Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Children's Nutrition Research Center, Houston, Texas.
Clin Gastroenterol Hepatol. 2018 Feb;16(2):219-225.e1. doi: 10.1016/j.cgh.2017.09.043. Epub 2017 Sep 29.
BACKGROUND & AIMS: Dietary fructans exacerbate symptoms in some, but not all, adults with irritable bowel syndrome (IBS). We sought to determine whether fructans worsen symptoms in children with IBS and whether clinical and psychosocial factors, and/or gas production, can identify those who are fructan sensitive. METHODS: We performed a double-blind placebo-controlled (maltodextrin) cross-over trial of 23 children with IBS, based on pediatric Rome III criteria, from September 2014 through December 2016. At baseline, participants completed 1-week pain and stool diaries and a 3-day food record and psychosocial factors (depression, anxiety, and somatization) were measured. Subjects were randomly assigned to groups that were provided meals for 72 hours containing either fructans or maltodextrin (0.5 g/kg; maximum, 19 g). Following a washout period of 10 days or more, the subjects received the meal they were not given during the first study period (crossed over). Gastrointestinal symptoms and breath hydrogen and methane production were captured during each meal period. Fructan sensitivity was defined as an increase of 30% or more in abdominal pain frequency following fructan ingestion. RESULTS: Subjects had more mean episodes of abdominal pain/day during the fructan-containing diet (3.4 ± 2.6) vs the maltodextrin-containing diet (2.4 ± 1.7) (P < .01), along with more severe bloating (P < .05) and flatulence (P = .01). Hydrogen (but not methane) production was greater while subjects were on the fructan-containing diet (617 ± 305 ppm∗h) than the maltodextrin-containing diet (136 ± 78 ppm*h) (P < .001). Eighteen subjects (78.2%) had more frequent abdominal pain while on the fructan-containing diet and 12 (52.2%) qualified as fructan sensitive. We found no difference between fructan-sensitive and fructan-insensitive subjects in baseline abdominal pain or bowel movement characteristics, dietary intake, psychosocial parameters, IBS subtype, or gas production. CONCLUSIONS: In a randomized controlled trial of children with IBS, we found fructans to exacerbate several symptoms. However, fructan sensitivity cannot be identified based on baseline gastrointestinal symptoms, dietary intake, psychosocial factors, or gas production. Clinicaltrials.gov no: NCT02842281.
背景与目的：膳食中的果聚糖会使某些，但不是所有，肠易激综合征（IBS）患者的症状加重。我们旨在确定果聚糖是否会使 IBS 患儿的症状恶化，以及临床和社会心理因素，和/或气体生成，是否可以识别出那些对果聚糖敏感的人。
方法：我们于 2014 年 9 月至 2016 年 12 月，基于儿科罗马 III 标准，对 23 名 IBS 患儿进行了一项双盲安慰剂对照（麦芽糊精）交叉试验。在基线时，参与者完成了为期 1 周的疼痛和排便日记以及为期 3 天的食物记录，并测量了社会心理因素（抑郁、焦虑和躯体化）。受试者被随机分配到两组，两组均接受为期 72 小时的含有果聚糖或麦芽糊精（0.5 g/kg；最大量 19 g）的膳食。在 10 天或更长的洗脱期后，受试者接受他们在第一研究期间未接受的膳食（交叉）。在每次膳食期间，均采集胃肠道症状和呼气氢和甲烷生成情况。将摄入果聚糖后腹痛频率增加 30%或更多定义为果聚糖敏感性。
结果：与摄入麦芽糊精饮食相比，受试者在摄入果聚糖饮食时的平均腹痛发作次数更多（3.4 ± 2.6 vs 2.4 ± 1.7）（P <.01），腹胀（P <.05）和肠胃气胀（P =.01）更严重。当受试者摄入果聚糖饮食时，氢（但不是甲烷）的产生更多（617 ± 305 ppm∗h），而摄入麦芽糊精饮食时（136 ± 78 ppm*h）（P <.001）。18 名受试者（78.2%）在摄入果聚糖饮食时腹痛更频繁，12 名受试者（52.2%）被认定为果聚糖敏感。在基线腹痛或排便特征、饮食摄入、社会心理参数、IBS 亚型或气体产生方面，我们未发现果聚糖敏感和非敏感受试者之间存在差异。
结论：在一项针对 IBS 患儿的随机对照试验中，我们发现果聚糖会加重几种症状。然而，无法根据基线胃肠道症状、饮食摄入、社会心理因素或气体生成来识别果聚糖敏感性。临床试验.gov 编号：NCT02842281。
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