Can diet change the natural history of gastrointestinal diseases?

Abstract

Belatedly, gastroenterologists have begun to pay attention to the role of diet in the exacerbation of gastrointestinal symptoms in many digestive disorders—a recognition that has spurred both high‐quality clinical trials and translational research into this area. It has become clear that multiple mechanisms acting either in isolation or together can induce gut symptoms and that appropriate interventions can lead to significant relief. What this review will explore is not the role of diet in the production of certain symptoms or symptom clusters, but rather whether a dietary intervention can beneficially alter the natural history of a gastrointestinal disease—a much more demanding expectation. Yet there are examples of where a diet, if sustained, can have a long‐term impact on at least some of those affected by conditions such as eosinophilic esophagitis, celiac disease, food allergy, and constipation.

Innovative concepts in diet therapies in disorders of gut–brain interaction

“…As such, if used in clinical practice, careful monitoring for symptom response and side effects is needed. Given the range of diet‐induced mechanisms for symptom induction in DGBI, 16 other food triggers may need to be considered when fiber and enzyme therapies are unsuccessful at improving symptom response.…”

“… 11 , 12 , 13 , 14 Additionally, mechanistic evidence of the role of diet beyond FODMAPs suggests that local immune response to dietary antigens triggered by bacterial infection may lead to food‐induced symptoms 15 requiring further exploration, as reviewed recently. 16 Beyond these, evidence is accumulating for two innovative supplemental diet therapies in DGBI: targeting specific pathophysiology through manipulation of dietary fibers and modulating digestion through the use of digestive enzymes. These innovative therapies may be used in conjunction with or instead of other diet‐ and nondiet‐focused therapies.…”