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Hammer K, Memaran N, Huber WD, Hammer J. Comparative analysis of hydrogen breath test devices for the diagnosis of carbohydrate malabsorption: fructose tests lack reliability. Eur J Gastroenterol Hepatol 2025; 37:733-737. [PMID: 40359280 DOI: 10.1097/meg.0000000000002976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Abstract
INTRODUCTION Hydrogen breath tests are commonly used to diagnose lactose and fructose malabsorption. While lactose breath tests are reliable, the utility of fructose tests is debated due to inconsistent results. This study aimed to compare the performance of two hydrogen breath test devices - handheld and stationary - in diagnosing lactose and fructose malabsorption in paediatric patients. METHODS Seventy-eight lactose and 53 fructose breath tests were performed in children (mean age: 11.4 ± 3.1 years) using both a handheld electrochemical detector and a stationary gas chromatograph. Malabsorption was defined as a rise in hydrogen ≥20 ppm over baseline. Device performance was compared using Pearson correlation, McNemar's test, and Bland-Altman analysis. RESULTS For lactose, 28 (35.9%) tested positive with the handheld device and 31 (39.7%) with the stationary device, showing 93.6% agreement ( P = 0.38). For fructose, 16 (30.2%) tested positive with the handheld device and 26 (49.1%) with the stationary device, with only 81.1% agreement ( P = 0.002). McNemar's test for marginal homogeneity suggested equivalence of the two instruments for the lactose breath tests ( P = 0.38), but there was strong evidence of inequality between the two instruments for the fructose breath tests ( P = 0.002). Bland-Altman analysis showed a bias toward higher hydrogen levels with the stationary device, especially in fructose tests. CONCLUSION Lactose breath tests were reliable across both devices, but significant discrepancies in fructose testing, particularly higher hydrogen levels with the stationary device, raise concerns about the diagnostic reliability of fructose tests. These findings suggest the need for caution when using fructose breath tests in clinical practice.
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Affiliation(s)
| | - Nima Memaran
- Klinische Abteilung für Pädiatrische Nephrologie und Gastroenterologie, Universitätsklinik für Kinder- und Jugendheilkunde
| | - Wolf-Dietrich Huber
- Klinische Abteilung für Pädiatrische Nephrologie und Gastroenterologie, Universitätsklinik für Kinder- und Jugendheilkunde
| | - Johann Hammer
- Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin 3, Medical University of Vienna, Vienna, Austria
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Memel ZN, Shah ND, Beck KR. Diet, nutraceuticals, and lifestyle interventions for the treatment and management of irritable bowel syndrome. Nutr Clin Pract 2025. [PMID: 40346863 DOI: 10.1002/ncp.11307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 03/26/2025] [Accepted: 04/06/2025] [Indexed: 05/12/2025] Open
Abstract
Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) disorder of the gut-brain interaction and causes significant GI distress. The etiology of IBS is multifactorial, with food intolerances being a frequent contributing factor to IBS symptoms. Diet and lifestyle interventions are key components in comprehensive IBS care. In this review, we examine the current evidence-based dietary approaches for treating IBS. The low-FODMAP diet has the most robust data for improving overall symptom burden. In conjunction with guidance from a registered dietitian, certain patients may benefit from targeted dietary elimination of specific carbohydrates such as lactose or fructose or gluten. Among the nutraceuticals used to treat IBS, peppermint oil has sufficient evidence and appropriate safety data to recommend adjunctive use to reduce IBS symptoms. Although prebiotic and probiotic food sources may be beneficial to the microbiome, there is not enough evidence to support the routine use of prebiotic or probiotic supplements. Given the complexity of IBS, a holistic approach in which clinicians address a patients' diet, culture, sleep hygiene, exercise habits, and mental health may improve patients' overall quality of life.
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Affiliation(s)
- Zoe N Memel
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - Neha D Shah
- Colitis and Crohn's Disease Center, University of California, San Francisco, California, USA
| | - Kendall R Beck
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
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Narayana V, Chang J, McMeans AR, Murphy T, Levy RL, Shulman RJ, Chumpitazi BP. Characterizing fermentable carbohydrate foods in the diets of children with abdominal pain-related disorders of gut-brain interaction and healthy children. PLoS One 2025; 20:e0311589. [PMID: 40333954 PMCID: PMC12057903 DOI: 10.1371/journal.pone.0311589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 01/13/2025] [Indexed: 05/09/2025] Open
Abstract
OBJECTIVES Restricting dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can alleviate symptoms in children with disorders of gut-brain interaction (DGBI). Due to the restrictions of a low FODMAP diet (LFD), a less restrictive FODMAP Gentle diet (FGD) has been suggested. However, the types and amounts of high FODMAP foods and carbohydrates commonly consumed by children have not been studied. We aimed to identify the high FODMAP foods and proportions of FODMAP carbohydrates consumed by children with DGBI and healthy children (HC) and to determine which usually ingested FODMAPs would be restricted on the FGD. METHODS Three-day diet records from both children with DGBI and HC were analyzed and compared to assess the type and amount of high FODMAP foods and carbohydrates ingested. Additionally, the ingested FODMAPs that would be restricted on the FGD were determined. RESULTS Diet records from 77 children with DGBI and 64 HC were analyzed. The number of foods ingested daily was similar between children with DGBI and HC (12.3 ± 4.2 vs 12.9 ± 3.4, respectively); high FODMAP foods comprised most foods eaten in both groups. Children with DGBI (vs. HC) ate fewer high FODMAP foods per day (6.5 ± 2.3 vs 8.7 ± 2.4, P < 0.0001, respectively). Fructans were the most consumed FODMAP carbohydrate in both groups, and children with DGBI (vs. HC) consumed fewer fructans, lactose, fructose, and polyols (all P < 0.0001). The top 3 food categories consumed in both groups were wheat-containing foods, dairy, and fruits/ 100% fruit juices. In children with DGBI, 80.9% of the high FODMAP foods consumed would be limited on the FGD. CONCLUSIONS Children with DGBI consume fewer high FODMAP foods and carbohydrates than HC, with the top consumed FODMAP carbohydrates being fructans, lactose, and fructose. A FGD would restrict most high FODMAP foods consumed by children with DGBI.
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Affiliation(s)
- Vishnu Narayana
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jocelyn Chang
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Children’s Nutrition Research Center, Houston, Texas, United States of America
| | - Ann R. McMeans
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Children’s Nutrition Research Center, Houston, Texas, United States of America
| | - Tasha Murphy
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Rona L. Levy
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Children’s Nutrition Research Center, Houston, Texas, United States of America
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
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Mikhael-Moussa H, Desprez C, Gillibert A, Leroi AM, Mion F, Gourcerol G, Melchior C. Is Carbohydrate Intolerance Associated With Carbohydrate Malabsorption in Disorders of Gut-Brain Interaction? Am J Gastroenterol 2025:00000434-990000000-01690. [PMID: 40197400 DOI: 10.14309/ajg.0000000000003483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/01/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION We aimed to explore the prevalence of carbohydrate (lactose and fructose) intolerance in patients with disorders of gut-brain interaction (DGBI) and to characterize those patients regarding gastrointestinal and nongastrointestinal symptoms. METHODS Patients with DGBI who were referred to the physiology unit of our hospital between May 2022 and December 2023 for lactose (25 g) and fructose (25 g) breath tests were prospectively included. Patients were required to have a negative glucose breath test, before lactose and fructose breath tests, and to have completed the adult carbohydrate perception questionnaire during each breath test. Intolerance was defined as an increase of ≥20 mm in the Visual Analog Scale score from baseline in at least 1 of the 5 symptoms (pain, nausea, bloating, flatulence, and diarrhea) assessed with the adult Carbohydrate Perception Questionnaire. RESULTS Among the 301 patients with DGBI included in our analysis, 178 (59.1%) had carbohydrate intolerance. Carbohydrate-intolerant patients were significantly more likely to be female ( P value < 0.001), to have 2 or more DGBI ( P value = 0.001), to have lactose maldigestion ( P value< 0.001) and fructose malabsorption ( P value = 0.023), higher irritable bowel syndrome and somatic symptom severity, and lower quality of life ( P value < 0.001) compared with patients without carbohydrate intolerance. The binary logistic regression showed that lactose maldigestion ( P value = 0.001), as well as somatic symptoms ( P value = 0.025), were independently associated with carbohydrate intolerance (Nagelkerke R Square = 0.206). DISCUSSION Carbohydrate intolerance affects a substantial group of patients with DGBI, affecting their quality of life and symptom severity. Further research is needed to explore the underlying mechanisms in patients who do not have carbohydrate malabsorption/maldigestion.
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Affiliation(s)
- Hiba Mikhael-Moussa
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen, France
| | - Charlotte Desprez
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen, France
- Department of Physiology, CIC-CRB 1404, CHU Rouen, Rouen, France
| | | | - Anne-Marie Leroi
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen, France
- Department of Physiology, CIC-CRB 1404, CHU Rouen, Rouen, France
| | - François Mion
- Hospices Civils de Lyon, Université Lyon 1, Digestive Physiology Department, Hôpital Edouard-Herriot, Lyon, France
| | - Guillaume Gourcerol
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen, France
- Department of Physiology, CIC-CRB 1404, CHU Rouen, Rouen, France
| | - Chloé Melchior
- Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen, France
- Department of Gastroenterology, CIC-CRB 1404, CHU Rouen, Rouen, France
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Cash BD, Patel D, Scarlata K. Demystifying Carbohydrate Maldigestion: A Clinical Review. Am J Gastroenterol 2025; 120:1-11. [PMID: 40249016 DOI: 10.14309/ajg.0000000000003374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 02/07/2025] [Indexed: 04/19/2025]
Abstract
Carbohydrate intolerance is a poorly understood and potentially overlooked cause of unexplained gastrointestinal symptoms, particularly among patients with disorders of gut-brain interaction. Symptoms related to carbohydrate intolerance arise from bacterial fermentation of unabsorbed carbohydrates leading to increased gases and osmotic load within the gastrointestinal tract. This mechanism is shared across various carbohydrates, including lactose, sucrose, maltose, fructose, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Primary forms of carbohydrate maldigestion typically affect one specific type of carbohydrate and result from inherited defects in specific brush-border enzymes or transport mechanisms, whereas secondary, or acquired, forms of carbohydrate maldigestion can arise from conditions that affect the structural integrity or function of the pancreas and small intestine. Although confirmation of a disaccharidase deficiency does not imply clinical relevance, obtaining a careful patient history with appropriate use of breath testing, duodenal disaccharidase assay, and response to dietary modification can help identify patients whose symptoms are associated with carbohydrate maldigestion and who may benefit from treatment. Dietary modification remains the cornerstone of therapy for patients with carbohydrate intolerance and should focus on determining the most liberal diet for patients that allows symptom control. Given the complexity and time-consuming nature of this process, clinicians are encouraged to engage the help of dietitians with expertise in the treatment of disorders of gut-brain interaction where available. Enzyme replacement therapy can also be an important adjunct to dietary management, with sacrosidase improving symptoms in sucrase-isomaltase deficiency and helping patients to liberalize their diet.
