低 FODMAP 饮食盲法随机再引入阶段对肠易激综合征的疗效和发现。

Efficacy and Findings of a Blinded Randomized Reintroduction Phase for the Low FODMAP Diet in Irritable Bowel Syndrome.

机构信息

Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium.

Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

Gastroenterology. 2024 Jul;167(2):333-342. doi: 10.1053/j.gastro.2024.02.008. Epub 2024 Feb 23.

DOI:10.1053/j.gastro.2024.02.008

PMID:38401741

Abstract

BACKGROUND & AIMS: The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in irritable bowel syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP powders to objectively identify triggers and evaluated the effect on symptoms, quality of life, and psychosocial comorbidities.

METHODS

Responders to a 6-week low FODMAP diet, defined by a drop in IBS symptom severity score (IBS-SSS) compared with baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP trigger. Patients completed daily symptom diaries and questionnaires for quality of life and psychosocial comorbidities.

RESULTS

In 117 recruited patients with IBS, IBS-SSS improved significantly after the elimination period compared with baseline (150 ± 116 vs 301 ± 97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5 ± 2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides, and day 3 for lactose.

CONCLUSION

We confirmed the significant benefit of the low FODMAP diet in tertiary-care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP triggers. Ethical commission University hospital of Leuven reference number: s63629; Clinicaltrials.gov number: NCT04373304.

摘要

背景与目的

低可发酵寡糖、二糖、单糖和多元醇（FODMAP）饮食治疗肠易激综合征（IBS）的疗效已得到充分证实。在消除期后，引入期旨在确定触发因素。我们研究了使用 FODMAP 粉末进行盲法再引入以客观确定触发因素的效果，并评估其对症状、生活质量和心理社会共病的影响。

方法

对 6 周低 FODMAP 饮食有反应的患者（IBS 症状严重程度评分（IBS-SSS）与基线相比下降）进入 9 周的盲随机再引入期，使用 6 种 FODMAP 粉末（果聚糖、果糖、半乳糖寡糖、乳糖、甘露醇、山梨糖醇）或对照（葡萄糖）。IBS-SSS 升高（≥50 分）定义为 FODMAP 触发因素。患者完成每日症状日记和生活质量及心理社会共病问卷。

结果

在 117 名招募的 IBS 患者中，与基线相比，消除期后 IBS-SSS 显著改善（150±116 比 301±97，P＜.0001，80%的患者有反应）。85%的 FODMAP 粉末引发症状复发，平均每位患者 2.5±2 种 FODMAP。最常见的触发因素是果聚糖（56%）和甘露醇（54%），其次是半乳糖寡糖、乳糖、果糖、山梨糖醇和葡萄糖（分别为 35%、28%、27%、23%和 26%），山梨糖醇/甘露醇在第 1 天、果聚糖/半乳糖寡糖在第 2 天、乳糖在第 3 天显著增加腹痛。