Dietary guidance normalizes large intestinal endocrine cell densities in patients with irritable bowel syndrome

Mazzawi, Tarek; Hausken, Trygve; Gundersen, Doris

doi:10.1038/ejcn.2015.191

Cited by 34 publications

(50 citation statements)

References 56 publications

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“…28,30 The changes in the different enteroendocrine cell densities identified herein may have contributed to the previously reported improvement in IBS symptoms and the QOL of these IBS patients. 12 The results of the current study shed some light on the involvement of the enteroendocrine cells in the pathophysiology of IBS.…”

Section: Resultsmentioning

confidence: 55%

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Mazzawi

2017

Exp Biol Med (Maywood)

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Several contributing factors to the symptomology of irritable bowel syndrome (IBS) have been identified, such as abnormal densities of enteroendocrine cells and diet; however, the interactions between these factors have not been studied yet. The current study aims at exploring the dynamic changes between these two factors by studying the effect of using low fermentable oligo-, di-, monosaccharides and polyol (FODMAP) diet (known to improve IBS symptoms) through dietary guidance on the enteroendocrine cell densities in the duodenum. The findings showed that the densities of different enteroendocrine cells in the duodenum were abnormal before the patients received dietary guidance and tend to change/normalize after receiving guidance, which may have contributed in improving the symptoms of IBS. These findings highlight the importance of enteroendocrine cells in IBS pathophysiology and the mechanism behind the positive effect of low FODMAP dietary guidance in improving IBS symptoms and its usage as first step in the line of IBS management. AbstractThe densities of enteroendocrine cells are abnormal in patients with irritable bowel syndrome (IBS); however, they tend to change toward normal levels in stomach, ileum, and colon following dietary guidance. The aim was to identify the types of duodenal enteroendocrine cells affected after receiving dietary guidance in the same group of patients with IBS. Fourteen patients with IBS and 14 control subjects were included. The patients received three sessions of dietary guidance. Both groups underwent gastroscopies at baseline, and again for the patients after 3-9 months (median, four months) from receiving dietary guidance. Tissue biopsies were collected from the descending part of the duodenum and were immunostained for all the types of enteroendocrine cells and were then quantified by using computerized image analysis. Using the Kruskal-Wallis non-parametric test with Dunn's test as a post-test, the results showed a significant difference in the secretin cell densities between control subjects and patients with IBS prior to and following dietary guidance (P ¼ 0.0001 and 0.011, respectively). The corresponding P values for cholecystokinin (CCK) cell densities were 0.03 and 0.42, respectively; gastric inhibitory peptide (GIP) cell densities were 0.06 and 0.43, respectively; serotonin cell densities were <0.0001 and 0.002, respectively; and for somatostatin cell densities were <0.0001 and 0.052, respectively. The Paired t-test showed a significant difference only in the serotonin (P ¼ 0.03) and somatostatin (P < 0.0001) cell densities between IBS patients prior to and following dietary guidance. The changes in the cell densities of secretin, CCK, and GIP were not significant between IBS patients prior to and following dietary guidance. In conclusion, the densities of several duodenal enteroendocrine cells in IBS patients changed toward the values measured in control subjects following dietary guidance. The changes in serotonin and somatostatin cell densities may have contrib...

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Section: Resultsmentioning

confidence: 55%

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Mazzawi

2017

Exp Biol Med (Maywood)

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“…In addition to these effects, a recent study demonstrated that patients on a diet low in FODMAP, in combination with other dietary means, normalized the cell density of colonic serotonin after 3–9 months. This situation suggests modulation of intestinal transit time or of visceral sensitivity as possible mechanisms associated with the improvement of gastrointestinal symptoms …”

Section: Discussionmentioning

confidence: 99%

“…This situation suggests modulation of intestinal transit time or of visceral sensitivity as possible mechanisms associated with the improvement of gastrointestinal symptoms. 45 However, a potential concern is that diets low in fructose may decrease the expression of GLUT-5 and further compromise the absorption of this carbohydrate. In addition, a diet low in FODMAP limits the effect of many dietary components that present prebiotic effects that assist in reducing the risk for development of colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Content of Poorly Absorbed Short‐Chain Carbohydrates (FODMAP) in Enteral Homemade Diets

et al. 2018

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Background Recent studies have shown that commercial enteral formulas with low FODMAP (FO, fermentable oligosaccharides; D, disaccharides; M, monosaccharides; AP, and polyols) content decrease diarrhea of individuals receiving enteral nutrition therapy (ENT). There is no information, however, regarding the content of FODMAP in homemade enteral formula. The objective of this study was to assess energy and macronutrient content, and to quantify the amount of FODMAP content in homemade enteral formula, commonly prescribed for home use after hospital discharge. Methods Recipes of homemade enteral formula were requested from all hospitals and healthcare centers in a Brazilian city, totaling 24 recipes. The diets were quantified in relation to their energy content, macronutrients, and FODMAP content. Results Of the 19 hospitals, 68.4% prescribe only commercial enteral formulas at the time of hospital discharge, and 31.6% prescribe homemade enteral formula, both conventional and commercial. The homemade enteral formula showed a variation from 700 to 3000 kcal/d. The macronutrient levels of carbohydrates, proteins, and fats were 49.0% ± 6.8%, 17.4% ± 3.1%, and 33.5% ± 6.2%, respectively. On average, homemade enteral formula had 58.5% of high FODMAP content, 7.1% of moderate content, and 34.5% of low FODMAP content, considering that milk is the main food responsible for the high content of FODMAP. Conclusions Homemade enteral formula presented adequate nutrition characteristics and is rich in FODMAP. It is important to consider FODMAP in enteral diets prescribed for individuals intolerant to these carbohydrates by individualizing the diet prescription.

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“…One RCT of patients provided low FODMAP advice in combination with other dietary advice (n=13) reported normalisation of colonic serotonin cell density after 3–9 months 55. It was suggested that this may have mediated symptom improvement by modulating transit time and visceral sensitivity.…”

Section: The Low Fodmap Dietmentioning

confidence: 99%

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

Staudacher

Whelan

2017

Gut

269

236

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There is an intensifying interest in the interaction between diet and the functional GI symptoms experienced in IBS. Recent studies have used MRI to demonstrate that short-chain fermentable carbohydrates increase small intestinal water volume and colonic gas production that, in those with visceral hypersensitivity, induces functional GI symptoms. Dietary restriction of short-chain fermentable carbohydrates (the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet) is now increasingly used in the clinical setting. Initial research evaluating the efficacy of the low FODMAP diet was limited by retrospective study design and lack of comparator groups, but more recently well-designed clinical trials have been published. There are currently at least 10 randomised controlled trials or randomised comparative trials showing the low FODMAP diet leads to clinical response in 50%-80% of patients with IBS, in particular with improvements in bloating, flatulence, diarrhoea and global symptoms. However, in conjunction with the beneficial clinical impact, recent studies have also demonstrated that the low FODMAP diet leads to profound changes in the microbiota and metabolome, the duration and clinical relevance of which are as yet unknown. This review aims to present recent advances in the understanding of the mechanisms by which the low FODMAP diet impacts on symptoms in IBS, recent evidence for its efficacy, current findings regarding the consequences of the diet on the microbiome and recommendations for areas for future research.

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Dietary guidance normalizes large intestinal endocrine cell densities in patients with irritable bowel syndrome

Cited by 34 publications

References 56 publications

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Content of Poorly Absorbed Short‐Chain Carbohydrates (FODMAP) in Enteral Homemade Diets

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

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