Department of Gastroenterology, Hospital Universitary MútuaTerrassa, 08221 Terrassa, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
Nutrients. 2022 May 4;14(9):1923. doi: 10.3390/nu14091923.
This review summarizes dietary carbohydrate intolerance conditions and recent advances on the possible role of carbohydrate maldigestion and dietary outcomes in patients with functional bowel disease. When malabsorbed carbohydrates reach the colon, they are fermented by colonic bacteria, with the production of short-chain fatty acids and gas lowering colonic pH. The appearance of diarrhoea or symptoms of flatulence depends in part on the balance between the production and elimination of these fermentation products. Different studies have shown that there are no differences in the frequency of sugar malabsorption between patients with irritable bowel disease (IBS) and healthy controls; however, the severity of symptoms after a sugar challenge is higher in patients than in controls. A diet low in 'Fermentable, Oligo-Di- and Monosaccharides and Polyols' (FODMAPs) is an effective treatment for global symptoms and abdominal pain in IBS, but its implementation should be supervised by a trained dietitian. A 'bottom-up' approach to the low-FODMAP diet has been suggested to avoid an alteration of gut microbiota and nutritional status. Two approaches have been suggested in this regard: starting with only certain subgroups of the low-FODMAP diet based on dietary history or with a gluten-free diet.
这篇综述总结了饮食性碳水化合物不耐受的情况，以及碳水化合物消化不良和饮食结果在功能性肠病患者中的可能作用的最新进展。当未被吸收的碳水化合物到达结肠时，它们会被结肠细菌发酵，产生短链脂肪酸和气体，降低结肠 pH 值。腹泻或胀气症状的出现部分取决于这些发酵产物的产生和消除之间的平衡。不同的研究表明，肠易激综合征（IBS）患者和健康对照组之间的糖吸收不良频率没有差异；然而，患者在糖负荷后症状的严重程度高于对照组。低“可发酵的、寡糖-二糖和单糖及多元醇”（FODMAPs）饮食是治疗 IBS 整体症状和腹痛的有效方法，但应由经过培训的营养师进行监督。建议采用“自下而上”的方法来实施低 FODMAP 饮食，以避免肠道微生物群和营养状况的改变。在这方面提出了两种方法：根据饮食史或无麸质饮食，仅从低 FODMAP 饮食的某些亚组开始，或从无麸质饮食开始。
