Systematic review with meta‐analysis: effect of fibre supplementation on chronic idiopathic constipation in adults

Christodoulides, Stephanos; Dimidi, Eirini; Fragkos, Konstantinos C.; Ad, Farmer; Whelan, Kevin; Sm, Scott

doi:10.1111/apt.13662

Cited by 107 publications

(87 citation statements)

References 59 publications

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“…Constipation has long been associated with a low fiber intake, and a typical low FODMAP diet can often lack fiber content. Nevertheless, a recent meta-analysis showed that there was low evidence on the importance of a high fiber diet in treating constipation: only 44% of RCTs demonstrated a significant increase in stool frequency and only 2 studies showed fiber-enhanced stool consistency [35]. In our study, we did not find a worsening of constipation despite the low FODMAP diet followed by patients with IBS and CD.…”

Section: Discussioncontrasting

confidence: 66%

Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

Testa

Imperatore

Rispo

et al. 2018

Dig Dis

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Background and Aim: To evaluate the usefulness of a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet on patients with irritable bowel syndrome (IBS), non-active inflammatory bowel diseases (IBD), and celiac disease (CD) on a gluten-free diet (GFD). Methods: Dietetic interventional prospective study. IBS, IBD, and CD subjects were evaluated to check if they fulfilled the Rome III criteria. Each subject was educated to follow a low FODMAP diet after being evaluated by filling out questionnaires that assessed the quality of life (QoL) and symptoms experienced (IBS-SSS and SF-36), and was reevaluated after 1 and 3 months. Results: One hundred twenty-seven subjects were enrolled: 56 with IBS, 30 with IBD, and 41 with CD. IBS-SSS showed that abdominal symptoms improved after 1 and 3 months of diet in all subjects, with significant difference among the 3 groups at T0 (average scores IBS: 293 ± 137, IBD: 206 ± 86, CD: 222 ± 65, p < 0.001), but no difference at T3 (IBS: 88 ± 54, IBD: 73 ± 45, CD: 77 ± 49, p = ns). By analyzing the SF-36 questionnaire, we did not observe any difference between the 3 groups, in terms of response to diet (p = ns), we observed a clinical improvement from T0 to T3 for most of the questionnaire’s domains. Conclusions: A low FODMAP diet could be a valid option to counter abdominal symptoms in patients with IBS, non-active IBD, or CD on a GFD, and thus, improve their QoL and social relations.

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Section: Discussioncontrasting

confidence: 66%

Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

Testa

Imperatore

Rispo

et al. 2018

Dig Dis

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“…Some studies found that prebiotics had a positive effect in constipated patients. Christodoulides et al [34] suggested that fiber was moderately effective for chronic idiopathic constipation in adults. Suares et al [35] also reported that soluble fiber might be more beneficial than insoluble fiber in constipated patients in alleviating straining, pain on defecation, improving stool consistency, and other constipation-related symptoms.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Synbiotics in Patients with Slow Transit Constipation: A Prospective Randomized Trial

Ding

Zhang

et al. 2016

Nutrients

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Synbiotic intake may efficiently restore the balance of gut microbiota and improve gastrointestinal functions. The aim of the study was to evaluate the efficacy of a synbiotic in patients with slow transit constipation. A total of 100 patients with slow transit constipation were randomized to receive either a synbiotic or placebo twice daily for 12 weeks. The primary efficacy endpoints were the clinical remission and improvement rates at weeks 4 and 12. Stool frequency and consistency, colonic transit time (CTT), evacuation and abdominal symptoms, patient assessment of constipation symptoms, gastrointestinal quality-of-life index scores, satisfaction scores, and adverse events were also monitored. The clinical remission rates reached 37.5% at week 4 and 45.8% at week 12 in the treatment group, compared to 13.3% at week 4 and 16.7% at week 12 in the placebo group (p < 0.01 for both comparisons). Over 12 weeks, 64.6% of the patients who received the synbiotic experienced clinical improvement, compared to 29.2% of the patients in the placebo group (p < 0.01). During the intervention period, patients who were treated with the synbiotic exhibited increased stool frequency, improved stool consistency, decreased CTT, and improved constipation-related symptoms. This randomized, placebo-controlled trial suggested that dietary supplementation with a synbiotic improved evacuation-parameters-associated symptoms and colonic motility in patients with slow transit constipation (STC).

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“…A systematic review by Suares and Ford, 56 which included six randomised controlled trials (RCTs) of soluble and insoluble fibre, found evidence of limited benefit overall in CIC, but suggested that soluble fibre was more effective than placebo, and led to improvements in individual symptoms. A further systematic review with meta‐analysis by Christodoulides and colleagues 57 also suggested that soluble fibre was effective for treating CIC, but highlighted that it may also cause unwanted gastrointestinal side effects, such as increased flatulence. Overall, the quality of evidence was low and the findings should be interpreted cautiously, due to a high risk of bias among all included studies.…”

Section: Managementmentioning

confidence: 99%

Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management

Black

Ford

2018

Medical Journal of Australia

131

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Chronic idiopathic constipation (CIC) is one of the most common gastrointestinal disorders, with a global prevalence of 14%. It is commoner in women and its prevalence increases with age. There are three subtypes of CIC: dyssynergic defaecation, slow transit constipation and normal transit constipation, which is the most common subtype. Clinical assessment of the patient with constipation requires careful history taking, in order to identify any red flag symptoms that would necessitate further investigation with colonoscopy to exclude colorectal malignancy. Screening for hypercalcaemia, hypothyroidism and coeliac disease with appropriate blood tests should be considered. A digital rectal examination should be performed to assess for evidence of dyssynergic defaecation. If this is suspected, further investigation with high resolution anorectal manometry should be undertaken. Anorectal biofeedback can be offered to patients with dyssynergic defaecation as a means of correcting the associated impairment of pelvic floor, abdominal wall and rectal functioning. Lifestyle modifications, such as increasing dietary fibre, are the first step in managing other causes of CIC. If patients do not respond to these simple changes, then treatment with osmotic and stimulant laxatives should be trialled. Patients not responding to traditional laxatives should be offered treatment with prosecretory agents such as lubiprostone, linaclotide and plecanatide, or the 5-HT4 receptor agonist prucalopride, where available. If there is no response to pharmacological treatment, surgical intervention can be considered, but it is only suitable for a carefully selected subset of patients with proven slow transit constipation.

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Systematic review with meta‐analysis: effect of fibre supplementation on chronic idiopathic constipation in adults

Cited by 107 publications

References 59 publications

Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

Efficacy of Synbiotics in Patients with Slow Transit Constipation: A Prospective Randomized Trial

Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management

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