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Affiliation(s)
- Brooks D Cash
- Gastroenterology, Hepatology, and Nutrition, UT Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Daksesh Patel
- Illinois Gastroenterology Group, Chicago, Illinois, USA
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Jung DH, Nam GM, Lee CK, Kim CH, Lim HS, Lee JY, Lim HS. Changes in Nutritional Status Through Low-Lactose Processed Milk Consumption in Korean Adults With Lactose Intolerance. Clin Nutr Res 2025; 14:30-40. [PMID: 39968275 PMCID: PMC11832292 DOI: 10.7762/cnr.2025.14.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/12/2025] [Accepted: 01/20/2025] [Indexed: 02/20/2025] Open
Abstract
This study was conducted to evaluate changes in hydrogen breath test results and nutritional improvements when Korean adults diagnosed with lactose intolerance consumed processed milk containing approximately 10 g of lactose continuously. Participants consumed 240 mL of intervention food daily for a month and visited the research institute before and after the intervention to undergo nutrient intake survey and hydrogen breath tests. Data from 32 participants, with a mean age of 52.9 years, were analyzed. Hydrogen breath tests showed a significant decrease in hydrogen levels at all but baseline and the first of five 20-minute intervals of expiratory hydrogen concentration measurements. The third and fourth measurements showed the most significant changes (p < 0.001). The gastrointestinal symptoms showed a decreasing trend. Nutrient intake analysis demonstrated significant increases in animal protein (p < 0.001), calcium (p < 0.001), percentage of energy from protein (p = 0.032), vitamin A (p = 0.032), and retinol levels (p = 0.023). Regarding dietary habits, significant improvements were observed in nutritional quotient variables, including nutritional score (p = 0.042) and balance (p = 0.034). This study suggests that the removal of lactose and dairy products is not necessary for individuals with lactose intolerance. Incorporating low-lactose processed milk into their usual diet might be a practical dietary management strategy.
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Affiliation(s)
- Dong Hoon Jung
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
| | - Gi Moon Nam
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
| | - Chang Kyun Lee
- Center for Crohn’s and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul 02447, Korea
| | - Chul hong Kim
- Food Research Center, Binggrae Co., Ltd, Namyangju 12253, Korea
| | - Hyun-San Lim
- Food Research Center, Binggrae Co., Ltd, Namyangju 12253, Korea
| | - Ji Yeon Lee
- Food Research Center, Binggrae Co., Ltd, Namyangju 12253, Korea
| | - Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
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Balsiger LM, Houben E, Vanuytsel T, van Ranst M, Tack J, Verbeke K. Added Value of 13C Analysis in Breath Tests in H 2-Negative Subjects to Diagnose Lactose Malabsorption: A Proof of Concept Study. Dig Dis Sci 2024; 69:2147-2153. [PMID: 38499733 PMCID: PMC7616739 DOI: 10.1007/s10620-024-08304-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/13/2023] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Diagnosing lactose malabsorption is usually based on hydrogen excretion in breath after a lactose challenge. However, a proportion of subjects with lactose malabsorption will not present a rise in hydrogen. Measuring excretion of methane or stable isotope labeled 13CO2 after ingestion of 13C-lactose has been proposed to mitigate this problem. OBJECTIVE The aim of the study was to assess the performance of measuring methane and 13CO2 in individuals with normal hydrogen excretion compared to a genetic lactase non-persistence test. METHODS Individuals referred for lactose breath testing and healthy controls were included. Participants received 13C-enriched lactose, performed breath testing, and underwent genotyping for a marker of lactase non-persistence (13910C*T). Using genotype as gold standard, the performance of measuring methane and 13CO2 excretion was assessed. RESULTS 151 subjects participated in the study, 50 of which presented a lactase non-persistent genotype. Of these, 72% were correctly diagnosed through hydrogen excretion of ≥ 20 ppm above baseline. In subjects with normal hydrogen excretion, cumulative 13C excretion had an area under the curve (AUC) of the receiver operating characteristics (ROC) curve of 0.852. Sensitivity was 93% and specificity was 51% for the current cutoff of 14.5%. The optimal cutoff was 12.65% (sensitivity 93%, specificity 70%). The ROC curve of peak methane had an AUC of 0.542 (sensitivity of 14%, specificity of 91% for cutoff ≥ 10 ppm). CONCLUSIONS In individuals with genetically demonstrated lactase non-persistence and negative hydrogen breath test, the use of 13C-lactose with measurement of 13CO2 excretion and hydrogen is a well-performing test to detect the lactose malabsorption and performs better than methane in our cohort.
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Affiliation(s)
- Lukas Michaja Balsiger
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Els Houben
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Laboratory Medicine Cosis, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc van Ranst
- Department of Laboratory Medicine Cosis, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Liao KF, Tsai HY, Chen CF, Hsu TF, Hsu CY, Ho TK, Liu DH, Kao CL, Wang CY, Hsieh AR. Body constitutions of traditional Chinese medicine caused a significant effect on irritable bowel syndrome. J Chin Med Assoc 2024; 87:558-566. [PMID: 38451103 DOI: 10.1097/jcma.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND According to the theory of traditional Chinese medicine (TCM), all types of body constitutions, except for the Gentleness (ie, the control group in our study), have disease susceptibility and affect the disease development process. This study attempted to investigate the relationship between TCM body constitutions and irritable bowel syndrome (IBS). METHODS This cross-sectional study was based on Taiwan Biobank (TWB) and collected clinical data from 13 941 subjects aged 30 to 70. The results of the study showed that subjects with Yang-deficiency (N = 3161 subjects, odds ratio [OR] = 2.654, 95% CI = 1.740-3.910), Ying-deficiency (N = 3331 subjects, OR = 1.096, 95% CI = 0.627-1.782) or Stasis (N = 2335 subjects, OR = 1.680, 95% CI = 0.654-3.520) were more likely to have IBS. RESULTS If the subjects with two or more TCM body constitutions: Yang-deficiency + Ying-deficiency (OR = 3.948, 95% CI = 2.742-5.560), Yang-deficiency + Stasis (OR = 2.312, 95% CI = 1.170-4.112), Ying-deficiency + Stasis (OR = 1.851, 95% CI = 0.828-3.567), or Yang-deficiency + Ying-deficiency + Stasis (OR = 3.826, 95% CI = 2.954-4.932) were also prone to IBS. CONCLUSION These results confirmed the high correlation between TCM body constitutions and IBS. Because the current treatment for IBS is not entirely satisfactory, integrated traditional Chinese and Western medicine might provide patients with an alternative treatment option to alleviate IBS.
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Affiliation(s)
- Kuo-Fan Liao
- Department of Traditional Chinese Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Han-Ying Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan, ROC
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Teh-Fu Hsu
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Yi Hsu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ta-Kai Ho
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ding-Hao Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-Ying Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Trauma, Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan, ROC
| | - Ai-Ru Hsieh
- Department of Statistics, Tamkang University, New Taipei City, Taiwan, ROC
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Wang Y, Ma W, Mehta R, Nguyen LH, Song M, Drew DA, Asnicar F, Huttenhower C, Segata N, Wolf J, Spector T, Berry S, Staller K, Chan AT. Diet and gut microbial associations in irritable bowel syndrome according to disease subtype. Gut Microbes 2023; 15:2262130. [PMID: 37786251 PMCID: PMC10549191 DOI: 10.1080/19490976.2023.2262130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
The role of diet and the gut microbiome in the etiopathogenesis of irritable bowel syndrome (IBS) is not fully understood. Therefore, we investigated the interplay between dietary risk factors and gut microbiota in IBS subtypes using a food frequency questionnaire and stool metagenome data from 969 participants aged 18-65 years in the ZOE PREDICT 1 study, an intervention study designed to predict postprandial metabolic responses. We identified individuals with IBS subtype according to the Rome III criteria based on predominant bowel habits during symptom onset: diarrhea (i.e. looser), constipation (i.e. harder), and mixed. Participants with IBS-D (n = 59) consumed more healthy plant-based foods (e.g. whole grains, leafy vegetables) and fiber, while those with IBS-C (n = 49) tended to consume more unhealthy plant-based foods (e.g. refined grains, fruit juice) than participants without IBS (n = 797). Microbial diversity was nominally lower in patients with IBS-D than in participants without IBS or with IBS-C. Using multivariable-adjusted linear regression, we identified specific microbiota variations in IBS subtypes, including slight increases in pro-inflammatory taxa in IBS-C (e.g. Escherichia coli) and loss of strict anaerobes in IBS-D (e.g. Faecalibacterium prausnitzii). Our analysis also revealed intriguing evidence of interactions between diet and Faecalibacterium prausnitzii. The positive associations between fiber and iron intake and IBS-diarrhea were stronger among individuals with a higher relative abundance of Faecalibacterium prausnitzii, potentially driven by carbohydrate metabolic pathways, including the superpathway of β-D-glucuronide and D-glucuronate degradation. In conclusion, our findings suggest subtype-specific variations in dietary habits, gut microbial composition and function, and diet-microbiota interactions in IBS, providing insights into potential microbiome-informed dietary interventions.
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Affiliation(s)
- Yiqing Wang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raaj Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H. Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - David A. Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Francesco Asnicar
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nicola Segata
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
- European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare, Milan, Italy
| | | | - Tim Spector
- Department of Twin Research, King’s College London, London, UK
| | - Sarah Berry
- Department of Nutritional Sciences, King’s College London, London, UK
| | - Kyle Staller
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
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10
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Zingone F, Bertin L, Maniero D, Palo M, Lorenzon G, Barberio B, Ciacci C, Savarino EV. Myths and Facts about Food Intolerance: A Narrative Review. Nutrients 2023; 15:4969. [PMID: 38068827 PMCID: PMC10708184 DOI: 10.3390/nu15234969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Most adverse reactions to food are patient self-reported and not based on validated tests but nevertheless lead to dietary restrictions, with patients believing that these restrictions will improve their symptoms and quality of life. We aimed to clarify the myths and reality of common food intolerances, giving clinicians a guide on diagnosing and treating these cases. We performed a narrative review of the latest evidence on the widespread food intolerances reported by our patients, giving indications on the clinical presentations, possible tests, and dietary suggestions, and underlining the myths and reality. While lactose intolerance and hereditary fructose intolerance are based on well-defined mechanisms and have validated diagnostic tests, non-coeliac gluten sensitivity and fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intolerance are mainly based on patients' reports. Others, like non-hereditary fructose, sorbitol, and histamine intolerance, still need more evidence and often cause unnecessary dietary restrictions. Finally, the main outcome of the present review is that the medical community should work to reduce the spread of unvalidated tests, the leading cause of the problematic management of our patients.
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Affiliation(s)
- Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Luisa Bertin
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Daria Maniero
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Michela Palo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Brigida Barberio
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Salerno, Italy;
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
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11
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Teichenné J, Catalán Ú, Mariné-Casadó R, Domenech-Coca C, Mas-Capdevila A, Alcaide-Hidalgo JM, Chomiciute G, Rodríguez-García A, Hernández A, Gutierrez V, Puiggròs F, Del Bas JM, Caimari A. Bacillus coagulans GBI-30, 6086 (BC30) improves lactose digestion in rats exposed to a high-lactose meal. Eur J Nutr 2023; 62:2649-2659. [PMID: 37249602 DOI: 10.1007/s00394-023-03183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Bacillus coagulans GBI-30, 6086 (BC30) was previously shown to improve nutrient digestibility and amino acid absorption from milk protein in vitro. However, the effect of supplementation with this probiotic on lactose digestibility has not yet been evaluated in vivo. METHODS Wistar female rats were exposed to an acute high-lactose diet (LD; 35% lactose) meal challenge after 7 days of administration of BC30 (LD-BC; n = 10) or vehicle (LD-C; n = 10). Rats treated with vehicle and exposed to control diet (CD; 35% corn starch) meal were used as controls (CD-C; n = 10). Carbohydrate oxidation (CH_OX) and lipid oxidation (L_OX) were monitored by indirect calorimetry before and after lactose challenge. After the challenge, rats were treated daily with vehicle or probiotic for an additional week and were fed with CD or LD ad libitum to determine the effects of BC30 administration in a lactose-induced diarrhoea and malnutrition model. RESULTS LD-C rats showed lower CH_OX levels than CD rats, while LD-BC rats showed similar CH_OX levels compared to CD rats during the lactose challenge, suggesting a better digestion of lactose in the rats supplemented with BC30. BC30 completely reversed the increase in the small intestine length of LD-C animals. LD-BC rats displayed increased intestinal mRNA Muc2 expression. No significant changes were observed due to BC30 administration in other parameters, such as serum calprotectin, intestinal MPO activity, intestinal A1AT and SGLT1 levels or intestinal mRNA levels of Claudin2 and Occludin. CONCLUSION Treatment with BC30 improved the digestibility of lactose in an acute lactose challenge and ameliorated some of the parameters associated with lactose-induced malnutrition.
