Department Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia.
Am J Gastroenterol. 2018 Jan;113(1):124-134. doi: 10.1038/ajg.2017.245. Epub 2017 Aug 15.
Galacto-oligosaccharides (GOS) are dietary FODMAPs (fermentable carbohydrates) associated with triggering gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). This randomized, double-blind, placebo-controlled, cross-over trial aimed to assess whether oral α-galactosidase co-ingestion with foods high in GOS and low in other FODMAPs would reduce symptoms.
Patients meeting the Rome III criteria for IBS who were hydrogen-producers on breath testing were recruited. Participants were treated with full-dose (300 GALU (galactosidic units) α-galactosidase) and half-dose enzyme (150 GALU α-galactosidase), and placebo (glucose) in a random order with ≤14 days washout between arms. Following a 3-day low FODMAP run-in period, participants consumed provided diets high in GOS for a further 3-days. Gastrointestinal symptoms were measured daily using a 100 mm visual-analogue-scale, and breath samples taken hourly on the second last day with hydrogen content analysed as area-under-the-curve.
Thirty-one patients with IBS (20 IBS-D, 4 IBS-C, 7 IBS-M) completed the study. The addition of high GOS foods resulted in a significant increase in overall symptoms with 21 patients exhibiting GOS-sensitivity (>10 mm increase for overall symptoms). Of those, full-dose enzyme reduced overall symptoms (median 24. 5(IQR 17.5-35.8) vs. 5.5(1.5-15.0) mm; P=0.006) and bloating (20.5(9.5-42.0) vs. 6.5(2.0-15.8); P=0.017). Breath hydrogen production was minimal with no differences seen between placebo and full-dose (P=0.597).
Oral α-galactosidase taken with high GOS foods provides a clinically significant reduction in symptoms in GOS-sensitive individuals with IBS. This strategy can be translated into practice to improve tolerance to high GOS foods as an adjunct therapy to the low FODMAP diet.
半乳糖寡糖（GOS）是可发酵碳水化合物（FODMAPs），可引发肠易激综合征（IBS）患者的胃肠道症状。这项随机、双盲、安慰剂对照、交叉试验旨在评估口服α-半乳糖苷酶与富含 GOS 且其他 FODMAP 含量低的食物同时摄入是否能减轻症状。
招募符合 Rome III 标准的 IBS 患者，这些患者在氢呼气试验中是产氢者。参与者分别接受全剂量（300 GALU（半乳糖单位）α-半乳糖苷酶）、半剂量酶（150 GALU α-半乳糖苷酶）和安慰剂（葡萄糖）治疗，每种治疗方案之间间隔≤14 天。在进行为期 3 天的低 FODMAP 预适应期后，参与者进一步连续 3 天摄入提供的富含 GOS 的饮食。使用 100mm 视觉模拟量表每天测量胃肠道症状，在最后两天的前一天每小时采集呼气样本，通过分析曲线下面积来测量氢含量。
31 名 IBS 患者（20 名 IBS-D、4 名 IBS-C、7 名 IBS-M）完成了这项研究。添加富含 GOS 的食物会导致整体症状显著增加，其中 21 名患者表现出 GOS 敏感性（整体症状增加>10mm）。在这些患者中，全剂量酶可减轻整体症状（中位数 24.5（IQR 17.5-35.8） vs. 5.5（1.5-15.0）mm；P=0.006）和腹胀（20.5（9.5-42.0） vs. 6.5（2.0-15.8）；P=0.017）。呼气氢生成量很少，安慰剂与全剂量之间无差异（P=0.597）。
口服α-半乳糖苷酶与富含 GOS 的食物同时摄入可显著减轻 GOS 敏感型 IBS 患者的症状。这种策略可以转化为实践，作为低 FODMAP 饮食的辅助疗法，提高对高 GOS 食物的耐受性。
