Goyal Omesh, Nohria Sahil, Batta Shaveta, Dhaliwal Armaan, Goyal Prerna, Sood Ajit
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
Department of Dietetics, Dayanand Medical College and Hospital, Ludhiana, India.
J Gastroenterol Hepatol. 2022 Feb;37(2):301-309. doi: 10.1111/jgh.15694. Epub 2021 Oct 5.
Prospective trials evaluating efficacy of specific diet restriction in functional dyspepsia (FD) are scarce. We aimed to assess efficacy of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet in FD, compared with traditional dietary advice (TDA).
In this prospective, single-blind trial, patients with FD (Rome IV) were randomized into low FODMAP diet (LFD) and TDA groups, for 4 weeks (phase I). In phase II (4-12 weeks), LFD group was advised systematic re-introduction of FODMAPs. Symptom severity and quality of life were assessed using "Short-Form Nepean Dyspepsia Index (SF-NDI)." Primary outcome was symptomatic response (symptom score reduction of ≥ 50%), at 4 weeks. Study was registered with CTRI (2019/06/019852).
Of 184 patients screened, 105 were randomized to LFD (n = 54) and TDA (n = 51) groups. At 4 weeks, both groups showed significant reduction in SF-NDI symptom scores compared with baseline, with no significant difference in inter-group response rates [LFD: 66.7% (36/54); TDA: 56.9% (29/51); P = 0.32]. On sub-group analysis, patients with postprandial distress syndrome or bloating had significantly better symptomatic response with LFD (P = 0.04). SF-NDI quality of life scores improved significantly in both groups. On multivariate analysis, factors predicting response to LFD were bloating and male gender. Incidences of adverse events (minor) were similar in both groups.
In patients with FD, LFD and TDA lead to significant symptomatic and quality of life improvement. Patients with postprandial distress syndrome or bloating respond significantly better to LFD. Therefore, dietary advice for FD should be individualized according to FD subtype.
评估特定饮食限制对功能性消化不良（FD）疗效的前瞻性试验较少。我们旨在评估低可发酵寡糖、双糖、单糖和多元醇（FODMAP）饮食与传统饮食建议（TDA）相比，对FD的疗效。
在这项前瞻性单盲试验中，FD（罗马IV型）患者被随机分为低FODMAP饮食（LFD）组和TDA组，为期4周（第一阶段）。在第二阶段（4 - 12周），建议LFD组系统性重新引入FODMAPs。使用“短式内皮恩消化不良指数（SF - NDI）”评估症状严重程度和生活质量。主要结局是4周时的症状反应（症状评分降低≥50%）。该研究已在CTRI注册（2019/06/019852）。
在184例筛查患者中，105例被随机分为LFD组（n = 54）和TDA组（n = 51）。4周时，两组的SF - NDI症状评分与基线相比均显著降低，组间反应率无显著差异[LFD组：66.7%（36/54）；TDA组：56.9%（29/51）；P = 0.32]。亚组分析显示，餐后不适综合征或腹胀患者接受LFD治疗后的症状反应显著更好（P = 0.04）。两组的SF - NDI生活质量评分均显著改善。多因素分析显示，预测对LFD反应的因素是腹胀和男性性别。两组不良事件（轻微）发生率相似。
在FD患者中，LFD和TDA均可显著改善症状和生活质量。餐后不适综合征或腹胀患者对LFD的反应显著更好。因此，FD的饮食建议应根据FD亚型个体化制定。
