Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy.
Clinical and Experimental Medicine-Rheumatology Unit, University of Pisa, 56100 Pisa, Italy.
Nutrients. 2020 Nov 1;12(11):3368. doi: 10.3390/nu12113368.
Irritable Bowel Syndrome (IBS) is a very common functional gastrointestinal disease. Its pathogenesis is multifactorial and not yet clearly defined, and hence, its therapy mainly relies on symptomatic treatments. Changes in lifestyle and dietary behavior are usually the first step, but unfortunately, there is little high-quality scientific evidence regarding a dietary approach. This is due to the difficulty in setting up randomized double-blind controlled trials which objectively evaluate efficacy without the risk of a placebo effect. However, a Low Fermentable Oligo-, Di- and Mono-saccharides And Polyols (FODMAP) Diet (LFD) and Gluten Free Diet (GFD) are among the most frequently suggested diets. This paper aims to evaluate their possible role in IBS management. A GFD is less restrictive and easier to implement in everyday life and can be suggested for patients who clearly recognize gluten as a trigger of their symptoms. An LFD, being more restrictive and less easy to learn and to follow, needs the close supervision of a skilled nutritionist and should be reserved for patients who recognize that the trigger of their symptoms is not, or not only, gluten. Even if the evidence is of very low-quality for both diets, the LFD is the most effective among the dietary interventions suggested for treating IBS, and it is included in the most updated guidelines.
肠易激综合征(IBS)是一种非常常见的功能性胃肠道疾病。其发病机制是多因素的,尚未明确,因此其治疗主要依赖于对症治疗。改变生活方式和饮食行为通常是第一步,但不幸的是,关于饮食方法的高质量科学证据很少。这是由于设置客观评估疗效而没有安慰剂效应风险的随机双盲对照试验存在困难。然而,低可发酵寡糖、双糖、单糖和多元醇(FODMAP)饮食(LFD)和无麸质饮食(GFD)是最常推荐的饮食之一。本文旨在评估它们在 IBS 管理中的可能作用。GFD 限制较少,在日常生活中更容易实施,并且可以建议那些明确认识到麸质是其症状触发因素的患者使用。LFD 限制更多,更难学习和遵循,需要有经验的营养师密切监督,并且应该保留给那些认识到其症状的触发因素不是(或不仅是)麸质的患者。即使对于这两种饮食的证据质量都非常低,LFD 是治疗 IBS 所建议的饮食干预中最有效的方法,并且包含在最新的指南中。
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