Section for Gastroenterology, Department of Medicine, Stord Helse-Fonna Hospital, Stord, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Indian J Gastroenterol. 2021 Apr;40(2):111-119. doi: 10.1007/s12664-020-01144-6. Epub 2021 Mar 5.
Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder that reportedly affects 5% to 20% of the world population. The etiology of IBS is not completely understood, but diet appears to play an important role in its pathophysiology. Asian diets differ considerably from those in Western countries, which might explain differences in the prevalence, sex, and clinical presentation seen between patients with IBS in Asian and Western countries. Dietary regimes such as a low-fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet and the modified National Institute for Health and Care Excellence (NICE) diet improve both symptoms and the quality of life in a considerable proportion of IBS patients. It has been speculated that diet is a prebiotic for the intestinal microbiota and favors the growth of certain bacteria. These bacteria ferment the dietary components, and the products of fermentation act upon intestinal stem cells to influence their differentiation into enteroendocrine cells. The resulting low density of enteroendocrine cells accompanied by low levels of certain hormones gives rise to intestinal dysmotility, visceral hypersensitivity, and abnormal secretion. This hypothesis is supported by the finding that changing to a low-FODMAP diet restores the density of GI cells to the levels in healthy subjects. These changes in gut endocrine cells caused by low-FODMAP diet are also accompanied by improvements in symptoms and the quality of life.
肠易激综合征（IBS）是一种慢性胃肠道（GI）疾病，据报道影响了世界人口的 5%至 20%。IBS 的病因尚不完全清楚，但饮食似乎在其病理生理学中起着重要作用。亚洲饮食与西方国家的饮食有很大的不同，这可能解释了亚洲和西方国家的 IBS 患者在患病率、性别和临床表现方面的差异。低发酵寡糖、二糖、单糖和多糖（FODMAP）饮食和改良的英国国家卫生与临床优化研究所（NICE）饮食等饮食方案可改善相当一部分 IBS 患者的症状和生活质量。有人推测饮食是肠道微生物群的益生元，有利于某些细菌的生长。这些细菌会发酵饮食成分，发酵产物作用于肠干细胞，影响其向肠内分泌细胞分化。由此产生的肠内分泌细胞密度低伴随着某些激素水平低会导致肠道运动障碍、内脏高敏感和异常分泌。这一假设得到了以下发现的支持：改为低 FODMAP 饮食会使 GI 细胞的密度恢复到健康受试者的水平。低 FODMAP 饮食引起的肠道内分泌细胞的这些变化也伴随着症状和生活质量的改善。
