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Carbone F, Van den Houte K, Besard L, Tack C, Arts J, Caenepeel P, Piessevaux H, Vandenberghe A, Matthys C, Biesiekierski J, Capiau L, Ceulemans S, Gernay O, Jones L, Maes S, Peetermans C, Raat W, Stubbe J, Van Boxstael R, Vandeput O, Van Steenbergen S, Van Oudenhove L, Vanuytsel T, Jones M, Tack J. Diet or medication in primary care patients with IBS: the DOMINO study - a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut 2022; 71:2226-2232. [PMID: 35483886 PMCID: PMC9554021 DOI: 10.1136/gutjnl-2021-325821] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Europe, IBS is commonly treated with musculotropic spasmolytics (eg, otilonium bromide, OB). In tertiary care, a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet provides significant improvement. Yet, dietary treatment remains to be explored in primary care. We evaluated the effect of a smartphone FODMAP-lowering diet application versus OB on symptoms in primary care IBS. METHODS IBS patients, recruited by primary care physicians, were randomised to 8 weeks of OB (40 mg three times a day) or diet and followed for 24 weeks. We compared IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points) in all patients and the subgroup fulfilling Rome IV criteria (Rome+). We also evaluated treatment efficacy, quality of life, anxiety, depression, somatic symptom severity (Patient Health Questionnaire (PHQ15, PHQ9)) and treatment adherence and analysed predictors of response. RESULTS 459 primary care IBS patients (41±15 years, 76% female, 70% Rome+) were randomised. The responder rate after 8 weeks was significantly higher with diet compared with OB (71% (155/218) vs 61% (133/217), p=0.03) and more pronounced in Rome+ (77% (118/153) vs 62% (98/158), p=0.004). Patients allocated to diet (199/212) were 94% adherent compared with 73% with OB (148/202) (p<0.001). The significantly higher response rate with diet was already observed after 4 weeks (62% (132/213) vs 51% (110/215), p=0.02) and a high symptom response persisted during follow-up. Predictors of response were female gender (OR=2.08, p=0.04) for diet and PHQ15 (OR=1.10, p=0.02) for OB. CONCLUSION In primary care IBS patients, a FODMAP-lowering diet application was superior to a spasmolytic agent in improving IBS symptoms. A FODMAP-lowering diet should be considered the first-line treatment for IBS in primary care. TRIAL REGISTRATION NUMBER NCT04270487.
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Affiliation(s)
- Florencia Carbone
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Karen Van den Houte
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Linde Besard
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Céline Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Joris Arts
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Philip Caenepeel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hubert Piessevaux
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Christophe Matthys
- Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jessica Biesiekierski
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Luc Capiau
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Steven Ceulemans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivier Gernay
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Lydia Jones
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Sophie Maes
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Christian Peetermans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Willem Raat
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jeroen Stubbe
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Rudy Van Boxstael
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivia Vandeput
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | | | - Lukas Van Oudenhove
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Michael Jones
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jan Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium .,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Rome Foundation Research Institute, Raleigh, North Carolina, USA.,Rome Foundation, Raleigh, North Carolina, USA
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