Summary of findings 1. Low FODMAP diet compared to sham diet for the management of abdominal pain in Crohn's disease and inflammatory bowel disease.
| Low FODMAP diet compared to sham diet for the management of abdominal pain in Crohn's disease and inflammatory bowel disease | |||||
| Patient or population: people with inflammatory bowel disease Setting: multicentre, 2 gastroenterology clinics in the UK and an unstated setting in Italy Intervention: low FODMAP diet Comparison: sham diet | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with sham diet | Risk with low FODMAP diet | ||||
| Treatment success as defined by the authors | ‐ | ‐ | ‐ | ‐ | Note measured |
| Pain frequency IBD (measured in days of pain on the IBS‐SSS questionnaire) | ‐ | MD 2 lower (15.86 lower to 11.86 higher) | ‐ | 52 (1 study) | ⊕⊝⊝⊝ very low a b |
| Pain frequency IBD (measured in days with moderate or severe pain on the GSRS questionnaire) | ‐ | MD 0.4 higher (0.44 lower to 1.24 higher) | ‐ | 52 (1 study) | ⊕⊝⊝⊝ very low a b |
| Pain frequency CD (measured in days of pain on the IBS‐SSS questionnaire) | ‐ | MD 12 lower (114.55 lower to 90.55 higher) | ‐ | 26 (1 study) | ⊕⊝⊝⊝ very low a b |
| Pain intensity IBD (0‐10cm visual analogue scale) | ‐ | MD 8.46 lower (15.76 lower to 1.16 lower) | ‐ | 82 (2 studies) | ⊕⊝⊝⊝ very lowa b |
| Pain intensity IBD (0‐3 point GSRS scale) | ‐ | MD 8 lower (66.27 lower to 50.27 higher) | ‐ | 26 (1 study) | ⊕⊝⊝⊝ very low a b |
| Pain intensity CD (0‐10cm visual analogue scale) | ‐ | MD 0.2 higher (8.67 lower to 9.07 higher) | ‐ | 52 (1 study) | ⊕⊝⊝⊝ very low a b |
| Withdrawal due to adverse events | 4 per 1000 | 7.4 per 1000 (1 to 77) |
RR 1.85 (0.18 to 19.19) | 52 (1 study) | ⊕⊝⊝⊝ very lowa b |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CD: Crohn's disease; CI: confidence interval; FODMAP: fermentable oligo‐, di‐, monosaccharides and polyols; GSRS: Gastrointestinal Symptom Rating Scale; IBD: inflammatory bowel disease; IBS‐SSS: Irritable Bowel Syndrome Severity Scoring System; MD: mean difference; RR: risk ratio | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded one level due to risk of bias. bDowngraded two levels due to imprecision from very sparse data.