Effects of varying dietary content of fermentable short‐chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome

Hustoft, T. N.; Hausken, Trygve; Ystad, S.O.; Valeur, Jørgen; Brokstad, Karl Albert; Hatlebakk, Jan Gunnar; Lied, Gülen Arslan

doi:10.1111/nmo.12969

Cited by 168 publications

(200 citation statements)

References 41 publications

(64 reference statements)

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“…The comparator group in one study was a high FODMAP diet42 and in the other was a low FODMAP diet supplemented with fructo-oligosaccharide (fructans) to achieve a ‘normal’ FODMAP intake 48…”

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

272

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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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

272

236

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“…The mechanism of benefit is assumed to relate to reduced colonic fermentation25 or greater microbial diversity and reduced total bacterial abundance 26. More specifically, a recent study of 20 patients with diarrhoea-predominant IBS (IBS-D) or IBS-M reported that low FODMAP diet decreased serum levels of proinflammatory interleukin (IL)-6 and IL-8, as well as levels of faecal bacteria (Actinobacteria, Bifidobacterium and Faecalibacterium prausnitzii ), as well as faecal total SCFAs and n-butyric acid compared with baseline 27. Lower levels of Bifidobacteria were confirmed with low FODMAP diet in another study 28.…”

Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 99%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

121

122

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This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

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“…For example, in a placebo-controlled crossover feeding study that evaluated 247 gluten-free, casein-free diets in autism, most parents of children could not distinguish the placebo diet from the experimental diet (33) . In this feeding study, all meals and snacks were everyday practice, such as non-adherence (34,35) and the potential for information to be 261 misconstrued on transmission from practitioner to the patient, are replicated in these types of to investigate the impact of the low FODMAP diet on symptoms and immune function (36) .…”

mentioning

confidence: 99%

The challenges of control groups, placebos and blinding in clinical trials of dietary interventions

et al. 2017

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Effects of varying dietary content of fermentable short‐chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome

Abstract: Our findings support the efficacy of a LFD in alleviating IBS symptoms, and show changes in inflammatory cytokines, microbiota profile, and SCFAs, which may have consequences for gut health.

Cited by 168 publications

References 41 publications

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

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

Dietary and pharmacological treatment of abdominal pain in IBS

The challenges of control groups, placebos and blinding in clinical trials of dietary interventions

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