Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.
Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK.
J Intern Med. 2019 Nov;286(5):490-502. doi: 10.1111/joim.12966. Epub 2019 Aug 29.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo-, di-, mono- saccharides and polyols (FODMAPs) diet and (iii) the gluten-free diet (GFD). Although traditional dietary advice is considered as the first-line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short-term, with some emerging data on the long-term 'adapted' low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets - such as the low FODMAP and GFD - may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.
肠易激综合征（IBS）是一种常见的功能性胃肠道疾病，影响约 10%的人口。饮食在绝大多数 IBS 患者中引发症状。鉴于此，人们一直关注饮食在 IBS 中的作用。目前针对 IBS 的饮食包括：（i）传统饮食建议，（ii）低可发酵寡糖、二糖、单糖和多元醇（FODMAP）饮食，和（iii）无麸质饮食（GFD）。虽然传统饮食建议被认为是一线饮食疗法，但它的证据基础是可变的，只有少数随机对照试验（RCT）探索了这种方法的疗效，而不仅仅是针对纤维。现在有越来越多的 RCT 证明了低 FODMAP 饮食在短期内的疗效，并且有一些关于长期“适应”低 FODMAP 饮食的新兴数据。也有几项 RCT 表明 GFD 在 IBS 中的益处；然而，由于作用机制不确定，这个概念存在不确定性。尽管如此，所有这些饮食疗法都是 IBS 患者的可行选择，营养师和患者的参与是取得成功的关键。然而，需要未来进行实用的研究来阐明这些不同饮食在常规生活中的比较疗效和便利性。此外，必须更好地阐明一个问题，即限制饮食——如低 FODMAP 和 GFD——可能会导致营养不足、饮食行为紊乱，并导致肠道微生物群的不利变化。
