{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:52:58Z","timestamp":1792637578286,"version":"4.5.0"},"reference-count":50,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T00:00:00Z","timestamp":1712534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Persistent symptoms in coeliac disease (CD) can be due to not only poor gluten-free diet (GFD) adherence and complications of CD, but also functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Although the role of a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet is well-established in IBS, little data are available on its role in coeliac patients with persistent IBS-like symptoms despite a GFD. Methods: We systematically reviewed the literature in accordance with the PRISMA guidelines for studies evaluating the role of FODMAPs and\/or a low-FODMAP diet in coeliac patients with persistent symptoms. PubMed and Embase were searched from inception to 16 January 2024 for eligible full-text papers. The study protocol was registered on Open Science Framework. Results: A total of 239 records were identified, and six papers were included. Of these, four were interventional studies comparing a low-FODMAP GFD to a regular GFD for persistent symptoms in 115 total coeliac patients (two randomized controlled trials and two open-label studies). A low-FODMAP GFD for a minimum of 4 weeks was significantly more effective than a regular GFD in reducing symptoms (p &lt; 0.05 in 3\/4 studies). Dietary FODMAP content of a conventional GFD was significantly lower than that of non-coeliac patients on a gluten-containing diet (both p &lt; 0.05), especially regarding high-FODMAP grain products. However, coeliac patients consumed more servings of fruits\/vegetables high in FODMAP. No relationship between FODMAP intake and persistence of symptoms was reported. Conclusions: A low-FODMAP diet may be beneficial for uncomplicated celiac patients with persistent IBS-like symptoms despite strict adherence to a GFD.<\/jats:p>","DOI":"10.3390\/nu16071094","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T12:01:22Z","timestamp":1712577682000},"page":"1094","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Efficacy of a Low-FODMAP Diet for Coeliac Patients with Persistent IBS-like Symptoms despite a Gluten-Free Diet: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Francesca","family":"Lusetti","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8493-7698","authenticated-orcid":false,"given":"Annalisa","family":"Schiepatti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri, Gastroenterology Unit of IRCCS Pavia Institute, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7051-5432","authenticated-orcid":false,"given":"Davide","family":"Scalvini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"},{"name":"PhD Course in Experimental Medicine, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2057-8179","authenticated-orcid":false,"given":"Stiliano","family":"Maimaris","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri, Gastroenterology Unit of IRCCS Pavia Institute, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2227-4622","authenticated-orcid":false,"given":"Federico","family":"Biagi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"},{"name":"Istituti Clinici Scientifici Maugeri, Gastroenterology Unit of IRCCS Pavia Institute, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.dld.2022.06.023","article-title":"Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis","volume":"54","author":"Zingone","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.14309\/ajg.0000000000002075","article-title":"American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease","volume":"118","author":"Hill","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1177\/2050640619844125","article-title":"European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders","volume":"7","author":"Volta","year":"2019","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/j.1365-2036.2009.04053.x","article-title":"Systematic review: Adherence to a gluten-free diet in adult patients with celiac disease","volume":"30","author":"Hall","year":"2009","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Penny, H.A., Baggus, E.M.R., Rej, A., Snowden, J.A., and Sanders, D.S. (2020). Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients, 12.","DOI":"10.3390\/nu12010216"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.cgh.2012.11.033","article-title":"Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: A meta-analysis","volume":"11","author":"Sainsbury","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.cgh.2006.12.006","article-title":"Etiologies and predictors of diagnosis in nonresponsive celiac disease","volume":"5","author":"Leffler","year":"2007","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/MCG.0000000000000392","article-title":"Frequency and Cause of Persistent Symptoms in Celiac Disease Patients on a Long-term Gluten-free Diet","volume":"50","author":"Stasi","year":"2016","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3374","DOI":"10.1007\/s10620-022-07727-x","article-title":"High Prevalence of Functional Gastrointestinal Disorders in Celiac Patients with Persistent Symptoms on a Gluten-Free Diet: A 20-Year Follow-Up Study","volume":"68","author":"Schiepatti","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.cgh.2021.07.026","article-title":"Functional