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Affiliation(s)
- Joan Teichenné
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain.
| | - Úrsula Catalán
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Roger Mariné-Casadó
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | - Cristina Domenech-Coca
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | - Anna Mas-Capdevila
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | - Juan María Alcaide-Hidalgo
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | - Gertruda Chomiciute
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | | | - Ana Hernández
- Delafruit SLU, 43470, La Selva del Camp, Catalonia, Spain
| | | | - Francesc Puiggròs
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
| | - Josep M Del Bas
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain.
| | - Antoni Caimari
- Eurecat, Centre Tecnològic de Catalunya, Technological Unit of Nutrition and Health, Avinguda Universitat 1, 43204, Reus, Catalonia, Spain
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12
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Chakraborty PS, Daniel R, Navarro FA. Non-pharmacologic approaches to treatment of pediatric functional abdominal pain disorders. Front Pediatr 2023; 11:1118874. [PMID: 37397151 PMCID: PMC10311071 DOI: 10.3389/fped.2023.1118874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/24/2023] [Indexed: 07/04/2023] Open
Abstract
Functional abdominal pain disorders (FAPDs) affect up to 25% of children in the United States. These disorders are more recently known as disorders of "brain-gut" interaction. The diagnosis is based on the ROME IV criteria, and requires the absence of an organic condition to explain the symptoms. Although these disorders are not completely understood, several factors have been involved in the pathophysiology including disordered gut motility, visceral hypersensitivity, allergies, anxiety/stress, gastrointestinal infection/inflammation, as well dysbiosis of the gut microbiome. The pharmacologic and non-pharmacologic treatments for FAPDs are directed to modifying these pathophysiologic mechanisms. This review aims to summarize the non-pharmacologic interventions used in the treatment of FAPDs including dietary modifications, manipulation of the gut microbiome (neutraceuticals, prebiotics, probiotics, synbiotics and fecal microbiota transplant) and psychological interventions that addresses the "brain" component of the brain-gut axis (cognitive behavioral therapy, hypnotherapy, breathing and relaxation techniques). In a survey conducted at a large academic pediatric gastroenterology center, 96% of patients with functional pain disorders reported using at least 1 complementary and alternative medicine treatment to ameliorate symptoms. The paucity of data supporting most of the therapies discussed in this review underscores the need for large randomized controlled trials to assess their efficacy and superiority compared to other treatments.
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13
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Gaudin RGN, Figueiro G, Flores-Gutiérrez S, Mut P, Vega-Requena Y, Luna-Andrada L, Ackermann E, Hidalgo PC, Carracedo A, Torres M, Sans M. DNA polymorphisms associated with lactase persistence, self-perceived symptoms of lactose intolerance, milk and dairy consumption, and ancestry, in the Uruguayan population. Am J Hum Biol 2023; 35:e23868. [PMID: 36695417 DOI: 10.1002/ajhb.23868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Uruguay has one of the highest per capita milk intakes worldwide, even with a limited supply of lactose-free products; furthermore, the admixed nature of its population is well known, and various frequencies of lactase persistence (LP) are observed in the source populations. We aimed to contribute to the understanding of the relation between allelic variants associated with LP, milk consumption, digestive symptoms, and genetic ancestry in the Uruguayan population. Samples of saliva or peripheral blood were collected from 190 unrelated individuals from two regions of Uruguay, genotypes for polymorphic sites in a fragment within the LCT enhancer were determined and allelic frequencies calculated in all of them. Data were collected on frequency of milk and dairy consumption and self-reported symptoms in a subsample of 153 individuals. Biparental and maternal ancestry was determined by analyzing individual ancestry markers and mitochondrial DNA. Twenty-nine percentage of individuals reported symptoms attributed to the ingestion of fresh milk, with abdominal pain, bloating and flatulence being the most frequent. European LP-associated allele T-13910 showed a frequency of 33%, while other LP-associated alleles like G-13915 and T-14011 were observed in very low frequencies. Associations between self-reported symptoms, fresh milk intake, and C/T-13910 genotype were statistically significant. No evidence of association between genetic ancestry and C/T-13910 was found, although individuals carrying one T-13910 allele appeared to have more European ancestry. In conclusion, the main polymorphism capable of predicting lactose intolerance in Uruguayans is C/T-13910, although more studies are required to unravel the relation between genotype and lactase activity, especially in heterozygotes.
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Affiliation(s)
- Raúl Germán Negro Gaudin
- Departamento de Antropología Biológica, Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Montevideo, Uruguay
| | - Gonzalo Figueiro
- Departamento de Antropología Biológica, Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Montevideo, Uruguay
| | - Sara Flores-Gutiérrez
- Departamento de Antropología Biológica, Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Montevideo, Uruguay
| | - Patricia Mut
- Departamento de Antropología Biológica, Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Montevideo, Uruguay
| | - Yasser Vega-Requena
- Polo de Desarrollo Universitario Diversidad Genética Humana, Centro Universitario Regional Noreste, Tacuarembó, Universidad de la República, Montevideo, Uruguay
| | - Lorena Luna-Andrada
- Polo de Desarrollo Universitario Diversidad Genética Humana, Centro Universitario Regional Noreste, Tacuarembó, Universidad de la República, Montevideo, Uruguay
| | - Elizabeth Ackermann
- Polo de Desarrollo Universitario Diversidad Genética Humana, Centro Universitario Regional Noreste, Tacuarembó, Universidad de la República, Montevideo, Uruguay
| | - Pedro C Hidalgo
- Polo de Desarrollo Universitario Diversidad Genética Humana, Centro Universitario Regional Noreste, Tacuarembó, Universidad de la República, Montevideo, Uruguay
| | - Angel Carracedo
- Grupo de Medicina Xenómica, Centro en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica (SERGAS)-CIBERER, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Torres
- Fundación Pública Galega de Medicina Xenómica (SERGAS)-CIBERER, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Sans
- Departamento de Antropología Biológica, Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, Montevideo, Uruguay
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Strategies for Producing Low FODMAPs Foodstuffs: Challenges and Perspectives. Foods 2023; 12:foods12040856. [PMID: 36832931 PMCID: PMC9956220 DOI: 10.3390/foods12040856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
In recent years, there has been a growing interest in a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) as a promising therapeutic approach to reduce the symptoms associated with irritable bowel syndrome (IBS). Hence, the development of low FODMAPs products is an important challenge for the food industry, and among the various foodstuffs associated with the intake of FODMAPs, cereal-based products represent an issue. In fact, even if their content in FODMAPs is limited, their large use in diet can be an important factor in developing IBS symptoms. Several useful approaches have been developed to reduce the FODMAPs content in processed food products. Accurate ingredient selection, the use of enzymes or selected yeasts, and the use of fermentation steps carried out by specific lactic bacteria associated with the use of sourdough represent the technical approaches that have been investigated, alone or in combination, to reduce the FODMAPs content in cereal-based products. This review aims to give an overview of the technological and biotechnological strategies applicable to the formulation of low-FODMAPs products, specifically formulated for consumers affected by IBS. In particular, bread has been the foodstuff mainly investigated throughout the years, but information on other raw or processed products has also been reported. Furthermore, taking into account the required holistic approach for IBS symptoms management, in this review, the use of bioactive compounds that have a positive impact on reducing IBS symptoms as added ingredients in low-FODMAPs products is also discussed.
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15
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Oh CH, Kim JW, Park YM, Kim GA, Jang JY, Chang YW, Yang JO, Kho HY, Park JK. Benefits of Flavored Lactose-Free Milk for Korean Adults with Lactose Intolerance. J Med Food 2022; 25:1003-1010. [PMID: 36179067 DOI: 10.1089/jmf.2022.k.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although lactose-free dairy products for the clinical management of lactose intolerance (LI) are widely available, scientific evidence on their efficacy is still lacking. This study comparatively analyzed the efficacy of flavored lactose-free milk (LFM) and whole milk (WM) in reducing symptoms in South Korean adults with LI. This prospective study was conducted in adults suspected of LI. All screened participants underwent the hydrogen breath test (HBT) using 570 mL of chocolate-flavored WM (20 g of lactose) and responded to a symptom questionnaire. LI was confirmed when the ΔH2 peak exceeded 16 ppm above baseline values and with the occurrence of symptoms after WM consumption. The participants who were diagnosed with LI underwent the HBT again with 570 mL of chocolate-flavored LFM (0 g of lactose), followed by the symptom questionnaire survey after 1 week. After excluding 40 participants who did not meet the diagnostic criteria for LI and 2 who were lost to follow-up, a total of 28 lactose-intolerant individuals were enrolled in the study. The ΔH2 values in the first HBT were significantly higher than those in the second HBT (33.3 ± 21.6 ppm vs. 8.6 ± 6.3 ppm, P < .001). Similarly, there was a significant reduction in the total symptom score in the second HBT (4.18 ± 1.51 vs. 0.61 ± 0.98, P < .001). Flavored LFM is well tolerated in South Korean adults diagnosed with LI based on the HBT and symptom questionnaire results. Therefore, LFM may be a viable alternative to WM.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yoo Min Park
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Gi-Ae Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Woon Chang
- Department of Internal Medicine, Cheonan-Woori Hospital, Cheonan, Korea
| | - Jin Oh Yang
- Maeil Innovation Center, Maeil Dairies Co. Ltd., Pyeongtaek, Korea
| | - Ho Young Kho
- Maeil Innovation Center, Maeil Dairies Co. Ltd., Pyeongtaek, Korea
| | - Jun-Kyu Park
- Maeil Innovation Center, Maeil Dairies Co. Ltd., Pyeongtaek, Korea
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16
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Jansson-Knodell CL, White M, Lockett C, Xu H, Shin A. Associations of Food Intolerance with Irritable Bowel Syndrome, Psychological Symptoms, and Quality of Life. Clin Gastroenterol Hepatol 2022; 20:2121-2131.e3. [PMID: 34952206 PMCID: PMC9209586 DOI: 10.1016/j.cgh.2021.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The impact of different types of food intolerance on gastrointestinal symptoms and quality of life (QOL) is poorly understood. We aimed to investigate associations of food intolerance and type of intolerance with irritable bowel syndrome (IBS), health-related QOL, and psychological symptoms. METHODS We conducted an observational study of United States-based adults through an online survey. Demographics, culprit foods, symptoms, medical evaluation, Rome IV criteria for IBS, health-related QOL (Short-Form Health Survey 12), and anxiety and depression scores (Hospital Anxiety and Depression Scale) were collected in participants with self-reported food intolerance (lactose, non-lactose food, lactose plus food intolerance), and controls with no intolerance. Univariable associations of group with study endpoints were analyzed with the Kruskal-Wallis and Pearson χ2 or Fisher exact test. Multivariable comparisons were analyzed by logistic and linear regression. RESULTS A total of 197 patients with (59 lactose, 61 non-lactose food, 77 lactose plus food intolerance) and 273 patients without intolerance participated. Lactose, wheat, and eggs were the most common food triggers. Gas (54.2%), abdominal pain (40.2%), and diarrhea (37.3%) were frequently reported symptoms of food intolerance. Reactions caused 57.8% to eliminate the food. Rates of IBS, abnormal anxiety scores, and abnormal depression scores were highest in lactose plus food intolerance; Short-Form Health Survey 12 scores were lowest in lactose plus food intolerance. Multivariable analyses revealed all intolerance subgroups were more likely to have IBS than controls. CONCLUSIONS Food intolerance is associated with IBS, anxiety, depression, and decreased health-related QOL and frequently leads to food elimination. Adults with lactose and lactose plus food intolerance have higher rates of IBS, increased psychological symptoms, and poorer QOL.
