Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
Curr Opin Psychiatry. 2020 Sep;33(5):460-466. doi: 10.1097/YCO.0000000000000628.
This review summarizes recent progress in the diagnosis and management of irritable bowel syndrome, with a focus on dietary and microbiota aspects.
From a pathophysiological point of view, IBS is a multifactorial condition with both peripheral (transit) as central (visceral hypersensitivity, anxiety, depression) contribution in a cumulative fashion to the symptom pattern and severity. More recently, the focus has shifted to diet and microbiota. The number of dietary options that can be used for IBS and the understanding of determinants of their efficacy is rapidly increasing. Several studies have confirmed the efficacy of the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet. Sucrose-isomaltase deficiency has emerged as pathogenetic mechanisms in a subset of patients, who do not respond to low FODMAP diet but may respond to starch and sucrose elimination. Herbal remedies, probiotics and secretagogues have been the topic of additional treatment trials. The efficacy of fecal microbiota transplantation in IBS is variable across studies, but donor selection is emerging as a critical factor.
Irritable bowel syndrome has evolved into a disorder of interaction between dietary factors and gut microbiota, with impact on bowel symptoms as well as extra-intestinal, central, symptoms. Dietary adjustments and treatments targeting the gut microbiota are areas of active research and clinical progress.
本文总结了近年来肠易激综合征（IBS）的诊断和治疗进展，重点关注饮食和微生物群方面。
从病理生理学的角度来看，IBS 是一种多因素疾病，外周（转运）和中枢（内脏高敏性、焦虑、抑郁）均以累积的方式对症状模式和严重程度产生影响。最近，研究重点转移到饮食和微生物群。可用于 IBS 的饮食选择数量及其疗效决定因素的理解正在迅速增加。多项研究证实了低发酵寡糖、双糖、单糖和多元醇（FODMAP）饮食的疗效。蔗糖-异麦芽糖酶缺乏症已成为一部分患者的发病机制，这些患者对低 FODMAP 饮食无反应，但可能对淀粉和蔗糖的消除有反应。草药、益生菌和分泌素已成为其他治疗试验的主题。粪便微生物群移植在 IBS 中的疗效在不同研究中存在差异，但供体选择正在成为一个关键因素。
IBS 已演变为饮食因素和肠道微生物群相互作用的疾病，对肠道症状以及肠外、中枢症状均有影响。饮食调整和针对肠道微生物群的治疗是活跃的研究和临床进展领域。
