Turan Beril, Bengi Göksel, Cehreli Ruksan, Akpınar Hale, Soytürk Müjde
Department of Internal Medicine, Dokuz Eylül University, Izmir 35000, Turkey.
Department of Gastroenterology, Dokuz Eylul University Izmir, Izmir 35000, Turkey.
World J Clin Cases. 2021 Sep 6;9(25):7417-7432. doi: 10.12998/wjcc.v9.i25.7417.
There are various studies showing the relationship between irritable bowel syndrome (IBS) and diet, and some dietary adjustments are recommended to reduce symptoms. In recent years, there is a growing number of studies that show a 4-8 wk low fermentable oligo, di- and mono-saccharides and polyols (FODMAP) diet has a 50%-80% significant effect on symptoms in IBS patients. There is strong evidence suggesting that changes in fecal microbiota have an impact on IBS pathogenesis. Based on this argument, probiotics have been used in IBS treatment for a long time. As is seen, the FODMAP diet and probiotics are used separately in IBS treatment.
To evaluate the effectiveness of adding probiotics to a low FODMAP diet to control the symptoms in patients with IBS.
The patients who were admitted to the Gastroenterology Clinic of Dokuz Eylul University Hospital and diagnosed with IBS according to Rome IV criteria were enrolled into the study. They were randomized into 2 groups each of which consisted of 50 patients. All patients were referred to a dietitian to receive dietary recommendations for the low FODMAP diet with a daily intake of 9 g. The patients were asked to keep a diary of foods and beverages they consumed. The patients in Group 1 were given supplementary food containing probiotics (2 g) once a day in addition to their low FODMAP diet, while the patients in Group 2 were given a placebo once a day in addition to their low FODMAP diet. Visual analogue scale (VAS), the Bristol Stool Scale and IBS Symptom Severity Scale (IBS-SSS) scores were evaluated before and after the 21 d treatment.
The rate of adherence of 85 patients, who completed the study, to the FODMAP restricted diet was 92%, being 90% in Group 1 and 94% in Group 2. The mean scores of VAS and IBS-SSS of the patients in Group 1 before treatment were 4.6 2.7 and 310.0 78.4, respectively, and these scores decreased to 2.0 1.9 and 172.0 93.0 after treatment (both 0.001). The mean VAS and IBS-SSS scores of the patients in Group 2 before treatment were 4.7 2.7 and 317.0 87.5, respectively, and these scores decreased to 1.8 2.0 and 175.0 97.7 after treatment (both 0.001). The IBS-SSS score of 37 patients (86.04%) in Group 1 and 36 patients (85.71%) in Group 2 decreased by more than 50 points. Group 1 and Group 2 were similar in terms of differences in VAS and IBS-SSS scores before and after treatment. When changes in stool shape after treatment were compared using the Bristol Stool Scale, both groups showed significant change.
This study is the randomized controlled study to examine the efficiency of probiotic supplementation to a low FODMAP diet in all subtypes of IBS. The low FODMAP diet has highly positive effects on symptoms of all subtypes of IBS. It was seen that adding probiotics to a low FODMAP diet does not make an additional contribution to symptom response and adherence to the diet.
有多项研究表明肠易激综合征（IBS）与饮食之间的关系，并且推荐了一些饮食调整方法以减轻症状。近年来，越来越多的研究表明，为期4 - 8周的低可发酵寡糖、双糖和单糖及多元醇（FODMAP）饮食对IBS患者的症状有50% - 80%的显著改善效果。有强有力的证据表明粪便微生物群的变化会影响IBS的发病机制。基于这一观点，益生菌长期以来一直被用于IBS的治疗。可以看到，FODMAP饮食和益生菌在IBS治疗中是分开使用的。
评估在低FODMAP饮食中添加益生菌对控制IBS患者症状的有效性。
纳入多库兹埃于勒大学医院胃肠病科收治的、根据罗马IV标准诊断为IBS的患者。他们被随机分为2组，每组50例。所有患者均被转介给营养师，以获取每日摄入量为9克的低FODMAP饮食的饮食建议。要求患者记录他们食用的食物和饮料。第1组患者在低FODMAP饮食的基础上，每天额外给予含益生菌的补充食物（2克），而第2组患者在低FODMAP饮食的基础上，每天给予一次安慰剂。在21天治疗前后评估视觉模拟量表（VAS）、布里斯托大便分类法和IBS症状严重程度量表（IBS - SSS）评分。
完成研究的85例患者对FODMAP限制饮食的依从率为92%，第1组为90%，第2组为94%。第1组患者治疗前VAS和IBS - SSS的平均评分分别为4.6±2.7和310.0±78.4，治疗后这些评分分别降至2.0±1.9和172.0±93.0（均P<0.001）。第2组患者治疗前VAS和IBS - SSS的平均评分分别为4.7±2.7和317.0±87.5，治疗后这些评分分别降至1.8±2.0和175.0±97.7（均P<0.001）。第1组37例患者（86.04%）和第2组36例患者（85.71%）的IBS - SSS评分降低超过50分。第1组和第2组在治疗前后VAS和IBS - SSS评分的差异方面相似。当使用布里斯托大便分类法比较治疗后大便形状的变化时，两组均显示出显著变化。
本研究是一项随机对照研究，旨在检验在IBS所有亚型中，在低FODMAP饮食中补充益生菌的效果。低FODMAP饮食对IBS所有亚型的症状都有高度积极的影响。可以看到，在低FODMAP饮食中添加益生菌对症状反应和饮食依从性没有额外的贡献。