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Affiliation(s)
- Claire L Jansson-Knodell
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mattie White
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Carolyn Lockett
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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17
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Bek S, Teo YN, Tan XH, Fan KHR, Siah KTH. Association between irritable bowel syndrome and micronutrients: A systematic review. J Gastroenterol Hepatol 2022; 37:1485-1497. [PMID: 35581170 DOI: 10.1111/jgh.15891] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms. METHODS Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends. RESULTS Twenty-six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non-IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients. CONCLUSION Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.
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Affiliation(s)
- Schin Bek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin-Hui Tan
- Department of Dietetics, National University Hospital, Singapore
| | - Kristie H R Fan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,FAST and Chronic Programmes, Alexandra Hospital, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
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18
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Van den Houte K, Bercik P, Simren M, Tack J, Vanner S. Mechanisms Underlying Food-Triggered Symptoms in Disorders of Gut-Brain Interactions. Am J Gastroenterol 2022; 117:937-946. [PMID: 35506862 PMCID: PMC9169752 DOI: 10.14309/ajg.0000000000001812] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/26/2022] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Karen Van den Houte
- Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium
| | - Premysl Bercik
- Department of Medicine, Farncombe Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Magnus Simren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Tack
- Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium
| | - Stephen Vanner
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
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19
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Fernández-Bañares F. Carbohydrate Maldigestion and Intolerance. Nutrients 2022; 14:1923. [PMID: 35565890 PMCID: PMC9099680 DOI: 10.3390/nu14091923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
This review summarizes dietary carbohydrate intolerance conditions and recent advances on the possible role of carbohydrate maldigestion and dietary outcomes in patients with functional bowel disease. When malabsorbed carbohydrates reach the colon, they are fermented by colonic bacteria, with the production of short-chain fatty acids and gas lowering colonic pH. The appearance of diarrhoea or symptoms of flatulence depends in part on the balance between the production and elimination of these fermentation products. Different studies have shown that there are no differences in the frequency of sugar malabsorption between patients with irritable bowel disease (IBS) and healthy controls; however, the severity of symptoms after a sugar challenge is higher in patients than in controls. A diet low in 'Fermentable, Oligo-Di- and Monosaccharides and Polyols' (FODMAPs) is an effective treatment for global symptoms and abdominal pain in IBS, but its implementation should be supervised by a trained dietitian. A 'bottom-up' approach to the low-FODMAP diet has been suggested to avoid an alteration of gut microbiota and nutritional status. Two approaches have been suggested in this regard: starting with only certain subgroups of the low-FODMAP diet based on dietary history or with a gluten-free diet.
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Affiliation(s)
- Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitary MútuaTerrassa, 08221 Terrassa, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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20
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Wu J, Masuy I, Biesiekierski JR, Fitzke HE, Parikh C, Schofield L, Shaikh H, Bhagwanani A, Aziz Q, Taylor SA, Tack J, Van Oudenhove L. Gut-brain axis dysfunction underlies FODMAP-induced symptom generation in irritable bowel syndrome. Aliment Pharmacol Ther 2022; 55:670-682. [PMID: 35166384 DOI: 10.1111/apt.16812] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND FODMAPs produce similar small bowel water and colonic gas in patients with irritable bowel syndrome (IBS) and healthy controls (HCs), despite IBS patients reporting increased gastrointestinal (GI) symptoms. AIM To unravel the mechanisms underlying FODMAP-induced symptom reporting, we investigated gut and brain responses to fructan administration in IBS patients and HC. METHODS This randomised, double-blind, cross-over study consisted of three visits where fructans (40 g/500 mL saline), glucose (40 g/500 mL saline) or saline (500 mL) were infused intragastrically during 1 h MR brain scanning; abdominal MRI was performed before, 1 h, and 2 h post-infusion. Symptoms were rated using validated scales. RESULTS In IBS (n = 13), fructans induced more cramps, pain, flatulence and nausea compared to glucose (P = 0.03, 0.001, 0.009 and <0.001 respectively), contrary to HC (n = 13) (all P > 0.14), with between-group differences for cramps and nausea (P = 0.004 and 0.023). Fructans increased small bowel motility and ascending colonic gas and volume equally in IBS and HC (between-group P > 0.25). The difference in colonic gas between fructans and saline covaried with differences in bloating and cramps in IBS (P = 0.008 and 0.035 respectively). Pain-related brain regions responded differentially to fructans in IBS compared to HC, including the cerebellum, supramarginal gyrus, anterior and midcingulate cortex, insula and thalamus (pFWE-corrected < 0.05); these brain responses covaried with symptom responses in IBS. CONCLUSIONS Fructans increase small bowel motility and colon gas and volume similarly in IBS patients and HC. Increased symptom responses to fructans in IBS covary with altered brain responses in pain-related regions, indicating that gut-brain axis dysregulation may drive FODMAP-induced symptom generation in IBS.
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Affiliation(s)
- Jie Wu
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Imke Masuy
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Jessica R Biesiekierski
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Dietetics, Nutrition & Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Heather E Fitzke
- The Wingate Institute for Neurogastroenterology, Queen Mary University London, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Chinar Parikh
- Medical School, University College London, London, UK
| | | | - Hafsa Shaikh
- Medical School, University College London, London, UK
| | | | - Qasim Aziz
- The Wingate Institute for Neurogastroenterology, Queen Mary University London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.,University College London Hospital, London, UK
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Lab, Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
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21
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Sterniste G, Hammer K, Memaran N, Huber WD, Hammer J. Significance of validated symptom assessment versus breath testing for malabsorption after lactose load in children. Eur J Gastroenterol Hepatol 2022; 34:274-280. [PMID: 35100175 DOI: 10.1097/meg.0000000000002283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Lactose malabsorption and lactose-induced symptoms are poorly correlated, as shown by breath tests and various symptom assessment methods. Validated assessment is the key to overcome the limitations of biased symptom measurements. We characterized lactose-induced symptoms with the population-specific, validated paediatric carbohydrate perception questionnaire (pCPQ) and their correlation with the history of symptoms (HoS). METHODS A total of 130 patients with functional gastrointestinal symptoms underwent a lactose hydrogen breath and tolerance test (LBTT) allowing for a diagnosis of malabsorption (M+) and lactose sensitivity (S+). HoS indicative of lactose-induced symptoms (abdominal pain, nausea, bloating, flatulence, diarrhoea) in the 4 weeks preceding the test was determined using a validated questionnaire. The pCPQ was used to score lactose-induced symptoms. MAIN RESULTS The LBTT revealed 41 children (31.5%) with lactose malabsorption (M+), 56 (43.1%) with lactose sensitivity (S+) and 24 (18.5%) were M+/S+. Sensitivity correlated with HoS (P < 0.001), regardless of whether malabsorption was detectable. Malabsorption status did not correlate with HoS (NS). The odds of lactose sensitivity significantly increased when abdominal pain [odds ratio (OR) 3.5, confidence interval (CI) 1.6-7.8], nausea (OR 2.3, CI, 1.1-4.9) and flatulence (OR 3.1, CI 1.4-6.8) were reported in the 4 weeks preceding the LBTT. Symptoms after the lactose load were similar for M+/S+ and M-/S+, except for flatulence, which was more frequent in malabsorbers (P < 0.01). CONCLUSION Our findings fit well with the emerging view of the important role of a validated symptom assessment after a lactose load. The determination of symptoms may be more relevant than malabsorption for the clinical outcomes of paediatric patients with lactose-related gastrointestinal symptoms.
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Affiliation(s)
- Georg Sterniste
- Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin 3
| | - Karin Hammer
- St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Wolf-Dietrich Huber
- Klinische Abteilung für Pädiatrische Nephrologie und Gastroenterologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medical University of Vienna, Vienna, Austria
| | - Johann Hammer
- Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin 3
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
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22
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Poon D, Law GR, Major G, Andreyev HJN. A systematic review and meta-analysis on the prevalence of non-malignant, organic gastrointestinal disorders misdiagnosed as irritable bowel syndrome. Sci Rep 2022; 12:1949. [PMID: 35121775 PMCID: PMC8817019 DOI: 10.1038/s41598-022-05933-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022] Open
Abstract
Treatable gastrointestinal disorders in patients with symptoms typical for irritable bowel syndrome (IBS) may be overlooked. The prevalence of five gastrointestinal conditions-bile acid diarrhoea (BAD), carbohydrate malabsorption (CM), microscopic colitis (MC), pancreatic exocrine insufficiency (PEI) and small intestinal bacterial overgrowth (SIBO) was systematically assessed from studies including consecutive patients meeting diagnostic criteria for IBS. 4 databases were searched from 1978 to 2020. Studies were included if they evaluated the prevalence of these conditions in secondary healthcare setting. Estimated pooled rates were calculated and statistical heterogeneity between studies was evaluated using Q and I2 statistics. Seven studies (n = 597) estimated the pooled prevalence for BAD as 41% (95% CI 29-54). 17 studies (n = 5068) estimated that of MC as 3% (95% CI 2-4%). Two studies (n = 478) suggested a rate of 4.6% (range: 1.8-6.1%) for PEI. Using breath testing, 26 studies (n = 6700) and 13 studies (n = 3415) estimated the prevalence of lactose and fructose malabsorption as 54% (95% CI 44-64%) and 43% (95% CI 23-62%); 36 studies (n = 4630) and 22 studies (n = 2149) estimated that of SIBO as 49% (95% CI 40-57%) with lactulose and 19% (95% CI 13-27%) with glucose. Rates of all conditions were significantly higher than in healthy controls. A significant proportion of patients presenting to secondary care with IBS have an organic condition which may account for their symptoms. Failure to exclude such conditions will deny patients effective treatment.
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Affiliation(s)
- Dennis Poon
- Department of Gastroenterology, Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY, UK
| | - Graham R Law
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Giles Major
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Queens Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK
| | - H Jervoise N Andreyev
- Department of Gastroenterology, Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY, UK.
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
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23
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Hammer HF, Fox MR, Keller J, Salvatore S, Basilisco G, Hammer J, Lopetuso L, Benninga M, Borrelli O, Dumitrascu D, Hauser B, Herszenyi L, Nakov R, Pohl D, Thapar N, Sonyi M, European H 2‐CH 4‐breath test group. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10:15-40. [PMID: 34431620 PMCID: PMC8830282 DOI: 10.1002/ueg2.12133] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Measurement of breath hydrogen (H2 ) and methane (CH4 ) excretion after ingestion of test-carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline. METHODS This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of H2 -CH4 -breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria. RESULTS The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro-cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H2 -CH4 -breath tests in these indications and recommends approaches to mitigate these issues. CONCLUSION This clinical practice guideline should facilitate pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches.
