The low‐FODMAP diet in the management of functional dyspepsia in East and Southeast Asia

Tan, Victoria P.

doi:10.1111/jgh.13697

Cited by 34 publications

(22 citation statements)

References 53 publications

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“…In humans, indirect evidence of the presence of cologastric reflex comes from few studies—a study including IBS patients that reported increased upper GI symptoms with high FODMAP diet 28 ; a pediatric study demonstrating reduction of dyspeptic symptoms with relief of constipation by laxatives 29 ; and a recent study reporting relief of dyspeptic symptoms in FD patients after Rifaximin induced change in colonic microbiota 30 . Secondly, decreased short chain fatty acids production in colon with LFD, could lead to decreased chemoreceptor stimulation and modulation of immune response 17 . Also, reduction in osmotic pressure and gas production might lead to decrease stimulation of upper GI neural system, which is in a state of hypersensitivity in FD patients 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Low FODMAP diet (LFD) has proven to be effective in IBS patients in numerous prospective trials including a recent one in our population 15,16 . Dietary restriction of FODMAPs has been shown to improve DGBI symptoms in three out of four patients, 14 and LFD has been proposed to be beneficial in FD 17 . We planned this prospective, randomized trial to assess the efficacy of LFD in improving symptoms and QoL in patients with FD, compared with TDA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Nohria

Batta

Dhaliwal

et al. 2021

J of Gastro and Hepatol

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Background and Aim Prospective trials evaluating efficacy of specific diet restriction in functional dyspepsia (FD) are scarce. We aimed to assess efficacy of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet in FD, compared with traditional dietary advice (TDA). Methods In this prospective, single‐blind trial, patients with FD (Rome IV) were randomized into low FODMAP diet (LFD) and TDA groups, for 4 weeks (phase I). In phase II (4–12 weeks), LFD group was advised systematic re‐introduction of FODMAPs. Symptom severity and quality of life were assessed using “Short‐Form Nepean Dyspepsia Index (SF‐NDI).” Primary outcome was symptomatic response (symptom score reduction of ≥ 50%), at 4 weeks. Study was registered with CTRI (2019/06/019852). Results Of 184 patients screened, 105 were randomized to LFD (n = 54) and TDA (n = 51) groups. At 4 weeks, both groups showed significant reduction in SF‐NDI symptom scores compared with baseline, with no significant difference in inter‐group response rates [LFD: 66.7% (36/54); TDA: 56.9% (29/51); P = 0.32]. On sub‐group analysis, patients with postprandial distress syndrome or bloating had significantly better symptomatic response with LFD (P = 0.04). SF‐NDI quality of life scores improved significantly in both groups. On multivariate analysis, factors predicting response to LFD were bloating and male gender. Incidences of adverse events (minor) were similar in both groups. Conclusions In patients with FD, LFD and TDA lead to significant symptomatic and quality of life improvement. Patients with postprandial distress syndrome or bloating respond significantly better to LFD. Therefore, dietary advice for FD should be individualized according to FD subtype.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Nohria

Batta

Dhaliwal

et al. 2021

J of Gastro and Hepatol

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“…Studies have noted that a low FODMAP diet can improve both diarrhea and constipation [4], although less data is available for the constipation predominant subtype. More recently, studies have suggested that FODMAPs may alter upper GI motility, affecting intra-gastric pressure [20] and may be useful in the management of functional dyspepsia [21]. Extra-intestinal symptoms have not been well studied with the low FODMAP diet, although fatigue has also been noted to improve [22].…”

Section: Sensitivities (Non-allergic)mentioning

confidence: 99%

Food Intolerances

et al. 2019

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Food intolerances are estimated to affect up to 20% of the population but complete understanding of diagnosis and management is complicated, given presentation and non-immunological mechanisms associated vary greatly. This review aims to provide a scientific update on common food intolerances resulting in gastrointestinal and/or extra-intestinal symptoms. FODMAP sensitivity has strong evidence supporting its mechanisms of increased osmotic activity and fermentation with the resulting distention leading to symptoms in those with visceral hypersensitivity. For many of the other food intolerances reviewed including non-coeliac gluten/wheat sensitivity, food additives and bioactive food chemicals, the findings show that there is a shortage of reproducible well-designed double-blind, placebo-controlled studies, making understanding of the mechanisms, diagnosis and management difficult. Enzyme deficiencies have been proposed to result in other food sensitivities including low amine oxidase activity resulting in histamine intolerance and sucrase-isomaltase deficiency resulting in reduced tolerance to sugars and starch. Lack of reliable diagnostic biomarkers for all food intolerances result in an inability to target specific foods in the individual. As such, a trial-and-error approach is used, whereby suspected food constituents are reduced for a short-period and then re-challenged to assess response. Future studies should aim to identify biomarkers to predict response to dietary therapies.

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“…FD patients commonly complain symptoms related to food ingestion, including gluten and FODMAPs [96], and dietary intervention can be used to treat these patients [97].…”

Section: Symptoms Of Dgbi In Patients With Ncgsmentioning

confidence: 99%

Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

et al. 2020

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Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut–brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut–brain interaction.

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The low‐FODMAP diet in the management of functional dyspepsia in East and Southeast Asia

Cited by 34 publications

References 53 publications

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols dietversustraditional dietary advice for functional dyspepsia: a randomized controlled trial

Food Intolerances

Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

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