Functional bowel disorders are a common reason for referral to gastrointestinal services. A low FODMAP diet has been advocated as an adjunct to management for irritable bowel syndrome (IBS) especially when bloating and/or flatus are a major feature. In the last 12 months in our centre a new dietetic service was started dedicated to providing a low FODMAP diet and this audit was carried out to evaluate the service.Methods
All referrals to the dietitians are recorded on a Trust database and retrospective analysis of these referrals was performed. Patient demographics, source of referral, attendance at the clinic, dietary advice given, symptom response and reason for lack of response were recorded. Univariate analysis was performed to identify factors associated with poor attendance as well as lack of response.Results
256 patients (mean age 41.5 years, 204 females) were referred to the service of which 188 (73.4%) attended the clinic. 230/256 (89.8%) of referrals were from gastroenterology clinics and 26 from other sources (mainly colorectal surgery). Non-attendance at clinic was not associated with sex (13/39 (25.0%) males vs. 46/195 (23.6%) females, p=0.86) or mean age (attenders 41.9 years vs. non-attenders 40.1 years, p=0.32). There was a trend to non-attendance in those not referred from gastroenterology (10/25 (40.0%) non-GI patients vs. 49/211 (23.2%) GI patients, p=0.08). 134 patients had been given dietary advice of which 83 (61.9%) was a low FODMAP diet and 51 (38.1%) was general IBS advice. To date, 69 patients have completed follow of which 55/69 (79.7%) reported overall symptomatic improvement. There was no significant difference in improvement rates between the 2 dietary regimes (38/48 FODMAP (79.2%) vs. 17/21 IBS (80.9%), p=1.0). Improvement was not associated with sex (13/17 males vs. 42/52 females, p=0.73) or source of referral (2/4 Non-GI vs 53/65 GI, p=0.18). There was a trend to non-improvement in younger patients (improved 44.7 years vs. not improved 37.9 years, p=0.08). 18 patients described barriers to the diet with 8/18 (44.4%) not following instructions, 5/18 (27.8%) describing low mood and 5/18 (27/8%) describing poor motivation.Conclusion
Dietary advice in functional gut disorders can lead to significant symptom improvement with well selected patients and this new service has been crucial in delivering this. There are few predictors of outcome based on basic clinical features but age may play a role. Further research looking at the interplay of other factors such as quality of life would be useful.