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Background The low FODMAP diet (LFD) is effective in managing irritable bowel syndrome (IBS) in the short term. This study assessed the long-term effect of the LFD on symptoms, nutritional composition and socialising. Methods Patients with IBS who received dietetic-led LFD advice were approached at long term follow up (>6 months post LFD advice) from six centres across the United Kingdom. Participants completed questionnaires assessing gastrointestinal symptoms, adherence, nutritional intake, dietary acceptability and food related quality of life (QOL). Results 205 participants completed the study, with a mean follow up of 44 months (3.7 years). Adequate symptom relief was noted in 60% of individuals at long term follow up, with 76% being on the personalisation phase of the LFD (pLFD). Mean nutritional intake did not differ between individuals on the pLFD versus habitual diet, with no difference in fructan intake (2.9 g/d vs 2.9 g/d, p = 0.96). The majority (80%) of individuals on the pLFD consumed specific ‘free-from’ products at the long term, with the purchase of gluten or wheat free products being the commonest (68%). Conclusion The majority of patients follow the pLFD in the long term, with a large proportion purchasing gluten or wheat free products to manage their symptoms.

Background & Aims\ud \ud Various diets are proposed as first-line therapies for non-constipated irritable bowel syndrome (IBS) despite insufficient or low-quality evidence. We performed a randomized trial comparing traditional dietary advice (TDA) against the low FODMAP diet (LFD) and gluten-free diet (GFD).\ud \ud \ud \ud Methods\ud \ud Patients with Rome IV-defined non-constipated IBS were randomized to TDA, LFD, or a GFD (the latter allowing for minute gluten cross-contamination). The primary endpoint was clinical response after 4 weeks of dietary intervention, as defined by ≥50-point reduction in IBS symptom severity score (IBS-SSS). Secondary endpoints included i) changes in individual IBS-SSS items within clinical responders, ii) acceptability and food-related quality of life with dietary therapy, iii) changes in nutritional intake, iv) alterations in stool dysbiosis index, and v) baseline factors associated with clinical response.\ud \ud \ud \ud Results\ud \ud The primary endpoint of ≥50-point reduction in IBS-SSS was met by 42% (n=14/33) undertaking TDA, 55% (n=18/33) for LFD, and 58% (n=19/33) for GFD; p=0.43. Responders had similar improvements in IBS-SSS items regardless of their allocated diet. Individuals found TDA cheaper (p