A low FODMAP diet and the antibiotic rifaximin provided similar symptom relief for patients with irritable bowel syndrome with diarrhea, according to a study published April 21 in Clinical Gastroenterology and Hepatology.
In a randomized controlled trial of 65 subjects, researchers assigned patients to either a 14-day course of rifaximin or low FODMAP diet counseling. After five weeks, both groups saw comparable and significant reductions in abdominal pain and bloating.
The study also found gut microbiome differences tied to treatment response. Patients who responded to the low FODMAP diet had lower baseline abundance of saccharolytic taxa and increased microbial diversity over time. Rifaximin responders were enriched in taxa linked to short-chain fatty acid production and bile acid modification.
Patients who did not respond to either therapy showed a distinct microbial profile enriched in proteolytic taxa, suggesting potential markers of treatment resistance, researchers said.
The findings could support more personalized treatment strategies, though results are “hypothesis-generating rather than definitive.”
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