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Affiliation(s)
- Heinz F. Hammer
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineMedical UniversityGrazAustria
| | - Mark R. Fox
- Centre for Integrative GastroenterologyDigestive Function: BaselLaboratory and Clinic for Motility Disorders and Functional Gastrointestinal DiseasesKlinik ArlesheimArlesheimSwitzerland
- Division of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Jutta Keller
- Department of Internal MedicineIsraelitic HospitalAcademic Hospital of the University of HamburgHamburgGermany
| | - Silvia Salvatore
- Pediatric DepartmentHospital “F. Del Ponte”University of InsubriaVareseItaly
| | - Guido Basilisco
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanoItaly
| | - Johann Hammer
- Department of Gastroenterology and HepatologyUniversity Hospital of Internal Medicine 3Medical University of ViennaViennaAustria
| | - Loris Lopetuso
- UOC Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario A. Gemelli IRCCSRomeItalia
- Department of Medicine and Ageing Sciences“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Marc Benninga
- Department of Pediatric Gastroenterology, Hepatology and NutritionEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Osvaldo Borrelli
- UCL Great Ormond Street Institute of Child Health and Department of GastroenterologyNeurogastroenterology and MotilityGreat Ormond Street HospitalLondonUK
| | - Dan Dumitrascu
- Department of GastroenterologyClinica Medicala 2Cluj‐NapocaRomania
| | - Bruno Hauser
- Department of Paediatric Gastroenterology, Hepatology and NutritionKidZ Health Castle UZ BrusselBrusselsBelgium
| | - Laszlo Herszenyi
- Department of GastroenterologyMedical CentreHungarian Defence ForcesBudapestHungary
| | - Radislav Nakov
- Clinic of GastroenterologyTsaritsa Yoanna University HospitalMedical University of SofiaSofiaBulgaria
| | - Daniel Pohl
- Division of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Nikhil Thapar
- UCL Great Ormond Street Institute of Child Health and Department of GastroenterologyNeurogastroenterology and MotilityGreat Ormond Street HospitalLondonUK
- Gastroenterology, Hepatology and Liver TransplantQueensland Children's HospitalBrisbaneAustralia
| | - Marc Sonyi
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineMedical UniversityGrazAustria
- Clinic for General Medicine, Gastroenterology, and Infectious DiseasesAugustinerinnen HospitalCologneGermany
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24
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Nakov R, Dimitrova-Yurukova D, Snegarova V, Nakov V, Fox M, Heinrich H. Increased prevalence of gastrointestinal symptoms and disorders of gut-brain interaction during the COVID-19 pandemic: An internet-based survey. Neurogastroenterol Motil 2022; 34:e14197. [PMID: 34145679 DOI: 10.1111/nmo.14197] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quarantine with social distancing has reduced transmission of COVID-19; however, fear of the disease and these remedial measures cause anxiety and stress. It is not known whether these events have impacted the prevalence of gastrointestinal (GI) symptoms and disorders of brain-gut interaction (DGBI). METHODS An online platform evaluated the prevalence of GI symptoms during the COVID-19 pandemic. Data collection utilized validated questionnaires and was fully anonymized. Findings were compared with identical data acquired in 2019. The association of results with stress and anxiety was analyzed. RESULTS Data were collected from 1896 subjects May - August 2019 to 980 non-identical subjects May - June 2020. GI symptoms were reported by 68.9% during the COVID-19 lockdown compared with 56.0% the previous year (p < 0.001). The prevalence of irritable bowel syndrome (26.3% vs. 20.0%; p < 0.001), functional dyspepsia (18.3% vs. 12.7%; p < 0.001), heartburn (31.7% vs. 26.2%, p = 0.002), and self-reported milk intolerance (43.5% vs. 37.8% p = 0.004) was higher during the pandemic. Many individuals reported multiple symptoms. Anxiety was associated with presence of all GI symptoms. High levels of stress impacted functional dyspepsia (p = 0.045) and abdominal pain (p = 0.013). The presence of DGBI (p < 0.001; OR 22.99), self-reported milk intolerance (p < 0.001; OR 2.50), and anxiety (p < 0.001; OR 2.18) was independently associated with increased GI symptoms during COVID-19 pandemic. CONCLUSIONS The prevalence of GI symptoms was significantly higher during the COVID-19 lockdown than under normal circumstances the previous year. This increase was attributable to increased numbers of patients with DGBI, an effect that was associated with anxiety.
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Affiliation(s)
- Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | | | - Violeta Snegarova
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Ventsislav Nakov
- Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Mark Fox
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Center for Integrative Gastroenterology, Arlesheim, Switzerland
| | - Henriette Heinrich
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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25
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Galica AN, Galica R, Dumitrașcu DL. Diet, fibers, and probiotics for irritable bowel syndrome. J Med Life 2022; 15:174-179. [PMID: 35419092 PMCID: PMC8999090 DOI: 10.25122/jml-2022-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Many aspects make irritable bowel syndrome (IBS) challenging for both patients and physicians. The unclear pathogenesis with many pathways to be explored, bothering symptoms that affect the quality of life, and many subtypes of the condition are only a few reasons that make IBS difficult to control and obtain satisfactory results. Treatment options start with general advice for lifestyle, continue with non-pharmaceutical treatments, and finally touch classic treatments. In this review, pharmaceutical treatment options are not accounted for. Consensus groups and meta-analyses have concluded guidelines that overall are the same, with variations in the strength of recommendations and some cultural and geographical particularities. Dietary interventions, probiotics, and fibers can be seen as non-pharmaceutical treatments that coexist in various protocols because of the relevant evidence regarding their efficacy in treating IBS symptoms.
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Affiliation(s)
- Adelina Nicoleta Galica
- 2 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Nursing, Faculty of Natural and Human Sciences, Fan S. Noli University, Korçe, Albania
| | - Reitano Galica
- Department of Obstetrics and Gynecology, Regional Hospital Korçe, Korçe, Albania
| | - Dan Lucian Dumitrașcu
- 2 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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26
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Jahanshiri E, Goh EV, Wimalasiri EM, Azam‐Ali S, Mayes S, Tengku Mohd Suhairi TAS, Mohd Nizar NM, Mohd Sinin SS. The potential of Bambara groundnut: An analysis for the People’s Republic of China. Food Energy Secur 2022. [DOI: 10.1002/fes3.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Ee Von Goh
- Crops For the Future UK NIAB Cambridge UK
| | | | | | - Sean Mayes
- Crops For the Future UK NIAB Cambridge UK
- School of Biosciences Nottingham University Leicestershire UK
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27
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Subjective, but not documented, lactose intolerance accompanies irritable bowel syndrome. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Lactose intolerance, due to lactase deficiency, may overlap with the symptoms of irritable bowel syndrome (IBS) or lead to an incorrect diagnosis of IBS. Identification of lactose intolerance and lactase deficiency enables targeted treatment to be implemented.
The aim of the study was to search for a frequency of a lactose intolerance symptoms in patients with IBS, depending on the results of hydrogen breath test (HBT).
Materials and Methods
The study involved 56 patients with IBS and 23 healthy people. Both, IBS patients and healthy controls, were asked to complete a survey about IBS symptoms and tolerance of lactose-containing products. A HBT was performed on all subjects.
Results
Lactase deficiency was diagnosed in 60.7% of patients with IBS and 43.5% of control group. The differences between the study groups were not statistically significant. No statistically significant differences were observed between the incidence of lactase deficiency depending on the type of IBS.
In the group of patients with IBS and normal HBT results, as well as in patients with IBS and lactase deficiency, there were no statistically significant differences in the frequency of lactose intolerance symptoms. However, among people with normal HBT results, patients with IBS reported symptoms of intolerance after consuming lactose-containing foods significantly more often compared to the control group (p<0.05).
Conclusions
Frequency of lactase deficiency does not differ between IBS patients and healthy individuals. Patients with IBS are more likely to report symptoms of lactose intolerance, regardless of the HBT result, compared to healthy individuals.
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28
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Black CJ. Review article: Diagnosis and investigation of irritable bowel syndrome. Aliment Pharmacol Ther 2021; 54 Suppl 1:S33-S43. [PMID: 34927756 DOI: 10.1111/apt.16597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction. It is defined by the Rome criteria as the presence of abdominal pain, related to defaecation, associated with a change in stool form and/or frequency. The approach to diagnosis and investigation of suspected IBS varies between clinicians and, due in part to the uncertainty that can surround the diagnosis, many still consider it to be a diagnosis of exclusion. However, exhaustive investigation is both unnecessary and costly, and may also be counterproductive. Instead, physicians should aim to make a positive diagnosis, based on their clinical assessment of symptoms, and limit their use of investigations. The yield of routine blood tests in suspected IBS is low overall, but normal inflammatory markers may be reassuring. All patients should have serological testing for coeliac disease, irrespective of their predominant stool form. Routine testing of stool microbiology or faecal elastase is unnecessary; however, all patients with diarrhoea aged <45 should have a faecal calprotectin or a similar marker measured which, if positive, should lead to colonoscopy to exclude possible inflammatory bowel disease. Colonoscopy should also be undertaken in any patient reporting alarm symptoms suggestive of colorectal cancer, and in those whose presentation raises suspicion for microscopic colitis. Testing for bile acid diarrhoea should be considered for patients with IBS with diarrhoea where available. Hydrogen breath tests for lactose malabsorption or small intestinal bacterial overgrowth have no role in the routine assessment of suspected IBS. Adopting a standardised approach to the diagnosis and investigation of IBS will help to promote high-quality and high-value care for patients overall.
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Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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29
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Nee J, Lembo A. Review Article: Current and future treatment approaches for IBS with diarrhoea (IBS-D) and IBS mixed pattern (IBS-M). Aliment Pharmacol Ther 2021; 54 Suppl 1:S63-S74. [PMID: 34927757 DOI: 10.1111/apt.16625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome-diarrhoea (IBS-D) and IBS-mixed stool pattern (IBS-M) are disorders of gut-brain interaction characterised by abdominal pain associated with diarrhoea or both diarrhoea and constipation respectively. The pathophysiology of IBS-D/M is multifactorial and not completely understood; thus, treatment is aimed at multiple mechanisms such as altering gut microbiota, visceral hypersensitivity, intestinal permeability, gut-brain interaction and psychological strategies. AIM The goal of this article was to provide an up-to-date review of the current evidence for both non-pharmacological and pharmacological treatment options in IBS-D and IBS-M. Future treatments for IBS-D and IBS-M will also be discussed. METHODS Medline and Embase database searches (through April 30 2021) to identify clinical studies in subjects with IBS-D in which dietary modification, alternative treatments (probiotics, acupuncture, exercise) as well as FDA-approved medications were used. RESULTS Dietary modification is often the first line of therapy. Furthermore, lifestyle treatments include complementary alternative medications (CAM), probiotics and peppermint oil are useful adjuncts but have not specifically been described in IBS-D/M. Evidence strongly supports psychotherapy in the treatment of IBS. Beyond over-the counter anti-diarrhoeals, anti-spasmodics and anti-depressants, pharmacological treatment now includes treating for bile acid malabsorption and the FDA-approved medications rifaximin, eluxadoline and alosetron. CONCLUSIONS The treatment of IBS-D/M ideally involves a multidisciplinary approach of primary care, gastroenterologist and psychologist. Treatment often involves both non-pharmacological and pharmacological therapies. Future therapies may include faecal microbial transplant, Crofelemer and serotonin antagonists, but further studies are needed.
