Effectiveness of a FODMAP-Based, Coach-Supervised, and Peer-Supported Lifestyle Program in Reducing Gastrointestinal and Extraintestinal Symptoms in Irritable Bowel Syndrome.

BACKGROUND AND AIMS: We aimed to evaluate the impact of a comprehensive lifestyle program that integrates dietary, behavioral, and peer support strategies on gastrointestinal and extraintestinal symptoms in patients with irritable bowel syndrome (IBS). METHODS: We performed a cross-sectional study analyzing a consecutive series of patients with IBS according to Rome IV criteria who participated in a structured, 3-week digital program between July 2022 and January 2025. The intervention combined a low-FODMAP, low-starch, low-sucrose diet with continuous guidance from a nutritionist-coach, daily educational materials (recipes, meal planning tips), peer support through shared group participation, and non-pharmacological tools such as mindfulness and physical activity. Symptom severity was assessed before and after the program using the IBS Severity Scoring System, the Patient Health Questionnaire-9 for depression, and Likert scales for extraintestinal symptoms. RESULTS: A total of 14,186 patients with IBS were analyzed; the mean age was 44.5 (16-86) years, and 13,323 (93.9%) were female. IBS-M (mixed bowel habits) was the more frequent IBS subtype (n = 6,496, 45.8%); 8729 (61.5%) had ≥2 extraintestinal symptoms, and 6923 (48.8%) reported moderate or severe depressive symptoms. IBS-Severity Scoring System scores significantly decreased from 287.3 ± 69.5 to 188.3 ± 87.6 (P < .001), and Patient Health Questionnaire-9 scores improved from 10.2 ± 5.4 to 3.6 ± 3.4 (P < .001). All extraintestinal symptom scores showed significant reductions (P < .001), and 5540/8729 (63.5%) and 8403/11,746 (71.5%) reported >50% reduction of intensity in at least 2 extraintestinal digestive and non-digestive symptoms, respectively. CONCLUSION: A structured multidisciplinary intervention with dietary guidance and non-pharmacological strategies significantly improved both gastrointestinal and extraintestinal symptoms of IBS. A holistic approach addressing patients' diet, exercise habits, well-being, and mental health is recommended for the management of this complex disease.