Abstract
Background: Irritable Bowel Syndrome (IBS) is a functional bowel disorder that affects approximately 10-20% of New Zealanders. Currently, there is no curative treatment for IBS and IBS management focuses on symptomatic relief. The low FODMAP diet taught in a one to-one setting by a dietitian, is a validated dietary therapy in managing IBS symptoms. Yet, the number of patients requiring low FODMAP education is exceeding dietetic capacity. Group education and alternative delivery models have to be investigated.
Objective: This was a feasibility study for an non-randomised, interventional pilot study investigating the impact of a dietitian-led low FODMAP group education programme for adults with IBS living in Christchurch, New Zealand. This study aimed to examine the effects of this programme on gastrointestinal symptoms in a sample of New Zealand adults with a clinical diagnosis of IBS. It also aimed to explore participants’ perspectives and acceptability of the low FODMAP diet and the group education programme itself.
Design: The group education programme was advertised to general practices in the surrounding areas of the proposed session venues. Due to low referral rates from general practices, the sessions were also advertised on Community HealthPathways and Health Info Canterbury, promoted by the Canterbury Initiative leadership team on their practice visits and in the Pegasus Health email newsletter. The study aimed to recruit twenty-five adults with IBS. Information on baseline characteristics was provided and participants were booked to attend the first education session. The first session focused on how to implement and follow a low FODMAP diet. Participants followed the low FODMAP diet for six weeks. Participants were then called to determine if they found their IBS symptoms to be improved by ≥ 50% whilst being on the low FODMAP diet. Those that improved by ≥ 50% were invited to attend the second education session which focused on the reintroduction and rechallenging of FODMAPs. Participants completed the Structured Assessment Gastrointestinal Symptoms Scale (SAGIS) and Hospital Anxiety Depression Scale (HADS) questionnaires at baseline and after the intervention. They also completed a semi-structured interview that elicited participant’s perspectives around barriers and facilitators in adhering to the low FODMAP diet as well as their perceived acceptability of the group education programme.
Outcomes: In total, twenty-five participants were recruited. Twenty-two participants were booked into the first education session and three participants dropped out due to work and day commitments. The majority of the mean SAGIS scores significantly decreased between baseline (1.844) and follow-up (0.607) (p<0.05). There was a non-significant improvement in the HADS anxiety and depression scores from baseline to follow-up. Thirteen out of seventeen (76.5%) participants reported symptomatic improvement while two participants (11.8%) did not improve and two others (11.8%) did not implement the diet at all. Overall, participants were positive and grateful for the changes the low FODMAP diet made to their symptoms. Common barriers of the low FODMAP diet included eating out, social situations and restricting garlic and onion containing foods from the diet. Factors that helped participants adhere to the diet included having supportive partner/family, using the web apps and websites and meal planning.
Conclusion: A dietitian-led low FODMAP diet group education programme in a sample of twenty-two Christchurch adults diagnosed with IBS predominant diarrhoea (IBS-D) or IBS mixed (IBS-M) was found to be feasible.