Highlighting Potential Individualized Food Triggers in Paper Diaries of Patients With Irritable Bowel Syndrome: 1770

Introduction: There is currently no validated, objective, and reproducible methodology for determining trigger food(s) for an individual patient with irritable bowel syndrome (IBS). The aim of this study was to describe patterns of diet and gastrointestinal (GI) symptoms in seventeen patients with IBS using paper diaries. Secondary aims were to evaluate the feasibility and usability of these paper diaries. Methods: This descriptive pilot study included seventeen IBS patients between 18 to 70 years of age. Participants were asked to use a provided paper diary to record three sets of 3-day food and GI symptom diaries over a 15-day period. They were asked to record all food/drink consumed together with corresponding date and time. They were also asked to record peak GI symptoms (abdominal pain, bloating, diarrhea, constipation) since the prior entry on a scale from 0 to 3 (0 = none, 1 = mild, 2 = moderate, 3= severe). All food/drink entries were analyzed for nutrient and food composition using the Nutrition Data System for Research. For each participant's diary, regression analyses were conducted to examine relationships between key nutrients and subsequent GI symptoms (as recorded in the participant's next entry). Feasibility and usability of the paper diary were assessed by a customized postintervention survey. Results: Most participants were female (N = 14, 82%) and Caucasian (N = 13, 72%) with a mean age of 35 years (SD = 12). The predominant bowel pattern was diarrhea of moderate symptom severity based on the IBS-Symptom Severity Score (N = 11, 65%). Twelve participants (71%) demonstrated a strong association (p ≤ 0.05) of worsening GI symptoms with certain nutrients. Patterns of associations differed amongst individual participants (see table below). While most participants found it easy to record food/symptoms at home (82%) and work (57%), most found it difficult at restaurants (62%). Most found the paper diary easy to use (82%) and not burdensome (53%). Common reasons for not recording a diary entry were forgetfulness, social contexts, and diary inaccessibility. Most participants felt the diary helped them identify possible food triggers (82%) and manage their IBS (71%). Conclusion: Findings from this study support the anecdote that most IBS patients have food triggers and that these food trigger(s) and associated GI symptom(s) vary for each individual. Most participants found the paper diary easy to use, feasible and clinically useful.Table 1: Individualized Patterns of Association of Worsening Gastrointestinal Symptoms with Certain Food Nutrients