Ali Ather, Weiss Theresa R, McKee Douglas, Scherban Alisa, Khan Sumiya, Fields Maxine R, Apollo Damian, Mehal Wajahat Z
School of Medicine, Yale University, New Haven, Connecticut, USA.
Department of Economics, Cornell University, Ithaca, New York, USA.
BMJ Open Gastroenterol. 2017 Sep 20;4(1):e000164. doi: 10.1136/bmjgast-2017-000164. eCollection 2017.
Patients with irritable bowel syndrome (IBS) are often placed on diets guided by food intolerance assays, although these have not been validated. We assessed the effects of individualised diets in patients with IBS guided by a leucocyte activation test.
This is a parallel-group, double-blind, randomised controlled trial of 58 adults with IBS seen at an academic health centre in Northeast USA. Peripheral venous blood was analysed using a leucocyte activation test; individual foods were reported to produce positive or negative results. Participants were randomised to a 4-week diet with either individualised guidance to eliminate foods with positive assay results and allow foods with negative assay results (intervention), or with individualised guidance, matched in rigour and complexity, to eliminate foods with negative assay results and allow foods with positive assay results (comparison). The primary outcome was between-group differences in the IBS Global Improvement Scale (GIS). Secondary outcomes included reductions in IBS Symptom Severity Scale (SSS) scores and increases in IBS Adequate Relief (AR) and Quality of Life (QOL) scores. An aptamer-based proteomic analysis was conducted in strong responders.
The intervention group had significantly greater increases in mean GIS score after 4 weeks (0.86 vs comparison; 95% CI 0.05 to 1.67; p=0.04) and 8 weeks (1.22 vs comparison; 95% CI 0.22 to 2.22; p=0.02). The intervention group also had significantly greater reductions in mean SSS score at 4 weeks (-61.78 vs comparison; 95% CI -4.43 to -119.14; p=0.04) and 8 weeks (-66.42 vs comparison; 95% CI -5.75 to -127.09; p=0.03). There were no significant differences between intervention and comparison groups in mean AR or QOL scores. A reduction in neutrophil elastase concentration was associated with reduced symptoms.
Elimination diets guided by leucocyte activation tests reduced symptoms. These findings could lead to insights into the pathophysiology of IBS.
NCT02186743.
肠易激综合征（IBS）患者常依据食物不耐受检测结果来安排饮食，尽管这些检测方法尚未得到验证。我们评估了在白细胞活化试验指导下的个体化饮食对IBS患者的影响。
这是一项平行组、双盲、随机对照试验，研究对象为美国东北部一家学术健康中心的58名成年IBS患者。采用白细胞活化试验分析外周静脉血；报告每种食物产生阳性或阴性结果。参与者被随机分为两组，进行为期4周的饮食干预：一组接受个体化指导，排除检测结果为阳性的食物，允许食用检测结果为阴性的食物（干预组）；另一组接受在严格程度和复杂性上与之匹配的个体化指导，排除检测结果为阴性的食物，允许食用检测结果为阳性的食物（对照组）。主要结局指标是两组在IBS全球改善量表（GIS）上的差异。次要结局指标包括IBS症状严重程度量表（SSS）评分的降低以及IBS充分缓解（AR）和生活质量（QOL）评分的提高。对反应强烈者进行了基于适配体的蛋白质组学分析。
干预组在4周后（0.86对对照组；95%可信区间0.05至1.67；p = 0.04）和8周后（1.22对对照组；95%可信区间0.22至2.22；p = 0.02）的平均GIS评分显著升高。干预组在4周时（-61.78对对照组；95%可信区间-4.43至-119.14；p = 0.04）和8周时（-66.42对对照组；95%可信区间-5.75至-127.09；p = 0.03）的平均SSS评分也显著降低。干预组和对照组在平均AR或QOL评分上无显著差异。中性粒细胞弹性蛋白酶浓度的降低与症状减轻相关。
在白细胞活化试验指导下的排除饮食可减轻症状。这些发现可能有助于深入了解IBS的病理生理学。
NCT02186743。
