Croagh Catherine, Shepherd Susan J, Berryman Melissa, Muir Jane G, Gibson Peter R
Department of Gastroenterology and Monash University Department of Medicine, Box Hill Hospital, Victoria, Australia.
Inflamm Bowel Dis. 2007 Dec;13(12):1522-8. doi: 10.1002/ibd.20249.
Poorly absorbed short-chain carbohydrates (FODMAPs) in the diet should, by virtue of their osmotic effects, increase fecal output following colectomy and ileal pouch formation or ileorectal anastomosis (IRA). The aim was to perform a proof-of-concept evaluation of this hypothesis.
Fifteen patients (13 pouch, 2 IRA) had dietary and symptomatic evaluation before and during a low FODMAP diet. Carbohydrate malabsorption was evaluated by breath tests. Pouchitis was assessed clinically/endoscopically or by fecal lactoferrin.
Of 8 patients with a breath hydrogen response to lactulose, 7 had fructose malabsorption, 3 with lactose malabsorption, and 1 had lactose malabsorption alone. Five of 7 studied retrospectively improved stool frequency (from median 8 to 4 per day; P = 0.02), this being sustained over 0.5-3 years of follow-up. Five of 8 patients completed a prospective arm of the study. One patient had sustained improvement in stool frequency and 1 had reduced wind production. Overall, none of 8 patients who had pouchitis improved. In contrast, median daily stool frequency fell from 8 to 4 (P = 0.001) in the 7 without pouchitis. The degree of change in FODMAP intake also predicted response. There was a tendency for pouchitis to be associated with low baseline FODMAP intake.
There is a high prevalence of carbohydrate malabsorption in these patients. Reduction of the intake of FODMAPs may be efficacious in reducing stool frequency in patients without pouchitis, depending on dietary adherence and baseline diet.
饮食中吸收不良的短链碳水化合物（FODMAPs），因其渗透作用，应会在结肠切除术后、回肠储袋成形术或回肠直肠吻合术（IRA）后增加粪便量。本研究旨在对这一假说进行概念验证评估。
15例患者（13例为回肠储袋患者，2例为IRA患者）在低FODMAP饮食前及饮食期间接受了饮食和症状评估。通过呼气试验评估碳水化合物吸收不良情况。通过临床/内镜检查或粪便乳铁蛋白评估储袋炎。
在8例对乳果糖有呼气氢气反应的患者中，7例存在果糖吸收不良，3例存在乳糖吸收不良，1例仅存在乳糖吸收不良。7例回顾性研究患者中有5例粪便频率改善（从每日中位数8次降至4次；P = 0.02），在0.5 - 3年的随访中持续改善。8例患者中有5例完成了前瞻性研究。1例患者粪便频率持续改善，1例患者产气减少。总体而言，8例患有储袋炎的患者均未改善。相比之下，7例无储袋炎的患者每日粪便中位数频率从8次降至4次（P = 0.001）。FODMAP摄入量的变化程度也可预测反应。储袋炎倾向于与低基线FODMAP摄入量相关。
这些患者中碳水化合物吸收不良的患病率较高。减少FODMAPs的摄入量可能对减少无储袋炎患者的粪便频率有效，这取决于饮食依从性和基线饮食情况。
