Table 3.

Diet therapy characteristics and outcomes of included studies: diarrhoea

First study author Year	Intervention Description Duration	Induction or adjunct to BAS BAS used, dose prescribed	Definition of diarrhoea used Measurement tools used	Diarrhoea description/Measurement		Evidence of an effect (%)
				Baseline	Endpoint	Vote count: Positive/Negative
Carbohydrate intake modification
Outcome by stool consistency and frequency, responder (%)
Fernandez‐Banares 2007	Lactose‐free and/or reduced fructose plus sorbitol intakesa Other components: undefined 12 months	Adjunct COL started at 8 g/day, 2–12 g/day	Three loose or liquid bowel movements/day for ≥4 weeks and a stool weight >200 g/day Aim after 12 months: 2 or fewer formed or semi‐formed stools/day and no clinical relapse at >12 months PR	Loose or liquid	–	Improved: ‘good response’ in 2/2 patients (100), unquantified ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
						Vote count: 1/0
Fat intake reduction
Outcome by stool consistency and frequency, responder (%)
Larsen 2019	Low‐fat: undefined Other dietary components: undefined 2–4 weeks	Induction and adjunct COL, COV, COS	Loose stools, BSFS types 6 and 7 Frequent, >3 movements per day BSFS PR	–	–	Improved bowel function in 14/14 patients (100), unquantified ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
Jackson 2017	Low‐fat: 20% total daily energy, all types of dietary fat Other dietary components: personalized, undefined 4–12 weeks	Induction and adjunct COVb	BSFS type 6 or 7 even intermittently Modified GSRS, BSFS PR	T7: 47% = 51/114 T6: 53% = 61/114 ≥7×/day: 37% = 42/114 ≥4–6×/day: 42%  = 48/114	Reduction in proportionc by: Consistency: T7, 40% T6, 17% Frequency: ≥7×/day: 32% ≥4–6×/day: 30%	Improved in no. of patients by Consistency: 20/51 (39) 10/61 (16) Frequency: 13/42 (31) 14/48 (29) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
Outcome by stool consistency, responder (%)
Bosaeus 1979	Low‐fat: 40g/day Defined by food items and preparation methods 3–6 months	Induction	Watery CR	Watery	Formed	Normalized in 8/9 (88) patients Unchanged in 1/9 (12) patients (cholecystectomized) until COL added to the low‐fat diet Watery diarrhoea returned in all 9 patients when fat intake was temporarily increased ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
Outcome by stool frequency, responder (%)
Danielsson 1991	Low‐fat: undefined Other dietary components: undefined 2 years	Adjunctd COL, 4–8 g/day	Severe chronic or intermittent diarrhoea interfering with daily activities 7‐day symptom and stool frequency diary card PR	Stool frequency per daye: 7.4, 5.7, 4, 3.4	Stool frequency per daye: 5.1, 5.0, 2.6, 2	Normalized in 2/4 (50) patients Improved in 4/4 (100) patients, unquantified ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
Outcome by change in stool frequency, scoring scale
Watson 2015	Low‐fat: 20% total energy from fat Other dietary components: tailored, undefined 7.9 weeks (3–20)	Induction or adjunct COVb	– Bowel frequency, NRS‐10 PR	Median score, 8/10	Median score, 5/10	Improved by median score, 3/10 (37.5), p < 0.01 ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
						Vote count: 5/0
Exclusive elemental
By stool consistency, responder (%)
Russell 1979	Vivonex Up to 6 sachets/day given orally Water allowed 2–3 weeks	Induction	Watery, unformed CR	Watery, unformed	Less watery and better formed	Improved in 3/3 (100) patients, unquantified ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
By stool frequency, responder (%)
Nelson 1977	Vivonex only Up to 6 sachets/day given orallyf 8–15 days	Induction	Urgent, watery CR	2–10×/day	0–7×/day	Normalized in 2/6 (33) patients Improved in 6/6 (100) patients, unquantified ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Positive
						Vote count: 2/0

Abbreviations: BAS, bile acid sequestrant; BSFS, Bristol Stool Form Scale; COL, colestyramine; COS, colestipol; COV, colesevelam; CR, clinician‐reported; GSRS, Gastrointestinal Symptoms Rating Scale; NRS‐10, Numeric Rating Scale‐10; PMH, past medical history; PR, patient‐reported.

^a Data on sorbitol, fructose, and glucose in Fernandez‐Bañares 66 (pp. 829–830, Appendix A).

^b An algorithm based on bile acid diarrhoea severity determined by SeHCAT was used to determine medication treatment before starting diet therapy.

^c Data extracted from spider diagram, in Jackson et al. 62 (figs. 2 and 3, p. 416).

^d Given metronidazole and doxycycline for 7–10 days before starting BAS.

^e Stool frequency data in Danielsson et al. 44 (fig. 6, p. 1185) was given per week, not per day and therefore divided by 7. Patient 7 did not have a high stool frequency: excluded from analysis.

^f One patient may have been fed via a nasogastric tube.