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Affiliation(s)
- Judy Nee
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony Lembo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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30
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Du M, Xie X, Yang S, Li Y, Jiang T, Yang J, Li L, Huang Y, Wu Q, Chen W, Zhang J. Lysozyme-like Protein Produced by Bifidobacterium longum Regulates Human Gut Microbiota Using In Vitro Models. Molecules 2021; 26:molecules26216480. [PMID: 34770899 PMCID: PMC8587964 DOI: 10.3390/molecules26216480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/08/2022] Open
Abstract
The extracellular secreted protein of Bifidobacterium longum (B. longum) plays an important role in maintaining the homeostasis of the human intestinal microenvironment. However, the mechanism(s) of interaction remain unclear. Lysozyme is a kind of antibacterial peptide. In this study, the amino acid sequence of a lysozyme-like protein of B. longum based on whole-genome data of an isolate from human gut feces was found. We further predicted functional domains from the amino acid sequence, purified the protein, and verified its bioactivity. The growth of some bacteria were significantly delayed by the 020402_LYZ M1 protein. In addition, the gut microbiota was analyzed via high-throughput sequencing of 16S rRNA genes and an in vitro fermentation model, and the fluctuations in the gut microbiota under the treatment of 020402_LYZ M1 protein were characterized. The 020402_LYZ M1 protein affected the composition of human gut microbiota significantly, implying that the protein is able to communicate with intestinal microbes as a regulatory factor.
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Affiliation(s)
- Mingzhu Du
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (M.D.); (S.Y.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Xinqiang Xie
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
- Correspondence: (X.X.); (J.Z.)
| | - Shuanghong Yang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (M.D.); (S.Y.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Ying Li
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Tong Jiang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Juan Yang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Longyan Li
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Yunxiao Huang
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China;
| | - Qingping Wu
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (M.D.); (S.Y.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jumei Zhang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou 510070, China; (Y.L.); (T.J.); (J.Y.); (L.L.); (Q.W.)
- Correspondence: (X.X.); (J.Z.)
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Abstract
Irritable bowel syndrome (IBS) is among the most common diagnoses made by medical providers and its symptoms are common causes for health care consultation. IBS is characterized by abdominal pain associated with abnormal stool consistency and/or frequency and is widely considered a diagnosis of exclusion, despite abundant evidence contradicting such an approach. A positive diagnosis is achieved through application of symptom-based clinical criteria, careful history and physical examination, evaluation for alarm sign/symptoms, and judicious use of diagnostic testing. This article reviews the symptom-based criteria for IBS and utility of diagnostic tests commonly included in the evaluation of IBS symptoms.
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Affiliation(s)
- Ryan S Goldstein
- Gastroenterology, Hepatology and Nutrition, UT Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA
| | - Brooks D Cash
- Gastroenterology, Hepatology and Nutrition, UT Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA.
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32
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Dbar S, Akhmadullina O, Sabelnikova E, Belostotskiy N, Parfenov A, Bykova S, Bakharev S, Baulo E, Babanova A, Indeykina L, Kuzmina T, Kosacheva T, Spasenov A, Makarova A. Patients with functional bowel disorder have disaccharidase deficiency: A single-center study from Russia. World J Clin Cases 2021; 9:4178-4187. [PMID: 34141780 PMCID: PMC8173401 DOI: 10.12998/wjcc.v9.i17.4178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/12/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional bowel disorder (FBD) may be caused by a decrease in disaccharidase activity. Thus, the timely diagnosis of disaccharidase deficiency could lead to a better prognosis in patients with this condition.
AIM To determine the potential value of intestinal disaccharidases glucoamylase, maltase, sucrase, and lactase in understanding the etiology and pathogenesis of FBD.
METHODS A total of 82 FBD patients were examined. According to the Rome IV criteria (2016), 23 patients had diarrhea-predominant irritable bowel syndrome (IBS), 33 had functional diarrhea, 10 had constipation-predominant IBS, 4 had functional constipation, and 12 had mixed IBS. The Dahlqvist method was used to measure disaccharidase activity in the brush-border membrane of mature enterocytes of the small intestine, in duodenal biopsies obtained during esophagogastroduodenoscopy.
RESULTS Lactase deficiency was detected in 86.5% of patients, maltase deficiency in 48.7%, sucrase deficiency in 50%, and glucoamylase deficiency in 84.1%. The activities of all enzymes were reduced in 31.7% of patients, and carbohydrase deficiency was detected in 63.5% of patients. The low activity of enzymes involved in membrane digestion in the small intestine was found in 95.2% of patients.
CONCLUSION In 78 of the 82 patients with FBD, gastrointestinal symptoms were associated with disaccharidase deficiency.
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Affiliation(s)
- Saria Dbar
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Olga Akhmadullina
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Elena Sabelnikova
- Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Nikolai Belostotskiy
- Pre-Clinical Research Laboratory, Moscow Clinical Scientific Center Named after A.S. Loginov MHD, Moscow 111123, Russia
| | - Asfold Parfenov
- Department of Bowel Pathology, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Svetlana Bykova
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Sergey Bakharev
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Elena Baulo
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Alexandra Babanova
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Lilia Indeykina
- Laboratory of Functional Diagnostics of Intestinal Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Tatyana Kuzmina
- Nutraceuticals Laboratory, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Tatiana Kosacheva
- Non-inflammatory Bowel Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Aleksey Spasenov
- Department of Medical Statistics, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
| | - Alina Makarova
- Laboratory of Functional Diagnostics of Intestinal Diseases, Moscow Health Department, Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow 111123, Russia
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33
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Zhang Y, Feng L, Wang X, Fox M, Luo L, Du L, Chen B, Chen X, He H, Zhu S, Hu Z, Chen S, Long Y, Zhu Y, Xu L, Deng Y, Misselwitz B, Lang BM, Yilmaz B, Kim JJ, Owyang C, Dai N. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113:1531-1545. [PMID: 33740048 DOI: 10.1093/ajcn/nqab005] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. OBJECTIVES We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. METHODS One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a ≥50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. RESULTS Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (∆6%; 95% CI: -13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides, and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: -0.1, 9.9; P = 0.05). CONCLUSIONS An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention.This trial was registered at clinicaltrials.gov as NCT03304041.
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Affiliation(s)
- Yawen Zhang
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Lijun Feng
- Department of Nutrition, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Xin Wang
- State Microbial Technology of Zhejiang Province, Institute of Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou, Zhejiang, China
| | - Mark Fox
- Digestive Function: Basel, Laboratory and Clinic for Disorders of Gastrointestinal Motility and Function, Center for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.,Department of Gastroenterology and Hepatology, Zurich University Hospital, University of Zurich, Zürich, Switzerland
| | - Liang Luo
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Lijun Du
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Binrui Chen
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Xiaoli Chen
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Huiqin He
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Shuwen Zhu
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.,Department of Gastroenterology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Zhefang Hu
- Department of Nutrition, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Shujie Chen
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yanqin Long
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yubin Zhu
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Li Xu
- Department of Nutrition, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yanyong Deng
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Brian M Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Bahtiyar Yilmaz
- Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - John J Kim
- Division of Gastroenterology, Loma Linda University Health, Loma Linda, CA, USA
| | - Chung Owyang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ning Dai
- Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.,School of Medicine, Zhejiang University City College, Hangzhou, Zhejiang, China
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34
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Bouchoucha M, Fysekidis M, Rompteaux P, Raynaud JJ, Sabate JM, Benamouzig R. Lactose Sensitivity and Lactose Malabsorption: The 2 Faces of Lactose Intolerance. J Neurogastroenterol Motil 2021; 27:257-264. [PMID: 33361550 PMCID: PMC8026364 DOI: 10.5056/jnm20094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/25/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of patients with FBD, without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features. Methods One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose tolerance test in which glycemia during 60 minutes and digestive symptoms for 3 hours were recorded. Results Abnormal lactose tolerance tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea (P = 0.040) and a lower frequency of dysphagia (P = 0.031). LS patients had a higher depression score (P = 0.007), higher frequency of globus (P = 0.042), irritable bowel syndrome (IBS) (P = 0.027) and mixed IBS (P = 0.049), and lower frequency of abdominal pain (P = 0.040). LS was significantly associated with a higher depression score (P = 0.002), and a higher frequency of globus (P = 0.046). Conclusions Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.
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Affiliation(s)
- Michel Bouchoucha
- epartment of Physiology, Université René Descartes, Paris V, Paris, France.,Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | | | - Pierre Rompteaux
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | | | - Jean-Marc Sabate
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
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35
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Altomare A, Di Rosa C, Imperia E, Emerenziani S, Cicala M, Guarino MPL. Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients 2021; 13:1506. [PMID: 33946961 PMCID: PMC8146452 DOI: 10.3390/nu13051506] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain associated with defecation or a change in bowel habits. Gut microbiota, which acts as a real organ with well-defined functions, is in a mutualistic relationship with the host, harvesting additional energy and nutrients from the diet and protecting the host from pathogens; specific alterations in its composition seem to play a crucial role in IBS pathophysiology. It is well known that diet can significantly modulate the intestinal microbiota profile but it is less known how different nutritional approach effective in IBS patients, such as the low-FODMAP diet, could be responsible of intestinal microbiota changes, thus influencing the presence of gastrointestinal (GI) symptoms. The aim of this review was to explore the effects of different nutritional protocols (e.g., traditional nutritional advice, low-FODMAP diet, gluten-free diet, etc.) on IBS-D symptoms and on intestinal microbiota variations in both IBS-D patients and healthy subjects. To date, an ideal nutritional protocol does not exist for IBS-D patients but it seems crucial to consider the effect of the different nutritional approaches on the intestinal microbiota composition to better define an efficient strategy to manage this functional disorder.
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Affiliation(s)
- Annamaria Altomare
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Claudia Di Rosa
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Elena Imperia
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy;
| | - Sara Emerenziani
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
| | - Michele Cicala
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
| | - Michele Pier Luca Guarino
- Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.A.); (S.E.); (M.C.); (M.P.L.G.)
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36
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Katoch GK, Nain N, Kaur S, Rasane P. Lactose Intolerance and Its Dietary Management: An Update. J Am Coll Nutr 2021; 41:424-434. [PMID: 33831336 DOI: 10.1080/07315724.2021.1891587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Milk is the most common food consumed worldwide and is also a major ingredient in the preparation of various dairy products. However, despite the high production and consumption of milk and milk-based products, there is a large percent of the world's population that suffer from allergies to milk solids and lactose intolerance. Lactose intolerance specifically means the inability of the body to breakdown the sugar to its simplest form for assimilation and it is due to the inefficiency or lack of the enzyme in the human body. The most convenient prevention method for the affected population is to avoid milk and milk-based products but this may be a cause of development of other health related issues that result from inadequate nutrient consumption. To help find an alternative to this problem, this study aims at first studying the underlying information on lactose intolerance and then studying plant-based beverages as a possible alternative to milk and milk-based products. Key teaching pointsLactose intolerance specifically means the inability of the body to breakdown the sugar to its simplest form for assimilation and it is due to the inefficiency or lack of the enzyme in the human body.Consumption of probiotics may help relieve the symptoms of lactose intolerance.Soy beverage can be an economical alternative for lactose intolerant populations and has calcium content comparable to bovine milk.Calcium absorption in fortified plant based beverages depends upon type of calcium salt used.
