Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome

A human pilot trial of ingestible electronic capsules capable of sensing different gases in the gut

“…The gases of the gut have been shown to be of significant value in understanding the pathogenesis of disorders of the gut and in diagnostics 6,14,15 . Gas production from bacterial fermentation is likely to induce abdominal symptoms via luminal distension in patients with irritable bowel syndrome (IBS) and visceral hypersensitivity 16 . Carbohydrate malabsorption 17 and small intestine bacterial overgrowth (SIBO) are also frequently diagnosed from H 2 measurements 18 .…”

The Dietary Fibers–FODMAPs Controversy

“…Major et al (29) reported that an intervention study in which subjects were exposed to three periods of drinking beverages containing either glucose, fructose, or inulin showed that the physiological responses after intake of fructose and inulin were similar in patients with IBS and healthy controls. Albeit, fructose induced more symptoms than did inulin.…”

Editorial: food for thought—the low‐FODMAP diet and IBS in perspective

“…[4][5][6] These molecules, poorly absorbed in the small intestine, are thought to generate increased, osmotically driven intraluminal volumes 7 and to be fermented by the colonic microbiota to short chain fatty acids and gases; thereby generating pain, bloating and distension in a viscerally sensitive subject. 8 Clinical trials supported this hypothesis (reviewed in reference 9); soon the low-FOD-MAP diet became a cornerstone of IBS management.The systematic review and meta-analysis by Rindom Krogsgaard and colleagues casts a cold eye on clinical trials of the low-FODMAP diet and points up a number of shortcomings: unrepresentative study population (tertiary referral rather than primary care), lack of blinding, inappropriate controls (in terms of diet or other intervention) and, most tellingly, short duration of exposure (maximum 6 weeks in a disorder that lasts a lifetime). 9 Furthermore, the reintroduction phase, fundamental to the low-FODMAP strategy, has not been subjected to critical assessment.…”

“…[4][5][6] These molecules, poorly absorbed in the small intestine, are thought to generate increased, osmotically driven intraluminal volumes 7 and to be fermented by the colonic microbiota to short chain fatty acids and gases; thereby generating pain, bloating and distension in a viscerally sensitive subject. 8 Clinical trials supported this hypothesis (reviewed in reference 9); soon the low-FOD-MAP diet became a cornerstone of IBS management.…”