Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples 80131, Italy.
World J Gastroenterol. 2020 Feb 7;26(5):456-465. doi: 10.3748/wjg.v26.i5.456.
Hypervigilance and symptoms anticipation, visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia (FD) patients. Many patients recognize meals as the main triggering factor; thus, dietary manipulations often represent the first-line management strategy in this cohort of patients. Nonetheless, scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms, resulting in non-standardized nutritional approaches. Most dietary advises are indeed empirical and often lead to exclusion diets, reinforcing in patients the perception of "being intolerant" to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology (., hypervigilance and symptom anticipation). Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals (., dietitians) are only available in tertiary referral settings. This in turn, can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia. In this review, we aim at evaluating the relationship between dietary habits, macronutrients and specific foods in determining FD symptoms. We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients, providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.
过度警觉和症状预期、内脏高敏性以及胃十二指肠感觉运动异常是功能性消化不良 (FD) 患者临床表现多样的原因。许多患者将进餐视为主要诱发因素；因此，饮食调整通常是该类患者的一线治疗策略。然而，关于特定食物和/或宏量营养素与 FD 症状发作之间的关系，仅有少量高质量证据，导致营养方法不规范。大多数饮食建议实际上是经验性的，往往导致排除饮食，使患者更加觉得自己对食物“不耐受”，从而自我强化了消化不良病理生理学的一些机制（如过度警觉和症状预期）。临床医生通常不确定特定食物对消化不良病理生理学的贡献，而且只有在三级转诊机构才有专业的营养师。这反过来又会导致营养不均衡的饮食，甚至在严重消化不良患者中鼓励限制饮食行为。在本次综述中，我们旨在评估饮食习惯、宏量营养素和特定食物在确定 FD 症状中的关系。我们将概述应在这些患者中采用的循证营养方法，为临床医生提供标准化营养建议的有价值工具，并防止患者进行不分青红皂白的食物排除。
