Trott Nick, Rej Anupam, Coleman Sarah H, Sanders David S
Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
Gastroenterol Hepatol Bed Bench. 2021 Fall;14(4):304-310.
This pilot study assessed the benefits of an adjuvant low FODMAP diet (LFD) in adult CD patients established on GFD who had a normal remission biopsy.
Patients with biopsy-proven adult celiac disease (CD) may have on-going gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). Functional gut symptoms, including irritable bowel syndrome (IBS), is one cause of persistent symptoms in CD patients.
Twenty-five adult CD patients who were adherent to the GFD were recruited. These patients had histologically normal villi on their remission biopsy. A specialist dietitian then offered an adjuvant LFD. Symptom response was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) from baseline to follow up.
Of the 25 CD patients in remission with concurrent IBS, 9 did not wish to pursue the LFD, and 1 had incomplete data. Fifteen patients completed a minimum of four weeks on the LFD (mean age 44 ± 17.3; range 43.2 years; median duration of CD follow-up 7.2 years). Global relief of gut symptoms was reported by 8/15 patients (53% = 0.007). Significant reductions in abdominal pain ( <0.01), distension ( < 0.02), and flatulence ( <0.01) were demonstrated.
This is the first study to demonstrate that an adjunct LFD is an effective dietary treatment for concurrent IBS in adult CD patients with biopsy-confirmed remission. Such patients should be seen by a specialist dietitian to ensure nutritional adequacy and appropriate reintroduction of FODMAP-containing foods.
本初步研究评估了辅助性低发酵性寡糖、双糖、单糖和多元醇饮食（LFD）对已采用无麸质饮食（GFD）且缓解期活检结果正常的成年克罗恩病（CD）患者的益处。
经活检证实患有成人乳糜泻（CD）的患者，即便坚持无麸质饮食（GFD），仍可能持续出现胃肠道症状。功能性肠道症状，包括肠易激综合征（IBS），是CD患者持续出现症状的原因之一。
招募了25名坚持GFD的成年CD患者。这些患者在缓解期活检时绒毛组织学表现正常。然后，由专业营养师提供辅助性LFD。使用胃肠道症状评分量表（GSRS）从基线到随访评估症状反应。
在25名处于缓解期且并发IBS的CD患者中，9名不希望采用LFD，1名数据不完整。15名患者至少完成了四周的LFD（平均年龄44±17.3岁；范围43.2岁；CD随访的中位时长7.2年）。8/15名患者（53%）报告肠道症状总体缓解（ = 0.007）。腹痛（<0.01）、腹胀（<0.02）和肠胃胀气（<0.01）均有显著减轻。
这是第一项表明辅助性LFD是对活检确诊缓解的成年CD患者并发IBS有效的饮食治疗方法的研究。此类患者应由专业营养师诊治，以确保营养充足，并适当重新引入含FODMAP的食物。
