Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation, in which gut dysbiosis and immune imbalance play pivotal roles. Dietary and microbiota-targeted interventions, particularly the low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet and probiotics, have individually shown benefits in symptom control and inflammation modulation. However, evidence on their combined impact remains limited. Methods This retrospective cohort study included 80 adults with mild-to-moderate UC managed at a tertiary inflammatory bowel disease center between 2022 and 2025. Patients were stratified into four exposure groups: low-FODMAP + probiotic, low-FODMAP only, probiotic only, and standard care. Clinical and biochemical outcomes were assessed over approximately 8 weeks. Primary endpoints included change in Mayo score and clinical remission. Secondary outcomes included changes in C-reactive protein (CRP) and fecal calprotectin (FCal). Results The combined low-FODMAP + probiotic group showed the greatest reduction in Mayo score (−2.4 ± 0.8; p 0.001) and CRP (−3.5 ± 1.8 mg/L), with 60% achieving clinical remission. A significant improvement in FCal (−180 ± 70 μg/g) was also observed in this group. Conclusion A combined low-FODMAP diet and probiotic regimen was associated with the most favorable clinical and inflammatory outcomes in this cohort of adults with mild-to-moderate UC. Because a formal statistical interaction test was not performed, these findings should not be interpreted as proof of synergy, but rather as evidence of an observed combined benefit in this retrospective study. This integrated nutritional–microbial strategy represents a promising adjunctive approach for personalized UC management.
Jia et al. (Thu,) studied this question.