Gastrointestinal Disorders and Associated Health Impairment in Individuals with Celiac Disease","volume":"20","author":"Parker","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1080\/00365521.2021.1930146","article-title":"High disease burden in treated celiac patients\u2014A web-based survey","volume":"56","author":"Skodje","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/2050640614560786","article-title":"Psychological morbidity of celiac disease: A review of the literature","volume":"3","author":"Zingone","year":"2015","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1111\/j.1572-0241.2002.05917.x","article-title":"Etiology of nonresponsive celiac disease: Results of a systematic approach","volume":"97","author":"Abdulkarim","year":"2002","journal-title":"Am. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Biagi, F., Marchese, A., Ferretti, F., Ciccocioppo, R., Schiepatti, A., Volta, U., Caio, G., Ciacci, C., Zingone, F., and D\u2019odorico, A. (2014). A multicentre case control study on complicated coeliac disease: Two different patterns of natural history, two different prognoses. BMC Gastroenterol., 14.","DOI":"10.1186\/1471-230X-14-139"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1053\/j.gastro.2020.04.014","article-title":"Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study","volume":"160","author":"Sperber","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1053\/j.gastro.2016.03.035","article-title":"Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction","volume":"150","author":"Drossman","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1002\/ueg2.12259","article-title":"Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility","volume":"10","author":"Savarino","year":"2022","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1136\/gutjnl-2021-324598","article-title":"British Society of Gastroenterology guidelines on the management of irritable bowel syndrome","volume":"70","author":"Vasant","year":"2021","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"860","DOI":"10.7326\/0003-4819-134-9_Part_2-200105011-00010","article-title":"Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome","volume":"134","author":"Creed","year":"2001","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.14309\/ajg.0000000000001036","article-title":"ACG Clinical Guideline: Management of Irritable Bowel Syndrome","volume":"116","author":"Lacy","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1053\/j.gastro.2021.12.248","article-title":"AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review","volume":"162","author":"Chey","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cardo, A., Churruca, I., Lasa, A., Navarro, V., V\u00e1zquez-Polo, M., Perez-Junkera, G., and Larretxi, I. (2021). Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet. Nutrients, 13.","DOI":"10.3390\/nu13082877"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1016\/j.cgh.2022.01.011","article-title":"A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients with Ongoing Symptoms-A Randomized Controlled Trial","volume":"20","author":"Skodje","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Roncoroni, L., Bascu\u00f1\u00e1n, K.A., Doneda, L., Scricciolo, A., Lombardo, V., Branchi, F., Ferretti, F., Dell\u2019osso, B., Montanari, V., and Bardella, M.T. (2018). A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients, 10.","DOI":"10.3390\/nu10081023"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1159\/000489487","article-title":"Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease","volume":"36","author":"Testa","year":"2018","journal-title":"Dig. Dis."},{"key":"ref_28","first-page":"304","article-title":"Adult celiac disease with persistent IBS-type symptoms: A pilot study of an adjuvant FODMAP diet","volume":"14","author":"Trott","year":"2021","journal-title":"Gastroenterol. Hepatol. Bed Bench"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Roncoroni, L., Elli, L., Doneda, L., Bascu\u00f1\u00e1n, K.A., Vecchi, M., Morreale, F., Scricciolo, A., Lombardo, V., and Pellegrini, N. (2018). A Retrospective Study on Dietary FODMAP Intake in Celiac Patients Following a Gluten-Free Diet. Nutrients, 10.","DOI":"10.3390\/nu10111769"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1080\/09637486.2021.1880553","article-title":"FODMAP intake in children with coeliac disease influences diet quality and health-related quality of life and has no impact on gastrointestinal symptoms","volume":"72","author":"Cyrkot","year":"2021","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e741","DOI":"10.1016\/j.cgh.2020.12.015","article-title":"Determinants and Trends of Adherence to a Gluten-Free Diet in Adult Celiac Patients on a Long-term Follow-up (2000\u20132020)","volume":"20","author":"Schiepatti","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"91","DOI":"10.23736\/S2724-5985.21.03037-0","article-title":"The GLU-10: A validated ten-point score to identify poorly instructed celiac patients in need of dietary interventions","volume":"68","author":"Vernero","year":"2022","journal-title":"Minerva Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/apt.14791","article-title":"Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease","volume":"48","author":"Halmos","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.appet.2018.02.023","article-title":"Maintenance