Mo1315 dietary triggers in irritable bowel syndrome are not related to subtypes or severity

Background and aims: diet plays an important role in symptom management of Irritable Bowel Syndrome (IBS). However, current diet therapies are not optimal nor successful for everyone, and previous research has only been done in small groups or regarding food allergens. Therefore, we investigated in an online nationwide study whether subgroups based on IBS subtypes or severity identify different dietary triggers, and whether these are associated with IBS severity and psychological factors. Methods: 1601 IBS patients filled in a crosssectional survey, which assessed subtypes, severity, self-reported response to 44 dietary
triggers (known from literature to instigate symptoms), IBS quality of life, anxiety and depression. Response to dietary triggers was analyzed using multiple correspondence analysis (MCA). Moreover, we developed a foodscore, which represents the number of foods and severity to which a participant responds to dietary triggers. Results: consistent with current knowledge, the five foods that caused the most complaints were greasy foods, onions, cabbage, spicy and fried foods. Response to individual dietary triggers differed between IBS subtypes and severity groups, but absolute differences were small. MCA analysis did not reveal clustering between the dietary triggers, and the ellipses of IBS subtypes overlapped, indicating that the variation in response to dietary triggers is not explained by the IBS subtypes. Some clustering was seen when ellipses were drawn for IBS severity, which indicates that IBS severity explained a fraction of the variation in response to dietary triggers. The foodscore was not significantly different between the IBS subtypes (constipation 30.9±19, diarrhea 33.8±20, mixed 33.1±20, unspecified 30.0±22), but was significantly higher with
higher levels of IBS severity (mild 20.9±17, moderate 29.2±19, severe 37.9±20), anxiety (no anxious symptoms 30.7±20 vs anxious symptoms 35.2±20) and depression (no depressive symptoms 31.4±20 vs depressive symptoms 37.4±20), and a lower IBS quality of life (low quality of life 38.5±19 vs high quality of life 26.5±19). Conclusion: patients with different subtypes or severity do not identify different dietary triggers, therefore there is no need for a subtype or severity specific diet. Patients with more severe IBS and who experience a low
IBS quality of life respond severely to more dietary triggers. Although significant
for anxiety and depression, differences in response to dietary triggers were small and therefore may not be clinically relevant. IBS severity seems a better classifier than Rome IV criteria regarding response to dietary triggers.