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Affiliation(s)
- Gunjan Kumari Katoch
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Neegam Nain
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
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37
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Jiang R, Sharma C, Bryant R, Mohan MS, Al-Marashdeh O, Harrison R, Torrico DD. Animal welfare information affects consumers' hedonic and emotional responses towards milk. Food Res Int 2021; 141:110006. [PMID: 33641951 DOI: 10.1016/j.foodres.2020.110006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
This research aimed to explore the effects of animal welfare information on consumers' hedonic and emotional responses towards milk. Two studies were conducted. For Study 1, participants (N = 101) were asked to fill out a questionnaire on attitudes towards animal welfare, in which a variety of factors including raising methods, quality of life, emotions, quality of the product, nutrition, price, and environment, were tested. For Study 2, participants (N = 63) tasted a milk sample (2% fat, standardized and homogenized) in two different conditions: [1] blind (without any previous information), and [2] informed (with information stating that the milk was obtained from a farm with an animal welfare system in place). For Study 1, participants with higher milk consumption per week showed a higher agreement with positive animal welfare statements. For Study 2, the overall liking for the milk in the informed condition was significantly higher than that of the milk in the blind condition (7.4 vs. 6.8, using a 9-point hedonic scale). Participants had higher penalizations for the milk in the blind condition as they suggested that the milk's flavor, sweetness, aroma, and mouthfeel were not enough in the product. This research showed that animal welfare can be an important extrinsic factor in the consumers' hedonic and emotional responses towards milk. These findings can be useful for understanding consumers' behaviors towards animal welfare.
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Affiliation(s)
- Ruizhi Jiang
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Chetan Sharma
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Racheal Bryant
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Maneesha S Mohan
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Omar Al-Marashdeh
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Roland Harrison
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand
| | - Damir D Torrico
- Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln 7647, New Zealand.
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38
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Abstract
Irritable bowel syndrome (IBS) affects a significant percentage of the general population and is more common in women. A large proportion of women affected with IBS are of childbearing age; however, there is a paucity of studies and guidelines to specifically address the epidemiology, course, maternal/fetal prognosis, or management of IBS in pregnancy. This scarcity of literature on IBS and pregnancy poses significant challenges to healthcare providers in counseling and managing patients. In this comprehensive review, we summarize the current literature and knowledge gaps regarding the effects of pregnancy on IBS and vice versa, along with the efficacy and safety profiles of commonly used IBS diets and medications in pregnancy. The management of pregnant women with IBS should be multidisciplinary, with emphasis on education and judicious use of dietary modifications and pharmacologic options that are deemed relatively safe during pregnancy.
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39
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Spiller R. Impact of Diet on Symptoms of the Irritable Bowel Syndrome. Nutrients 2021; 13:nu13020575. [PMID: 33572262 PMCID: PMC7915127 DOI: 10.3390/nu13020575] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
Irritable bowel syndrome (IBS), with its key features of abdominal pain and disturbed bowel habit, is thought by both patients and clinicians to be strongly influenced by diet. However, the complexities of diet have made identifying specific food intolerances difficult. Eating disorders can masquerade as IBS and may need specialist treatment. While typical food allergy is readily distinguished from IBS, the mechanisms of gut-specific adverse reactions to food are only just being defined. These may include gut-specific mast cell activation as well as non-specific activation by stressors and certain foods. Visceral hypersensitivity, in some cases mediated by mast cell activation, plays a key part in making otherwise innocuous gut stimuli painful. Rapidly fermented poorly absorbed carbohydrates produce gaseous distension as well as short-chain fatty acids and lowering of colonic pH which may cause symptoms in IBS patients. Limiting intake of these in low FODMAP and related diets has proven popular and apparently successful in many patients. Existing diet, colonic microbiota and their metabolic products may be helpful in predicting who will respond. Wheat intolerance may reflect the fact that wheat is often a major source of dietary FODMAPs. It may also be either a forme fruste of coeliac disease or non-specific immune activation. Wheat exclusion can be successful in some of these patients. More research is needed to fully understand the mechanisms of food intolerances and how to best ameliorate them in a personalised medicine approach to diet in IBS.
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Affiliation(s)
- Robin Spiller
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
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40
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Abstract
Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain associated with altered bowel habits. Patients with IBS often complain of food-related gastrointestinal symptoms. Specifically, those with diarrhea-predominant IBS report a significantly higher effect on quality on life because of food avoidance compared with those with other IBS subtypes. Physicians and patients often use dietary therapies to mitigate IBS symptoms. In the last 10 years, several dietary interventions such as a gluten-free diet, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diets have been studied in several studies. This review summarizes the current literature on the role of diets such as gluten-free diet, low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet, and other carbohydrate malabsorption in the pathophysiology and symptom management in patients with diarrhea-predominant IBS.
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41
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Sonyi M, Keller J, Fox M, Hammer HF. Development of a Multinational Clinical Practice Guideline: A Practical Structured Procedure. Dig Dis 2020; 39:477-487. [PMID: 32818943 DOI: 10.1159/000511007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The development of a clinical guideline is a challenging process. National and international organizations have established a variety of approaches, grading systems, evaluation scales, and voting modes; however, a practical description which illustrates all steps from starting the initiative to publication and dissemination of the guideline is usually not provided. We describe a structured guideline procedure that can be adjusted to the requirements of other multinational guidelines. METHODS A group of European specialist gastroenterological societies and national societies initiated a guideline for the use of breath tests in gastroenterology. A balance between scientific evidence and clinical experience was achieved by involving European specialist societies and physicians from 18 European countries. For persons contributing to the guideline process, different levels of involvement were defined. The tasks were assigned to different groups of persons, which formed scientific institutions. RESULTS We describe organizational structures and institutions, the stepwise approach, and illustrate the multistep guideline development procedure in a flowchart diagram that shows workflow and assigned responsibilities and provides details for the execution of each step, including timelines. The process is split into 4 phases: foundation, preparation, voting, and publication. DISCUSSION This structured procedure of a gastroenterological clinical practice guideline can serve as a blueprint for future multinational guideline initiatives and may aid future attempts to standardize and harmonize guideline development processes in gastroenterology and in other medical fields. Although the described procedure is for a diagnostic guideline, it may also be appropriate for therapeutic guidelines by adjusting the acceptance criteria for recommendations.
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Affiliation(s)
- Marc Sonyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Jutta Keller
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany
| | - Mark Fox
- Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.,Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Heinz F Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria,
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Jansson-Knodell CL, Krajicek EJ, Savaiano DA, Shin AS. Lactose Intolerance: A Concise Review to Skim the Surface. Mayo Clin Proc 2020; 95:1499-1505. [PMID: 32622451 DOI: 10.1016/j.mayocp.2020.04.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022]
Abstract
Lactose intolerance is a common but poorly understood cause of gastrointestinal symptoms. Contrary to popular belief, there is much more to its diagnosis beyond symptoms with exposure and management beyond milk- and dairy-product avoidance. In this article, we review definitions, genetic basis, pathogenesis, clinical signs, as well as diagnostic and management strategies.
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Affiliation(s)
| | - Edward J Krajicek
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN
| | - Dennis A Savaiano
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Andrea S Shin
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN.
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43
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Mack A, Bobardt J, Haß A, Nichols K, Schmid R, Stein-Thoeringer C. Changes in gut microbial metagenomic pathways associated with clinical outcomes after the elimination of malabsorbed sugars in an IBS cohort. Gut Microbes 2020; 11:620-631. [PMID: 31809634 PMCID: PMC7524390 DOI: 10.1080/19490976.2019.1686322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Specific diets to manage sugar malabsorption are reported to reduce clinical symptoms of irritable bowel syndrome (IBS). However, the effects of diets for malabsorbed sugars on gut microbiota signatures have not been studied, and associations with clinical outcomes in IBS have not been characterized. 22 IBS patients positively tested for either lactose-, fructose-, sorbitol- or combined malabsorptions were subjected to 2-weeks sugar elimination and subsequent 4-weeks re-introduction. 7 IBS patients tested negative for sugar malabsorption were used as controls. Nutrition and clinical symptoms were recorded throughout the study. Fecal samples were serially collected for 16S rRNA amplicon and shotgun-metagenome sequencing. Dietary intervention supervised by nutrition counseling reduced IBS symptoms during the elimination and tolerance phases. Varying clinical response rates were observed between subjects, and used to dichotomize our cohort into visual analogue scale (VAS) responders and non-responders. Alpha -and beta-diversity analyzes revealed only minor differences regarding 16S rRNA-based fecal microbiota compositions between responder and non-responder patients during baseline or tolerance phase. In shotgun-metagenome analyzes, however, we analyzed microbial metabolic pathways and found significant differences in pathways encoding starch degradation and complex amino acid biosynthesis at baseline between IBS controls and malabsorbers, and notably, between diet responder and non-responders. Faecalibacterium prausnitzii, Ruminococcus spp. and Bifidobacterium longum largely informed these metabolic pathways. Our study demonstrates that diet interventions for specific, malabsorbed carbohydrates reshaped the metagenomic composition of the gut microbiota, with a small community of bacterial taxa contributing to these changes rather than a single species.
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Affiliation(s)
- A. Mack
- Klinik und Poliklinik fuer Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,CONTACT Christoph K Stein-Thoeringer German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J.S. Bobardt
- Klinik und Poliklinik fuer Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Haß
- Klinik und Poliklinik fuer Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - K.B. Nichols
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - R.M. Schmid
- Klinik und Poliklinik fuer Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C.K. Stein-Thoeringer
- Klinik und Poliklinik fuer Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,Research Division Microbiome and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
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44
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James SC, Fraser K, Young W, McNabb WC, Roy NC. Gut Microbial Metabolites and Biochemical Pathways Involved in Irritable Bowel Syndrome: Effects of Diet and Nutrition on the Microbiome. J Nutr 2020; 150:1012-1021. [PMID: 31891398 PMCID: PMC7198292 DOI: 10.1093/jn/nxz302] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022] Open
Abstract
The food we consume and its interactions with the host and their gut microbiota affect normal gut function and health. Functional gut disorders (FGDs), including irritable bowel syndrome (IBS), can result from negative effects of these interactions, leading to a reduced quality of life. Certain foods exacerbate or reduce the severity and prevalence of FGD symptoms. IBS can be used as a model of perturbation from normal gut function with which to study the impact of foods and diets on the severity and symptoms of FGDs and understand how critical processes and biochemical mechanisms contribute to this impact. Analyzing the complex interactions between food, host, and microbial metabolites gives insights into the pathways and processes occurring in the gut which contribute to FGDs. The following review is a critical discussion of the literature regarding metabolic pathways and dietary interventions relevant to FGDs. Many metabolites, for example bile acids, SCFAs, vitamins, amino acids, and neurotransmitters, can be altered by dietary intake, and could be valuable for identifying perturbations in metabolic pathways that distinguish a "normal, healthy" gut from a "dysfunctional, unhealthy" gut. Dietary interventions for reducing symptoms of FGDs are becoming more prevalent, but studies investigating the underlying mechanisms linked to host, microbiome, and metabolite interactions are less common. Therefore, we aim to evaluate the recent literature to assist with further progression of research in this field.