of a gluten free diet in coeliac disease: The roles of self-regulation, habit, psychological resources, motivation, support, and goal priority","volume":"125","author":"Sainsbury","year":"2018","journal-title":"Appetite"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.dld.2017.12.001","article-title":"Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation","volume":"50","author":"Biagi","year":"2018","journal-title":"Dig. Liver Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1053\/j.gastro.2022.07.086","article-title":"AGA Clinical Practice Update on Management of Refractory Celiac Disease: Expert Review","volume":"163","author":"Green","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1111\/j.1365-2036.2011.04831.x","article-title":"Functional gastrointestinal disorders and coeliac disease in adults\u2014Negative impact on quality of life","volume":"34","author":"Kurien","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1017\/S0007114518003616","article-title":"Inadvertent and minimal gluten intake has a negligible role in the onset of symptoms in patients with coeliac disease on a gluten-free diet","volume":"121","author":"Schiepatti","year":"2019","journal-title":"Br. J. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1007\/s10620-018-4936-4","article-title":"Hypervigilance to a gluten-free diet and decreased quality of life in teenagers and adults with celiac disease","volume":"63","author":"Wolf","year":"2018","journal-title":"Dig. Dis. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/apt.14991","article-title":"Anxiety after coeliac disease diagnosis predicts mucosal healing: A population-based study","volume":"48","author":"Ludvigsson","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Clappison, E., Hadjivassiliou, M., and Zis, P. (2020). Psychiatric manifestations of coeliac disease, a systematic review and meta-analysis. Nutrients, 12.","DOI":"10.3390\/nu12010142"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.ijfoodmicro.2018.10.016","article-title":"Gluten-free and low-FODMAP sourdoughs for patients with coeliac disease and irritable bowel syndrome: A clinical perspective","volume":"290","author":"Muir","year":"2019","journal-title":"Int. J. Food Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Myhrstad, M.C.W., Slydahl, M., Hellmann, M., Garnweidner-Holme, L., Lundin, K.E.A., Henriksen, C., and Telle-Hansen, V.H. (2021). Nutritional quality and costs of gluten-free products: A case-control study of food products on the Norwegian marked. Food Nutr. Res., 65.","DOI":"10.29219\/fnr.v65.6121"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1111\/jhn.13137","article-title":"Diet quality, ultra-processed food consumption, and quality of life in a cross-sectional cohort of adults and teens with celiac disease","volume":"36","author":"Cadenhead","year":"2023","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Mambrini, S.P., Menichetti, F., Ravella, S., Pellizzari, M., De Amicis, R., Foppiani, A., Battezzati, A., Bertoli, S., and Leone, A. (2023). Ultra-Processed Food Consumption and Incidence of Obesity and Cardiometabolic Risk Factors in Adults: A Systematic Review of Prospective Studies. Nutrients, 15.","DOI":"10.3390\/nu15112583"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Sugavanam, T., Crocker, H., Violato, M., and Peters, M. (2024). The financial impact on people with coeliac disease of withdrawing gluten-free food from prescriptions in England: Findings from a cross-sectional survey. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-024-10600-4"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Rodr\u00edguez, A., Loaiza-Mart\u00ednez, D.A., S\u00e1nchez-S\u00e1nchez, J., Rubio-Arias, J.\u00c1., Alacid, F., Prats-Moya, S., Mart\u00ednez-Olcina, M., Y\u00e1\u00f1ez-Sep\u00falveda, R., and Marcos-Pardo, P.J. (2022). Personalised Nutritional Plan and Resistance Exercise Program to Improve Health Parameters in Celiac Women. Foods, 11.","DOI":"10.3390\/foods11203238"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Vereczkei, Z., Farkas, N., Hegyi, P., Imrei, M., F\u00f6ldi, M., Szak\u00e1cs, Z., Kiss, S., Solym\u00e1r, M., Nagy, R., and Bajor, J. (2021). It Is High Time for Personalized Dietary Counseling in Celiac Disease: A Systematic Review and Meta-Analysis on Body Composition. Nutrients, 13.","DOI":"10.3390\/nu13092947"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1053\/j.gastro.2019.09.024","article-title":"Effects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients with Quiescent Inflammatory Bowel Disease in a Randomized Trial","volume":"158","author":"Cox","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"110542","DOI":"10.1016\/j.nut.2019.06.023","article-title":"A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease","volume":"67\u201368","author":"Bodini","year":"2019","journal-title":"Nutrition"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/7\/1094\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:25:07Z","timestamp":1760106307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/7\/1094"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,8]]},"references-count":50,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["nu16071094"],"URL":"https:\/\/doi.org\/10.3390\/nu16071094","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,8]]}}}