Varjú Péter, Farkas Nelli, Hegyi Péter, Garami András, Szabó Imre, Illés Anita, Solymár Margit, Vincze Áron, Balaskó Márta, Pár Gabriella, Bajor Judit, Szűcs Ákos, Huszár Orsolya, Pécsi Dániel, Czimmer József
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
PLoS One. 2017 Aug 14;12(8):e0182942. doi: 10.1371/journal.pone.0182942. eCollection 2017.
BACKGROUND: Irritable bowel syndrome (IBS) and functional digestive tract disorders, e.g. functional bloating, carbohydrate maldigestion and intolerances, are very common disorders frequently causing significant symptoms that challenge health care systems. A low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) diet is one of the possible therapeutic approaches for decreasing abdominal symptoms and improving quality of life. OBJECTIVES: We aimed to meta-analyze data on the therapeutic effect of a low-FODMAP diet on symptoms of IBS and quality of life and compare its effectiveness to a regular, standard IBS diet with high FODMAP content, using a common scoring system, the IBS Symptom Severity Score (IBS-SSS). METHODS: A systematic literature search was conducted in PubMed, EMBASE and the Cochrane Library as well as in the references in a recent meta-analysis. Adult patients diagnosed with IBS according to the Rome II, Rome III, Rome IV or NICE criteria were included in the analysis. STATISTICAL METHODS: Mean differences with 95% confidence intervals were calculated from studies that contained means, standard deviation (SD) or mean differences and SD of differences and p-values. A random effect model was used because of the heterogeneity (Q test (χ2) and I2 indicator). A p-value of less than 0.05 was chosen to indicate a significant difference. RESULTS: The literature search yielded 902 publications, but only 10 were eligible for our meta-analysis. Both regular and low-FODMAP diets proved to be effective in IBS, but post-diet IBS-SSS values were significantly lower (p = 0.002) in the low-FODMAP group. The low-FODMAP diet showed a correlation with the improvement of general symptoms (by IBS-SSS) in patients with IBS. CONCLUSIONS: This meta-analysis provides high-grade evidence of an improved general symptom score among patients with irritable bowel syndrome who have maintained a low-FODMAP diet compared to those on a traditional IBS diet, therefore showing its superiority to regular IBS dietary therapy. These data suggest that a low-FODMAP diet with dietitian control can be a candidate for first-line therapeutic modality in IBS. Because of a lack of data, well-planned randomized controlled studies are needed to ascertain the correlation between improvement of separate key IBS symptoms and the effect of a low-FODMAP diet.
背景:肠易激综合征(IBS)以及功能性消化道疾病,如功能性腹胀、碳水化合物消化不良和不耐受,是非常常见的疾病,常常引发严重症状,给医疗保健系统带来挑战。低可发酵寡糖、双糖、单糖和多元醇(FODMAP)饮食是减轻腹部症状和改善生活质量的一种可能的治疗方法。 目的:我们旨在对低FODMAP饮食对IBS症状和生活质量的治疗效果数据进行荟萃分析,并使用常见的评分系统——IBS症状严重程度评分(IBS-SSS),将其有效性与高FODMAP含量的常规标准IBS饮食进行比较。 方法:在PubMed、EMBASE和Cochrane图书馆以及最近一项荟萃分析的参考文献中进行了系统的文献检索。根据罗马II、罗马III、罗马IV或英国国家卫生与临床优化研究所(NICE)标准诊断为IBS的成年患者纳入分析。 统计方法:从包含均值、标准差(SD)或均值差异及差异的SD和p值的研究中计算95%置信区间的均值差异。由于存在异质性(Q检验(χ2)和I2指标),使用随机效应模型。选择p值小于0.05表示有显著差异。 结果:文献检索共获得902篇出版物,但只有10篇符合我们的荟萃分析要求。常规饮食和低FODMAP饮食在IBS治疗中均被证明有效,但低FODMAP组饮食后的IBS-SSS值显著更低(p = 0.002)。低FODMAP饮食与IBS患者总体症状(通过IBS-SSS)的改善相关。 结论:这项荟萃分析提供了高级别证据,表明与传统IBS饮食的患者相比,坚持低FODMAP饮食的肠易激综合征患者总体症状评分有所改善,因此显示出其优于常规IBS饮食疗法。这些数据表明,在营养师指导下的低FODMAP饮食可以成为IBS一线治疗方式的候选方案。由于缺乏数据,需要精心设计的随机对照研究来确定IBS各关键症状的改善与低FODMAP饮食效果之间的相关性。
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