Hôpital Ambroise Paré, Service d’hépato-gastroentérologie, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
- Key words: irritable bowel syndrome, abdominal pain, bloating, diarrhea, constipation, FODMAPs, gluten
- DOI : 10.1684/hpg.2018.1660
Some digestive symptoms may be secondary to malabsorption of carbohydrates called FODMAPs, acronym for “Fermentable Oligo-, Di-, Monosaccharides And Polyols”. Ingestion may result in abdominal pain, bloating and transit disturbances by an osmotic effect with an increase in liquids entering the intestinal lumen and by increased production of gas and volatile fatty acids secondary to their colonic fermentation. The low FODMAP diet consists of eliminating them for 4 to 6 weeks, according to the Australian team of Gibson, with a symptomatic improvement in 70% of patients with irritable bowel syndrome, but efficacy was found as being similar to that of standard dietary advice in a Swedish study. As FODMAPs are present in a large number of foods, the setting up of this complex diet should preferably be carried out with a dietician. This very restrictive diet can lead to weight loss and is associated with dysbiosis whose long-term consequences are uncertain. After the initial test phase, reintroduction of some FODMAPs is possible with correct symptomatic tolerance. This diet is worthy of being tested in patients who are motivated and have no problem of being thin. It can help to better identify foods that trigger symptoms, with a reduction or even complete disappearance of these, and a marked improvement in the quality of life in some cases.