Faecal and urine metabolites, but not gut microbiota, may predict response to low FODMAP diet in irritable bowel syndrome

Wilson, Bridgette, Kanno, Tokuwa, Slater, Rachael ORCID: 0000-0001-9765-6978, Rossi, Megan, Irving, Peter M, Lomer, Miranda C, Probert, Chris ORCID: 0000-0003-0477-6714, Mason, A James and Whelan, Kevin (2023) Faecal and urine metabolites, but not gut microbiota, may predict response to low FODMAP diet in irritable bowel syndrome ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 58 (4). pp. 404-416. ISSN 0269-2813, 1365-2036

Text Aliment Pharmacol Ther - 2023 - Wilson - Faecal and urine metabolites but not gut microbiota may predict response to low (1).pdf - Open Access published version Download (2MB) | Preview

Abstract

Background: The low FODMAP diet (LFD) leads to clinical response in 50%–80% of patients with irritable bowel syndrome (IBS). It is unclear why only some patients respond. Aims: To determine if differences in baseline faecal microbiota or faecal and urine metabolite profiles may separate clinical responders to the diet from non-responders allowing predictive algorithms to be proposed. Methods: We recruited adults fulfilling Rome III criteria for IBS to a blinded randomised controlled trial. Patients were randomised to sham diet with a placebo supplement (control) or LFD supplemented with either placebo (LFD) or 1.8 g/d B-galactooligosaccharide (LFD/B-GOS), for 4 weeks. Clinical response was defined as adequate symptom relief at 4 weeks after the intervention (global symptom question). Differences between responders and non-responders in faecal microbiota (FISH, 16S rRNA sequencing) and faecal (gas–liquid chromatography, gas-chromatography mass-spectrometry) and urine (¹H NMR) metabolites were analysed. Results: At 4 weeks, clinical response differed across the 3groups with adequate symptom relief of 30% (7/23) in controls, 50% (11/22) in the LFD group and 67% (16/24) in the LFD/B-GOS group (p = 0.048). In the control and the LFD/B-GOS groups, microbiota and metabolites did not separate responders from non-responders. In the LFD group, higher baseline faecal propionate (sensitivity 91%, specificity 89%) and cyclohexanecarboxylic acid esters (sensitivity 80%, specificity 78%), and urine metabolite profile (Q² 0.296 vs. randomised −0.175) predicted clinical response. Conclusions: Baseline faecal and urine metabolites may predict response to the LFD.

Item Type:	Article
Uncontrolled Keywords:	FODMAP, IBS, microbiota, prebiotics
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	25 Sep 2023 08:39
Last Modified:	22 Jan 2026 12:21
DOI:	10.1111/apt.17609
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3172984
Disclaimer:	The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate.