)

Clinical Question

Which is more effective for the treatment of irritable bowel syndrome: an app to increase adherence to a low FODMAPS diet, or an oral antispasmodic agent (otilonium bromide)?

Bottom line

This pragmatic trial found a clinically meaningful benefit of a low FODMAPS diet, implemented using an app, compared with an active medication comparator. Given its safety and low cost, the authors argue (and I agree) that a low FODMAPS diet should be first-line therapy for our patients with IBS. The process includes elimination of FODMAPS from the diet and then reintroducing foods, one at a time, until the offending food or foods are identified. The app used in this Belgian study was in French and Dutch, but there are many highly rated apps available. I found a free "Fast FODMAPS" app in the App store that included food lists, a food search, and other features. Caveat: These apps have not been evaluated in clinical trials. 1b-

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (any)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

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Impact assessment

Very good