466 Symptoms and Duodenal Mucosal Integrity and Are Improved by a Dietary Intervention in Functional Dyspepsia

Houte, Karen Van den; Carbone, Florencia; Tóth, Joran; Mariën, Zoë; Schol, Jolien; Colomier, Esther; Jasmien, Van den Bergh; Julie, Vanderstappen; Pauwels, Nelle; Matthys, Christophe; Vanuytsel, Tim; Tack, Jan

doi:10.1016/s0016-5085(21)00971-9

Cited by 7 publications

(9 citation statements)

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“…Moreover, a reanalysis of data from a trial of low FODMAP diet in IBS,52 revealed a moderate correlation (r=0.44, p=0.009) between visceral pain severity and the concentration of urinary histamine 57. It has recently been proposed that not all FODMAPs are created equal and that fructans are significant detrimental molecules 85 86. This observation was consistent with physiology of saccharide absorption in the human small intestine (as discussed above).…”

Section: Treatment Strategysupporting

confidence: 64%

Irritable bowel syndrome: treatment based on pathophysiology and biomarkers

Camilleri

Boeckxstaens

2022

Gut

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ObjectiveTo appraise the evidence that pathophysiological mechanisms and individualised treatment directed at those mechanisms provide an alternative approach to the treatment of patients with irritable bowel syndrome (IBS).DesignA PubMED-based literature review of mechanisms and treatment of IBS was conducted independently by the two authors, and any differences of perspective or interpretation of the literature were resolved following discussion.ResultsThe availability of several noninvasive clinical tests can appraise the mechanisms responsible for symptom generation in IBS, including rectal evacuation disorders, abnormal transit, visceral hypersensitivity or hypervigilance, bile acid diarrhoea, sugar intolerances, barrier dysfunction, the microbiome, immune activation and chemicals released by the latter mechanism. The basic molecular mechanisms contributing to these pathophysiologies are increasingly recognised, offering opportunities to intervene with medications directed specifically to food components, receptors and potentially the microbiome. Although the evidence supporting interventions for each mechanism is not at the same level of proof, the current state-of-the-art provides the opportunity to advance the practice from treatment based on symptoms to individualisation of treatment guided by pathophysiology and clinically identified biomarkers.ConclusionThese advances augur well for the implementation of evidence-based individualised treatment for patients with IBS based on actionable biomarkers or psychological disturbances.

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Section: Treatment Strategysupporting

confidence: 64%

Irritable bowel syndrome: treatment based on pathophysiology and biomarkers

Camilleri

Boeckxstaens

2022

Gut

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“…Evidence-Based and Emerging Dietary Approaches changes in dyspeptic symptoms during a low FODMAP diet (69). However, there are indications that FODMAP may affect duodenal mucosal integrity, as in the study by Van den Houte et al (58), where symptom improvement during a low FODMAP diet correlated with increased transepithelial electrical resistance across the duodenal mucosa. Based on the emerging evidence, a low FODMAP diet can be considered in FD.…”

Section: Special Sectionmentioning

confidence: 99%

“…A low FODMAP diet was associated with a nonsignificant trend toward overall symptom improvement ( 69 ). A preliminary report on 25 patients with FD showed a clinically significant symptom improvement in 62% after 6 weeks of a low FODMAP diet ( 58 ). Improvement occurred both in overall and individual symptom scores of postprandial fullness, early satiation, and upper abdominal bloating.…”

Section: Dietary Interventionsmentioning

confidence: 99%

“…The blinded reintroduction phase of the study showed that a wide variety of FODMAP induced symptom recurrence, which occurred in an individualized pattern. Mannitol and galacto-oligosaccharides were the FODMAP that most commonly triggered FD symptom recurrence (both 29%), followed by fructans (21%), sorbitol (14%), fructose (14%), and lactose (12%) ( 58 ).…”

Section: Dietary Interventionsmentioning

confidence: 99%

“…Recently, PDS symptoms, such as early satiation, have been associated with increased duodenal eosinophil and mast cell numbers in patients with FD, and this is correlated to increased duodenal mucosal permeability (55)(56)(57). Early evidence suggests a role for nutrients triggering these events because preliminary reports show improvement of duodenal barrier function after 6 weeks of a low FODMAP diet in patients with FD (58), and exposure to proteins commonly associated with food allergy are able to acutely induce increased permeability (59,60).…”

Section: Special Sectionmentioning

confidence: 99%

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Evidence-Based and Emerging Dietary Approaches to Upper Disorders of Gut–Brain Interaction

et al. 2022

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Food ingestion is a major symptom trigger in functional esophageal and gastroduodenal disorders and gastroparesis. This review summarizes current knowledge and identifies areas of research on the role of food factors and the opportunities for dietary intervention in these disorders. While many patients experiencing functional esophageal and gastroduodenal disorders identify specific food items as symptom triggers, available data do not allow the identification of specific nutrient groups that are more likely to induce symptoms. In functional dyspepsia (FD), recent studies have shown the potential efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, although the underlying mechanism of action is unclear. Reports of favorable responses to gluten elimination in patients with FD are confounded by the concomitant benefit of reduced intake of fructans, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols present in wheat. Emerging data based on a 6-food elimination diet and confocal laser endomicroscopic evaluation of mucosal responses to food proteins suggest a role for duodenal allergic reactions in FD symptom generation. In patients with gastroparesis, a low-residue diet has been shown to improve symptoms. Novel dietary approaches under evaluation are the Mediterranean diet and the heating/cooling diet approach.

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