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Copyright ©The Author(s) 2015.
World J Gastroenterol. Jun 21, 2015; 21(23): 7089-7109
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7089
Table 2 Identification of foods triggering symptoms in irritable bowel syndrome patients
Ref.PatientsDiagnostic methodsFoodsComment
Nanda et al[13], 198991 of 200 IBS patients reported symptomatic improvement after 3 wk of elimination dietOpen challengeCheese 35.2% Onions 35.2% Milk 31.9% Wheat 29.7% Chocolate 27.5% Butter 25.3% Yoghurt 24.7% Coffee 24.2% Eggs 23.3% Nuts 18.0% Others 34.1%73 of the 91 improved patients were able to identify one or more foods responsible for their symptoms in the open challenge. All except one remained well on clinical follow-up
Carroccio et al[71], 2011160 IBS patientsDBPCFC to wheat and milkWheat and milk 18.75% Only milk 3.75% Only wheat 2.5%40 (25%) patients were found to suffer from food hypersensitivity. These patients had increased levels of fecal eosinophil cationic protein and tryptase, indicating that they might cause inflammation in patients with IBS
Dainese et al[112], 1999128 IBS patientsSelf-reported intolerance questionnaires vs SPTMilk (28.8% vs 3%) Wheat (17.5% vs 1.5%) Pepper (2.5% vs 6%) Peanut (6.3% vs 6%) Pear (5% vs 7.5%) Tomato (12.5% vs 9%) Onion (3.8% vs 9%) Celery (2.5% vs 9%) Banana (2.5% vs 9%) Carrot (0% vs 10.5%) Garlic (0% vs 10.5%) Parsley (0% vs 16%) Walnut (6.3% vs 18%) Apple (10% vs 18%)More than 50% of IBS patients were found sensitized to some food or inhalant without any symptom. There is a substantial lack of correlation between self-perceived food intolerance and SPT sensitization
Locke et al[115], 200076 IBS patients of 643 subjects from Olmsted County general populationSelf-reported intolerance questionnairesBeans 22.3% Chocolate 23.6% Dairy products 52.6% Eggs 21.0% Nuts 23.6% Onions 57.8% Spicy food 81.5%Among the 643 subjects, IBS symptoms were reported by 12% (76). IBS was significantly associated with use of analgesics, food allergy or sensitivity
Farah et al[116], 198513 of 49 patients suspected of food intolerance after elimination dietDBPCFC1/13 peas 1/13 coffee 1/13 eggsAfter DBPCFC 3 patients were confirmed to suffer from food intolerance. Authors found that 10 patients reacted to placebo, suggesting a psychogenic cause for their disturbances
Carlson et al[121], 201425 children suffering from gastrointestinal disorders and their parentsChild-reported intolerance questionnaires vs parent- reported intolerance questionnairesSpicy food 68% vs 60% Pizza 52% vs 48% Cow’s milk 56% vs 48% Fired foods 48% vs 36% Fast Foods 40% vs 40% Sodas 40% vs 36% Cheese 40% vs 36%Specific foods are perceived to exacerbate gastrointestinal symptoms in children with functional gastrointestinal disorders. No differences were found in severity or frequency of symptoms with ingestion of the foods between children and parents with respect to the 10 most frequent foods/food types
Böhn et al[126], 2013197 IBS patientsSelf-reported intolerance questionnairesDairy products 49.2% Beans 36.0% Apple 27.9% Wheat 24.4% Fried foods 52.3% Plum 23.4% Peas 19.3% Chocolate 16.8% Foods rich in biogenic amines (58%) Histamine-releasing foods (43%)Most IBS patients believe that certain foods could be triggers of their symptoms. They identified FODMAP containing foods, histamine-releasing foods, fried foods and foods rich in biogenic amines as the main culprits. Self-reported food intolerance seems to be associated with high symptom burden and reduced quality of life
Monsbakken et al[127], 200684 IBS patientsSelf-reported intolerance questionnairesMilk 41.7%70% of subjects perceived a food intolerance (mean 4.8 food items related to symptoms), 62% limited or excluded food items from their daily intake (mean 2.5 food items reduced or eliminated), and 12% made drastic changes in their diet potentially causing nutritional deficiencies in the long run
Cheese 14.3%
Eggs 11.9%
Peas 21.4%
Onions 35.7%
Cabbage 34.5%
Wheat 14.3%
Coffee 26.2%
Chocolate 25.0% Beer 16.9%
Parker et al[130], 2001122 IBS patientsLHBT, lactose elimination diet and DBPCFC (with 5/10/15 g of lactose)33/122 (27%) positive to LHBT 9/33 (27.7%) improved on lactose elimination diet 5/9 (55.5%) worsened on DBPCFC with 15 g of lactoseLactose intolerance was demonstrated in IBS patients with positive (33/122) or negative (13/122) LHBT. DBPCC were inconclusive
Yang et al[131], 201360 IBS patients vs 60 controlsLHBT and self-reported lactose intolerance18% vs 3% with 10 g LHBT 47% vs 22% with 20 g LHBT 85% vs 68% with 40 g LHBT 63% vs 22% with self- reported intoleranceThe risk of lactose intolerance is related to the dose ingested and is higher in IBS patients than in controls. Self-reported intolerance is associated with avoidance of dairy products
Dainese et al[132], 201451 IBS patientsLHBT (50 g) and self-reported lactose intolerance21/51 (41.1%) self-perceived lactose intolerance 24/51 (47%) positive LHBT 14/51 (27.4%) reported symptoms during LHBTPatients who experienced symptoms during LHBT had more severe IBS symptoms and higher anxiety, depression, and fatigue scores. Increase in hydrogen production and in the severity of IBS influenced the symptoms of lactose intolerance during LHBT
Carroccio et al[145], 201024/120 IBS patients who underwent DPBCFC after elimination dietDBPCFC and flow-CAST12.5% cow milk only on DBPCFC 8.3% wheat only on DBPCFC 79.1% both cow milk and wheat on DBPCFC 86.3% cow milk on Flow-CAST 85.7% wheat on Flow-CASTFlow-CAST had higher sensitivity than serum total IgE and serum food-specific IgE, both in the diagnosis of cow’s milk allergy and wheat protein allergy. Flow-CAST diagnostic accuracy proved higher than the two traditional techniques both for cow’s milk allergy and for wheat protein allergy diagnoses