Bristol Medical School, University of Bristol, Bristol, UK.
Department of Pharmacy and Pharmacology, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases (part of Royal United Hospitals Bath NHS Foundation Trust), Upper Borough Walls, BA1, 1RL Bath, UK.
Semin Arthritis Rheum. 2019 Aug;49(1):112-118. doi: 10.1016/j.semarthrit.2018.12.001. Epub 2018 Dec 6.
Gastrointestinal involvement in systemic sclerosis is common and a major cause of disease-related morbidity. Patients increasingly enquire about dietary modifications that may help with gastrointestinal symptoms. Many clinical practice reviews and treatment guidelines make specific reference to dietary modifications in the management of gastrointestinal involvement in systemic sclerosis. We report the findings of a systematic literature review designed to evaluate the evidence to support dietary modification in the management of gastrointestinal symptoms of systemic sclerosis.
A systematic literature review protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International prospective register of systematic reviews (CRD42018103549). Standardised searches of EMBASE and MEDLINE were undertaken to identify studies reporting the outcome of dietary modification in the management of gastrointestinal symptoms of systemic sclerosis. Wide heterogeneity in study design, interventions and study outcomes necessitated a qualitative data synthesis.
Our standardised searches identified 1032 articles, of which 3 were deemed eligible for full data extraction. These studies were small (mean 19 subjects per study), single centre, short-term (mean 6 week duration) open-label non-randomised studies examining the role of probiotics, low-fermentable oligo-saccharides, disaccharides, monosaccharides, and polyol (low-FODMAP) diet and highly individualised medical nutrition therapy counselling, respectively. Improvements in patient-reported outcome assessment of gastrointestinal symptoms were reported after intervention with probiotic therapy and low-FODMAP diet but not following tailored dietary and nutritional counselling. The Risk of Bias Assessment Tool for Nonrandomized Studies identified high risk-of-bias for confounding variables and blinding of assessors in each of the three studies evaluated.
The evidence-base to support dietary modification for gastrointestinal involvement in systemic sclerosis is currently limited and clinical practice guidelines should take a measured approach to such recommendations. The emergence of large patient registries could facilitate the capture of vital practice-based evidence regarding the efficacy of dietary modification in the management of gastrointestinal involvement in systemic sclerosis to inform future clinical practice guidelines.
系统性硬化症（硬皮病）常累及胃肠道，是导致相关疾病发病率升高的主要原因。患者越来越多地询问可能有助于缓解胃肠道症状的饮食调整方法。许多临床实践综述和治疗指南都专门针对饮食调整在系统性硬化症胃肠道受累管理中的作用进行了说明。我们报告了一项系统文献综述的结果，旨在评估支持饮食调整用于管理系统性硬化症胃肠道症状的证据。
根据系统评价和荟萃分析的首选报告项目制定了系统文献综述方案，并在国际前瞻性系统评价登记处（CRD42018103549）进行了注册。通过标准的 EMBASE 和 MEDLINE 检索，确定了报告饮食调整对系统性硬化症胃肠道症状管理效果的研究。由于研究设计、干预措施和研究结果存在广泛的异质性，因此需要进行定性数据综合。
我们的标准检索共确定了 1032 篇文章，其中 3 篇被认为符合全文数据提取标准。这些研究规模较小（每项研究平均 19 例受试者），均为单中心、短期（平均 6 周）、开放标签、非随机研究，分别考察了益生菌、低发酵寡糖、双糖、单糖和多元醇（低 FODMAP）饮食以及高度个体化的医学营养治疗咨询在治疗中的作用。益生菌治疗和低 FODMAP 饮食干预后，患者报告的胃肠道症状的评估结果得到了改善，但个性化饮食和营养咨询后则没有改善。非随机研究的偏倚风险评估工具发现，在评估的三项研究中，均存在混杂变量和评估者的偏倚高风险。
目前，支持饮食调整用于治疗系统性硬化症胃肠道受累的证据有限，临床实践指南应谨慎对待此类建议。大型患者登记处的出现可能有助于获取有关饮食调整在管理系统性硬化症胃肠道受累方面疗效的重要基于实践的证据，为未来的临床实践指南提供信息。
