An 8-week use of a diet-based application  (low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [FODMAP]) was superior to standard medical therapy in people suffering from irritable bowel syndrome (IBS), as deciphered from the findings of the DOMINO study. This smartphone application was linked to long-lasting responder rates and improvement of the IBS Symptom Severity Scale (IBS-SSS). Investigators sought to compare the efficacy of a smartphone application for a FODMAP-lowering diet versus otilonium bromide on IBS symptoms.

Primary care physicians recruited IBS patients who were then randomly assigned to receive either otilonium bromide (40 mg three times a day) or follow a FODMAP-lowering diet for 8 weeks. Participants were followed up for 24 weeks. The study evaluated the IBS-SSS and the proportion of responders (defined as those with an improvement of ≥50 points) in all patients and a subgroup meeting the Rome IV criteria (Rome+). Other factors assessed included therapeutic effectiveness, quality of life, depression, anxiety, somatic symptom severity (measured using the Patient Health Questionnaire [PHQ15, PHQ9]), therapy adherence, and predictors of response.

A total of 459 IBS-affected people (average age 41±15 years, 76% female, 70% Rome+) were randomized for the study. After 8 weeks, the responder rate was considerably greater in the diet group when compared to the otilonium bromide group, with the difference more pronounced in the Rome+ subgroup. Adherence to the assigned treatment was higher for the diet group when compared to the otilonium bromide group, as illustrated in Table 1:

Encouragingly, the higher response rate with the diet was evident even after 4 weeks [62% [132/213) vs. 51% (110/215)], and a sustained symptom response was observed during the follow-up period. Predictors of response were identified as female gender (Odds Ratio [OR]=2.08) for the diet group and PHQ15 score (OR=1.10) for the otilonium bromide group. Among primary care IBS patients, a smartphone application for a FODMAP-lowering diet demonstrated superior effectiveness in ameliorating IBS symptoms when compared to a spasmolytic agent.

Therefore, a FODMAP-lowering diet should be taken into consideration as the optimal first-line therapy for IBS in primary care settings. This research opens up new possibilities for more personalized and effective self-management options for IBS patients, empowering them to take control of their symptoms with the help of smartphone technology and dietary interventions.