University of Worcester Worcester Research and Publications

An algorithm for differentiating food antigen-related gastrointestinal symptoms

Rostami, Kamran, Bold, Justine, Ali, J.E., Parr, A., Dieterich, W., Zopf, Y., Htoo, A., Rostami-Nejad, M. and Danciu, M. (2021) An algorithm for differentiating food antigen-related gastrointestinal symptoms. Gastroenterology and Hepatology from Bed to Bench, 14 (1). pp. 8-16. ISSN Print: 2008-2258 Online: 2008-4234

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Aim: The aim of this clinical audit was to assess patient-reported outcomes on the effect of dietary intervention, to enhance our understanding of possible treatment options in irritable bowel syndrome (IBS).

Background: A large number of food-related gastro-intestinal disorders have been attributed to IBS for decades.

Methods: Patient-reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Patients all presented with symptoms fulfilling Rome III-IV criteria for IBS had negative coeliac serology and did not have other gastrointestinal (GI) conditions. A modified version of a low FODMAP diet had been recommended (gluten and lactose free diet (G/LFD)) and was implemented for 6 weeks. Outcomes and dietary adherence were recorded during outpatient's consultations.

Results: A total of 134 patients complied with the diet optimally. The majority had an improvement rate >70% and continued with the diet. Fifty-three percent became completely or almost asymptomatic, while 27.6% had a poor response to the diet (scoring < 30%) to G/LFD. The improvement was excellent in patients with normal BMI and good in overweight and obese and where BMI <18. Over 50% did not require any follow-up within 12 months.

Conclusion: Although it is unclear whether symptoms are triggered by gluten, fructans or lactose, elimination of gluten and lactose proved to be an effective treatment in patients with IBS. Multidisciplinary team management and implementation of detailed nutrition therapy using the audit algorithm might prove to be both cost effective and efficacious a treatment option in IBS.

Item Type: Article
Additional Information:

A Pdf file of the published article can be downloaded from this WRaP record.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uncontrolled Discrete Keywords: non-coeliac gluten sensitivity (NCGS), gluten, fructans, amylase trypsin inhibitors, FODMAP, lactose intolerance, irritable bowel syndrome
Divisions: College of Health, Life and Environmental Sciences > School of Allied Health and Community
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Copyright Info: Open Access article
Depositing User: Justine Bold
Date Deposited: 27 Apr 2021 08:36
Last Modified: 27 Apr 2021 11:07

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