The following is a summary of “A novel, IBS-specific IgG ELISA-based elimination diet in irritable bowel syndrome: A randomized, sham-controlled trial,” published in the January 2025 issue of Gastroenterology by Singh et al. 

Personalized dietary interventions for irritable bowel syndrome (IBS) remain a critical area of research, as conventional treatment strategies often fail to address the heterogeneity of symptoms across patients. An IgG-antibody-based elimination diet has emerged as a potential approach, yet prior studies have been hampered by methodological limitations. This randomized, double-blind, sham-controlled trial aimed to rigorously evaluate the efficacy of an elimination diet guided by a novel IBS-specific IgG assay. A total of 238 subjects with IBS were recruited from eight centers and underwent screening for food sensitivities using an 18-food IgG panel. 

Eligible participants, defined by a positive IgG response to at least one food and an average daily abdominal pain intensity (API) score between 3 and 7.5 on an 11-point scale during a two-week run-in period, were randomized to either an experimental IgG-guided elimination diet or a sham diet for eight weeks. The primary outcome was defined as a reduction of at least 30% in API for at least two of the last four weeks of the treatment period. Of the 238 randomized subjects, 223 were included in the modified intention-to-treat analysis. A significantly higher proportion of participants in the experimental diet group achieved the primary outcome compared to those in the sham diet group (59.6% vs. 42.1%, P=0.02). 

Subgroup analyses revealed that IBS with constipation (IBS-C) and IBS with mixed bowel habits (IBS-M) patients particularly benefited from the IgG-guided diet, with response rates of 67.1% vs. 35.8% (P<0.05) and 66.0% vs. 29.5% (P<0.05), respectively, when compared to their sham-diet counterparts. These findings suggest that an IgG-based elimination diet may offer a promising personalized treatment strategy, particularly for IBS-C and IBS-M patients, by identifying and eliminating specific dietary triggers. The results underscore the need for larger-scale trials to further validate the efficacy and long-term benefits of this approach in IBS management.

Source: gastrojournal.org/article/S0016-5085(25)00328-2/abstract