School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Manchester University NHS Foundation Trust, Manchester, UK.
J Hum Nutr Diet. 2022 Dec;35(6):1087-1104. doi: 10.1111/jhn.13005. Epub 2022 Apr 9.
Bile acid diarrhoea (BAD) causes chronic diarrhoea and is primarily treated pharmacologically. This systematic review aimed to evaluate the effectiveness of non-pharmacological therapies for evidence-based management of BAD in adults.
A systematic review of the medical literature was performed from 1975 to 13 July 2021 to identify studies on diet, psychological, and exercise therapies that met diagnostic criteria for BAD in adults with diarrhoea. Effectiveness was judged by responder or improvement in diarrhoea at study endpoint according to each study's definition of diarrhoea. Therapeutic effect on abdominal pain and flatulence was also measured. Risk of bias was assessed using the Risk Of Bias In Non-Randomised Studies of Interventions tool. A narrative review was conducted using 'Synthesis Without Meta-analysis' guidance. Certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
Eight prospective cohort studies were identified on diet therapies from 2 weeks to over 2 years involving 192 patients. No psychological or exercise therapies were found. Carbohydrate modification (one study, n = 2) in primary BAD, and dietary fat intake reductions (five studies, n = 181) and an exclusive elemental diet therapy (two studies, n = 9) in secondary BAD, showed beneficial directions of effect on diarrhoea, abdominal pain, and flatulence. Risks of bias for each study and across studies for each therapy type were serious. Certainty of the evidence was very low for all outcomes.
No conclusions could be drawn on the effectiveness of diet, psychological, or exercise therapies on diarrhoea, abdominal pain, and flatulence for the management of BAD in adults. High-quality randomised controlled trials are needed.
胆酸腹泻（BAD）可导致慢性腹泻，主要通过药物治疗。本系统综述旨在评估非药物疗法在成人 BAD 循证管理中的有效性。
从 1975 年至 2021 年 7 月 13 日，对医学文献进行了系统检索，以确定符合成人腹泻 BAD 诊断标准的饮食、心理和运动疗法的研究。根据每个研究对腹泻的定义，通过应答者或研究终点时腹泻的改善来判断有效性。还测量了对腹痛和腹胀的治疗效果。使用干预措施非随机研究的风险偏倚评估工具评估偏倚风险。使用“无荟萃分析综合”指南进行叙述性综述。使用推荐评估、制定与评价（GRADE）评估证据的确定性。
确定了 8 项关于饮食疗法的前瞻性队列研究，持续时间从 2 周至 2 年以上，涉及 192 名患者。未发现心理或运动疗法。原发性 BAD 的碳水化合物修饰（一项研究，n=2）和继发性 BAD 的饮食脂肪摄入量减少（五项研究，n=181）和专有的元素饮食疗法（两项研究，n=9）显示出对腹泻、腹痛和腹胀的有益作用。每个研究和每个治疗类型的研究之间的偏倚风险均为严重。所有结局的证据确定性均非常低。
对于成人 BAD 的管理，不能得出关于饮食、心理或运动疗法对腹泻、腹痛和腹胀的有效性的结论。需要高质量的随机对照试验。
