Eastern Health Clinical School, Monash University and Eastern Health, Box Hill, Victoria, Australia.
J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:128-31. doi: 10.1111/j.1440-1746.2011.06650.x.
Food-related symptoms are commonly described by patients with functional bowel disorders, but dietary change as an evidence-based therapy has not been part of routine management strategies. This reviews aims to discuss strategies commonly applied.
Published literature was reviewed.
Traditional approaches involve elimination diets followed by placebo-controlled reintroduction of specific foods, which is tedious at best and not applied in routine practice. Pathogenically-based approaches include determining what food components are inducing food hypersensitivity responses using specific biomarkers, but this is probably applicable to a small proportion of patients only and has met with only limited success. Food bioactive chemicals, such as salicylates, have been targeted, but there is a paucity of quality evidence for or against this approach. In contrast, targeting poorly absorbed dietary components that might induce luminal distension via osmotic effects and rapid fermentation (FODMAPs) has been successful and the efficacy of the dietitian-delivered low FODMAP diet is now supported by high quality evidence. Improvement of all symptoms of FBD in three out of four patients has been achieved. The diet may potentially improve stool frequency in patients with an ileal pouch or a high output ileostomy, or functional symptoms in patients with inflammatory bowel disease. FODMAPs in enteral formulas may also be responsible for diarrhoea induced by enteral nutrition.
Dietary restriction of FODMAPs is an effective therapy in the majority of patients with functional bowel symptoms and, provided dietitians are trained in the technique, should be first line therapy.
功能性肠病患者常描述与食物相关的症状，但饮食改变作为一种基于证据的治疗方法尚未纳入常规管理策略。本综述旨在讨论常用的策略。
回顾已发表的文献。
传统方法包括进行排除饮食，然后进行安慰剂对照的特定食物再引入，这在最好的情况下也很繁琐，且并未在常规实践中应用。基于发病机制的方法包括使用特定的生物标志物确定哪些食物成分引起食物过敏反应，但这可能仅适用于一小部分患者，并且仅取得了有限的成功。食物生物活性化学物质，如水杨酸盐，已成为目标，但针对这种方法的高质量证据很少。相比之下，针对可能通过渗透作用和快速发酵引起腔扩张的不易吸收的饮食成分（低 FODMAP 饮食）已取得成功，并且营养师提供的低 FODMAP 饮食的疗效现在得到了高质量证据的支持。四分之三的患者的所有功能性肠病症状都得到了改善。该饮食可能潜在地改善回肠造口或高输出回肠造口患者的粪便频率，或改善炎症性肠病患者的功能性症状。肠内配方中的 FODMAP 也可能导致肠内营养引起的腹泻。
限制 FODMAP 饮食是大多数功能性肠病症状患者的有效治疗方法，并且只要营养师接受过该技术的培训，就应该作为一线治疗方法。