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Affiliation(s)
- Shanalee C James
- Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
- The Riddet Institute, Massey University, Palmerston North, New Zealand
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Karl Fraser
- Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
- The Riddet Institute, Massey University, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Wayne Young
- Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
- The Riddet Institute, Massey University, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Warren C McNabb
- The Riddet Institute, Massey University, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Nicole C Roy
- Food Nutrition & Health Team, AgResearch, Palmerston North, New Zealand
- The Riddet Institute, Massey University, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
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45
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Cancarevic I, Rehman M, Iskander B, Lalani S, Malik BH. Is There a Correlation Between Irritable Bowel Syndrome and Lactose Intolerance? Cureus 2020; 12:e6710. [PMID: 32104635 PMCID: PMC7032600 DOI: 10.7759/cureus.6710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a poorly understood gastrointestinal disorder that affects a significant percentage of the population and has a strong negative effect on the quality of life. The lack of known pathophysiologic mechanisms has made finding effective treatment strategies difficult. One of the common recommendations by clinicians is a trial of a lactose-free diet. We have wondered if there was sufficient evidence in the currently available literature to support such a recommendation. We have also looked into other possible relationships between malabsorption syndromes and IBS. All the articles used for this review have been found in the PubMed database. We have taken into consideration the possibility that there may be both genetic differences and differences in the gut microbiome between populations living in different geographic regions. Therefore, we have included articles from different geographic regions to increase the generalizability of the findings. While there is a plethora of evidence that IBS patients commonly report milk intolerance, we have not found any conclusive evidence to suggest an objective link between IBS and any known malabsorption syndromes, including lactose malabsorption. Furthermore, trials of lactase supplementation have not led to clinical benefit. We concluded that there was no evidence to support routinely recommending a lactose-free diet for patients diagnosed with IBS, but including hydrogen breath testing in routine workup of IBS is a reasonable clinical decision. Ultimately, we believe that more clinical trials and chemical studies of the feces are needed to determine the pathophysiology and explore possible dietary recommendations for patients with IBS.
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Affiliation(s)
- Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mahnoor Rehman
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Beshoy Iskander
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sanee Lalani
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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46
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Konturek TJ, Martinez C, Niesler B, van der Voort I, Mönnikes H, Stengel A, Goebel-Stengel M. The Role of Brain-Derived Neurotrophic Factor in Irritable Bowel Syndrome. Front Psychiatry 2020; 11:531385. [PMID: 33519536 PMCID: PMC7840690 DOI: 10.3389/fpsyt.2020.531385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
Several studies have implied a role of brain-derived neurotrophic factor (BDNF) in abdominal pain modulation in irritable bowel syndrome (IBS). The aim of this study was to establish BDNF protein expression in human colonic biopsies and to show variation in IBS compared to controls. BDNF protein and mRNA levels were correlated with IBS symptom severity based on the IBS-symptom severity score (IBS-SSS). Biopsies from the descending colon and IBS-SSS were obtained from 10 controls and 20 IBS patients. Total protein of biopsies was extracted and assessed by ELISA and Western Blot. Total mRNA was extracted and gene expression measured by nCounter analysis. In IBS patients, symptom severity scores ranged from 124 to 486 (mean ± sem: 314.2 ± 21.2, >300 represents severe IBS) while controls ranged from 0 to 72 (mean ± sem: 27.7 ± 9.0, <75 represents healthy subjects, p < 0.001). IBS patients reported significantly more food malabsorption, former abdominal surgery and psychiatric comorbidities. BDNF protein was present in all samples and did not differ between IBS and controls or sex. Subgroup analysis showed that female IBS patients expressed significantly more BDNF mRNA compared to male patients (p < 0.05) and male IBS-D patients had higher IBS symptom severity scores and lower BDNF mRNA and protein levels compared to male controls (p < 0.05). Scatter plot showed a significant negative correlation between IBS-SSS and BDNF mRNA levels in the cohort of male IBS-D patients and their male controls (p < 0.05). We detected a high proportion of gastrointestinal surgery in IBS patients and confirmed food intolerances and psychiatric diseases as common comorbidities. Although in a small sample, we demonstrated that BDNF is detectable in human descending colon, with higher BDNF mRNA levels in female IBS patients compared to males and lower mRNA and protein levels in male IBS-D patients compared to male controls. Further research should be directed toward subgroups of IBS since their etiologies might be different.
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Affiliation(s)
- Thomas Jan Konturek
- Division of Gastroenterology, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, United States.,Department of Internal Medicine, Institute of Neurogastroenterology, Martin Luther Hospital, Johannesstift Diakonie, Berlin, Germany
| | - Cristina Martinez
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain.,Department of Human Molecular Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, University Hospital Heidelberg, Heidelberg, Germany.,nCounter Core Facility Heidelberg, Institute of Human Genetics, Heidelberg, Germany
| | - Ivo van der Voort
- Department of Internal Medicine, Institute of Neurogastroenterology, Martin Luther Hospital, Johannesstift Diakonie, Berlin, Germany.,Department of Internal Medicine and Gastroenterology, Berlin Jewish Hospital, Berlin, Germany
| | - Hubert Mönnikes
- Department of Internal Medicine, Institute of Neurogastroenterology, Martin Luther Hospital, Johannesstift Diakonie, Berlin, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Miriam Goebel-Stengel
- Department of Internal Medicine, Institute of Neurogastroenterology, Martin Luther Hospital, Johannesstift Diakonie, Berlin, Germany.,Department of Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany.,Department of Internal Medicine and Gastroenterology, Helios Clinic Rottweil, Rottweil, Germany
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47
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Trelis M, Taroncher-Ferrer S, Gozalbo M, Ortiz V, Soriano JM, Osuna A, Merino-Torres JF. Giardia intestinalis and Fructose Malabsorption: A Frequent Association. Nutrients 2019; 11:E2973. [PMID: 31817420 PMCID: PMC6950212 DOI: 10.3390/nu11122973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Nowadays, scientific studies are emerging on the possible etiological role of intestinal parasites in functional digestive disorders. Our study was carried out with healthy individuals (control group; n = 82) and symptomatic patients with lactose or fructose malabsorption, including positive (malabsorbers; n = 213) and negative (absorbers; n = 56) breath test, being analyzed for the presence of intestinal parasites. A high parasitic prevalence was observed in malabsorbers (41.8%), exclusively due to single-cell eukaryotes but not helminths. Giardia intestinalis was the predominant parasite in cases of abnormal absorption (26.5%), significantly associated with fructose malabsorption and doubling the probability of developing this pathology. Within controls, Blastocystis sp. (13.4%) was almost the only parasite, being the second among patients (12.6%), and Cryptosporidium parvum, the last species of clinical relevance, was detected exclusively in two malabsorbers (0.9%). The consumption of ecological food and professions with direct contact with humans arose as risk factors of parasitism. A diagnosis of carbohydrate malabsorption in adulthood is the starting point, making the search for the primary cause necessary. Accurate parasitological diagnosis should be considered another tool in the clinical routine for patients with recurrent symptoms, since their condition may be reversible with adequate therapeutic intervention.
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Affiliation(s)
- María Trelis
- Area of Parasitology, Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, 46010 Valencia, Spain;
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain; (J.M.S.); (J.F.M.-T.)
| | - Silvia Taroncher-Ferrer
- Area of Parasitology, Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, 46010 Valencia, Spain;
- University Clinic of Nutrition, Physical Activity and Physiotherapy (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46020 Valencia, Spain
| | - Mónica Gozalbo
- Area of Nutrition and Bromatology, University of Valencia, 46010 Valencia, Spain;
| | - Vicente Ortiz
- Department of Gastroenterology, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain;
| | - José M. Soriano
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain; (J.M.S.); (J.F.M.-T.)
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Antonio Osuna
- Biochemistry and Molecular Parasitology Group, Department of Parasitology, Institute of Biotechnology, University of Granada, 18003 Granada, Spain;
| | - Juan F. Merino-Torres
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain; (J.M.S.); (J.F.M.-T.)
- Department of Endocrinology and Nutrition, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
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48
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Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68:2080-2091. [PMID: 31427404 PMCID: PMC6839734 DOI: 10.1136/gutjnl-2019-318404] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022]
Abstract
Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo -13'910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.
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Affiliation(s)
- Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Matthias Butter
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Kristin Verbeke
- Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Mark R Fox
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland,Digestive Function: Basel, Laboratory and Clinic for motility disorders and functional GI diseases, Center for integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
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49
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Mehtab W, Agarwal A, Singh N, Malhotra A, Makharia GK. All that a physician should know about FODMAPs. Indian J Gastroenterol 2019; 38:378-390. [PMID: 31802437 DOI: 10.1007/s12664-019-01002-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
A diet low in poorly absorbed, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is now considered as an effective strategy for symptoms control in patients with irritable bowel syndrome (IBS). The low FODMAP diet is administered in three phases, namely restriction of all dietary FODMAPs followed by rechallenge and then reintroduction of specific FODMAPs according to the tolerance of patients. A dietician should be involved in patients in whom a low FODMAP diet is planned. While restricting high FODMAPs, it is pertinent that patients are advised a well-balanced diet and suitable alternatives with low FODMAP contents in each food groups are prescribed. Strict adherence to a low FODMAP diet has been shown to improve symptoms, stool output, quality of life, and the overall well-being of patients with IBS. For those who do not respond to this dietary approach, a normal diet may be initiated and other treatment strategies (dietary or nondietary) should be considered. Interestingly, the low FODMAP diet has also been tried in other functional disorders, nonceliac gluten sensitivity, and even inflammatory bowel disease. Since the concept of FODMAP is relatively new, there is only limited data on the content of FODMAP in the Indian food items and there is a need to address this question. There is also a need for well-designed and adequately powered studies to explore the efficacy of low FODMAP diet in patients with IBS. In the present review article, we have compiled all the relevant information about FODMAPs with an objective to provide comprehensive information on FODMAPs to a physician.
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Affiliation(s)
- Wajiha Mehtab
- Department of Home Science, Lady Irwin College, University of Delhi, New Delhi, 110 001, India
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Ashish Agarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anita Malhotra
- Department of Food Technology, Lakshmibai College, University of Delhi, New Delhi, 110 052, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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50
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Gwee KA, Gonlachanvit S, Ghoshal UC, Chua ASB, Miwa H, Wu J, Bak YT, Lee OY, Lu CL, Park H, Chen M, Syam AF, Abraham P, Sollano J, Chang CS, Suzuki H, Fang X, Fukudo S, Choi MG, Hou X, Hongo M. Second Asian Consensus on Irritable Bowel Syndrome. J Neurogastroenterol Motil 2019; 25:343-362. [PMID: 31327218 PMCID: PMC6657923 DOI: 10.5056/jnm19041] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/13/2019] [Accepted: 06/24/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. METHODS Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. RESULTS Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. CONCLUSIONS Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
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Affiliation(s)
- Kok Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Gleneagles Hospital,
Singapore
| | - Sutep Gonlachanvit
- Center of Excellence on Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
India
| | | | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo,
Japan
| | - Justin Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, New Territories,
Hong Kong
| | - Young-Tae Bak
- Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Oh Young Lee
- Department of Gastroenterology, College of Medicine, Hanyang University, Seoul,
Korea
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Hyojin Park
- Division of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Ari F Syam
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai,
India
| | - Jose Sollano
- Department of Internal Medicine, Division of Gastroenterology, University of Santo Tomas, Manila,
Philippine
| | - Chi-Sen Chang
- Taichung Veterans General Hospital, Taiwan Boulevard, Taichung City,
Taiwan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa,
Japan
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Aoba Sendai,
Japan
| | - Myung-Gyu Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Xiaohua Hou
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan,
China
| | - Michio Hongo
- Department of Medicine, Kurokawa General Hospital, Kurokawa, Miyagi,
Japan
| |
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