Fecal Fermentation in Irritable Bowel Syndrome: Influence of Dietary Restriction of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols

Valeur, Jørgen; Røseth, Arne; Knudsen, Torunn; Malmstrøm, Gunn Helen; Fiennes, Jennifer T; Midtvedt, Tore; Berstad, Arnold

doi:10.1159/000448280

Cited by 55 publications

(54 citation statements)

References 33 publications

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“…For severity of abdominal pain, the OR based on four trials was 1.81, with 95% CI of 1.13 to 2.88. The mechanism of benefit is assumed to relate to reduced colonic fermentation25 or greater microbial diversity and reduced total bacterial abundance 26. More specifically, a recent study of 20 patients with diarrhoea-predominant IBS (IBS-D) or IBS-M reported that low FODMAP diet decreased serum levels of proinflammatory interleukin (IL)-6 and IL-8, as well as levels of faecal bacteria (Actinobacteria, Bifidobacterium and Faecalibacterium prausnitzii ), as well as faecal total SCFAs and n-butyric acid compared with baseline 27.…”

Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 99%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

127

122

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This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

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Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 99%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

127

122

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“…Table 1 reports the clinical trials that are available in the literature on the effect of a low-FODMAP diet in IBS patients [3,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. In general, most studies and one meta-analysis [6] have shown that IBS symptoms, particularly bloating and abdominal pain, may benefit from this treatment.…”

Section: Efficacy Of the Low-fodmap Diet: What Is The Quality Of Tmentioning

confidence: 99%

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

et al. 2017

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FODMAP, “Fermentable Oligo-, Di- and Mono-saccharides And Polyols”, is a heterogeneous group of highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Dietary FODMAPs might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. In recent years the low-FODMAP diet for treatment of irritable bowel syndrome (IBS) has gained increasing popularity. In the present review we aim to summarize the physiological, clinical, and nutritional issues, suggesting caution in the prolonged use of this dietary treatment on the basis of the existing literature. The criteria for inclusion in the FODMAPs list are not fully defined. Although the low-FODMAP diet can have a positive impact on the symptoms of IBS, particularly bloating and diarrhea, the quality of the evidence is lower than optimal, due to frequent methodological flaws, particularly lack of a proper control group and/or lack of blinding. In particular, it remains to be proven whether this regimen is superior to conventional IBS diets. The drastic reduction of FODMAP intake has physiological consequences, e.g., on the intestinal microbiome and colonocyte metabolism, which are still poorly understood. A low-FODMAP diet imposes an important restriction of dietary choices due to the elimination of some staple foods, such as wheat derivatives, lactose-containing dairy products, many vegetables and pulses, and several types of fruits. For this reason, patients may be at risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins, and natural antioxidants. The nutritional risk of the low-FODMAP diet may be higher in persons with limited access to the expensive, alternative dietary items included in the low-FODMAP diet.

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“…62 However, in a feeding study there was no difference in SCFA production between baseline and following a low-FODMAP diet. 62 However, in a feeding study there was no difference in SCFA production between baseline and following a low-FODMAP diet.…”

Section: P Otential Inter Ac Ti On Of Die Tary Fodmaps and The Micrmentioning

confidence: 92%

“…61 In concordance, an increase in cytokine production caused by stress was prevented with the low-FODMAP diet in rats. 62 In a feeding study there was no difference in SCFA production between baseline and following a low-FODMAP diet. 62 In a feeding study there was no difference in SCFA production between baseline and following a low-FODMAP diet.…”

Section: All Fodmaps Combinedmentioning

confidence: 93%

Review article: biological mechanisms for symptom causation by individual FODMAP subgroups ‐ the case for a more personalised approach to dietary restriction

Wang

Camilleri

Vanner

et al. 2019

Aliment Pharmacol Ther

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Background: Due to the paucity of targeted therapy for irritable bowel syndrome (IBS), many patients turn to dietary modifications for symptom management. The combination of five subgroups of poorly absorbed and rapidly fermented carbohydrates-fructans, galacto-oligosaccharides, lactose, excess fructose and polyolsare thought to trigger gastrointestinal symptoms and are referred to collectively as "FODMAPs". Aims:To examine the biological plausibility and mechanisms by which foods high in specific FODMAP subgroups cause symptoms, and to use this information to explore the possibility of targeting select dietary components to allow for a more personalised approach to dietary adjustment Methods: Recent literature was analysed via search databases including Medline, PubMed and Scopus.Results: Lactose, fructans and galacto-oligosaccharides have strong biologic plausibility for symptom generation due to lack of hydrolases resulting in distention from osmosis and rapid fermentation. However, excess fructose and polyols may only cause symptoms in specific individuals when consumed in high doses, but this remains to be established. There is evidence to suggest that certain patient characteristics such as ethnicity may predict response to lactose, but differentiation of other subgroups is difficult prior to dietary manipulation. Conclusions:While some clear mechanisms of action for symptom generation have been established, further research is needed to understand which patients will respond to specific FODMAP subgroup restriction. We suggest that clinicians consider in some patients a tailored, personalised "bottom-up" approach to the low-FODMAP diet, such as dietary restriction relevant to the patients' ethnicity, symptom profile and usual dietary intake.

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Fecal Fermentation in Irritable Bowel Syndrome: Influence of Dietary Restriction of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols

Cited by 55 publications

References 33 publications

Dietary and pharmacological treatment of abdominal pain in IBS

Dietary and pharmacological treatment of abdominal pain in IBS

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

Review article: biological mechanisms for symptom causation by individual FODMAP subgroups ‐ the case for a more personalised approach to dietary restriction

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