Mechanisms Underlying Food-Triggered Symptoms in Disorders of Gut-Brain Interactions

Abstract

There has been a dramatic increase in clinical studies examining the relationship between disorders of gut-brain interactions and symptoms evoked by food ingestion in the upper and lower gastrointestinal tract, but study design is challenging to verify valid endpoints. Consequently, mechanistic studies demonstrating biological relevance, biomarkers and novel therapeutic targets are greatly needed. This review highlights emerging mechanisms related to nutrient sensing and tasting, maldigestion, physical effects with underlying visceral hypersensitivity, allergy and immune mechanisms, food–microbiota interactions and gut-brain signaling, with a focus on patients with functional dyspepsia and irritable bowel syndrome. Many patients suffering from disorders of gut-brain interactions exhibit these mechanism(s) but which ones and which specific properties may vary widely from patient to patient. Thus, in addition to identifying these mechanisms and the need for further studies, biomarkers and novel therapeutic targets are identified that could enable enriched patient groups to be studied in future clinical trials examining the role of food in the generation of gut and non-gut symptoms.

The epidemiology and impact of disorders of gut–brain interaction in Canada: Results from the Rome Foundation Global Epidemiologic Study

“…There are, however, also possible genetic 28 and cultural differences between English and French Canadians that could be hypothesized to account for the observed differences in DGBI prevalence, such as cultural differences in diet, life style, healthcare perception, and medication use 29 . Dietary factors, for example, are well known to have a significant impact on disorders of constipation and dyspepsia, 30 and some studies suggest important differences in diet of francophones compared to anglophones 31,32 . Further studies with comparable representation from both groups are needed to determine whether the differences are fully accounted for by selection bias, but such hypotheses are in keeping with other studies suggesting that some francophone cultural factors, such as diet, could contribute negatively to their well‐being and warrants further study 31 …”

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

“…For example, in a survey of nearly 200 patients with IBS from Sweden, 84% identified food as a key trigger for their GI symptoms (3). The reasons that underlie the relationship between food and the development of GI symptoms are discussed in detail in another manuscript (4). In many patients with meal-related GI symptoms, diet manipulation is a natural first step in the treatment plan.…”

The low-FODMAP diet and the gluten-free diet in the management of functional abdominal bloating and distension

“…Several pathophysiological mechanisms have already been proposed to explain the impact of food on the onset of GI symptoms. One of these involves an alteration of GI mechanoreceptors, chemoreceptors, and thermoreceptors responsible for nutrients sensing ( 15 , 16 ). Another possible underlining mechanism may be a defective processing of nutrients, as some studies suggested a potential role of fructose ( 17 ) or lactose intolerance ( 18 ) and of lactase-isomaltase polymorphism ( 19 ) in patients with DGBI.…”

“… Proposed pathogenetic mechanisms leading to gastrointestinal symptoms, including bloating, after FODMAPs ingestion in predisposed individuals. Modified from Singh et al ( 47 ) and Van den Houte et al ( 16 ). LPS, lipopolysaccharide; 5HT, 5-hydroxytryptamine; GI, gastrointestinal.…”