So Daniel, Tuck Caroline
Department of Gastroenterology Monash University and Alfred Health Melbourne Australia.
Department of Nursing and Allied Health Swinburne University Hawthorn Australia.
JGH Open. 2024 Jul 18;8(7):e70001. doi: 10.1002/jgh3.70001. eCollection 2024 Jul.
Diet therapy in disorders of gut-brain interaction (DGBI) is rapidly advancing, with accumulating evidence to support two innovative therapies-manipulation of dietary fibers and enzyme supplementation-that target specific DGBI pathophysiology and modulate digestion. Dietary fibers escape digestion in the upper gastrointestinal tract and can influence gut function by impacting digestion, improving laxation, and interacting with the microbiota. A more nuanced understanding of different fiber types and their ability to impact gut function in highly specific ways has shown that fibers can impact distinct gut symptoms and pathophysiology. By considering their functional characteristics of bulking, gel-forming, and fermentability, restriction or supplementation of specific fibers can offer clinical value in DGBI. Similarly to fiber specificity, emerging evidence suggests that supplemental digestive enzymes may be targeted to known food triggers with consideration that enzymes are substrate specific. Limited evidence supports use of lactase to target lactose, and α-galactosidase to target galacto-oligosaccharides. Application of enzymes during manufacturing of food products may prove to be an additional strategy, although evidence is scant. Both innovative therapies may be utilized in isolation or in combination with other diet and nondiet therapies. Implementation can be guided by the principles that fiber modulation can be targeted to specific symptomology or requirement for alterations to gut function, and digestive enzymes can be targeted to known food triggers. This review aims to summarize recent literature of these two innovative concepts and provide practical suggestions for their implementation in clinical practice.
肠-脑相互作用障碍(DGBI)的饮食疗法正在迅速发展,越来越多的证据支持两种创新疗法——膳食纤维的调控和酶补充疗法,它们针对特定的DGBI病理生理学并调节消化。膳食纤维在上消化道中不被消化,可通过影响消化、改善排便以及与微生物群相互作用来影响肠道功能。对不同纤维类型及其以高度特异性方式影响肠道功能的能力有了更细致入微的理解后发现,纤维可影响不同的肠道症状和病理生理学。通过考虑其膨胀性、凝胶形成性和可发酵性等功能特性,限制或补充特定纤维可为DGBI提供临床价值。与纤维特异性类似,新出现的证据表明,补充消化酶可能针对已知的食物触发因素,因为酶具有底物特异性。有限的证据支持使用乳糖酶针对乳糖,使用α-半乳糖苷酶针对低聚半乳糖。在食品生产过程中应用酶可能是一种额外的策略,尽管证据不足。这两种创新疗法可单独使用,也可与其他饮食和非饮食疗法联合使用。实施可遵循以下原则:纤维调节可针对特定症状或肠道功能改变的需求,消化酶可针对已知的食物触发因素。本综述旨在总结这两个创新概念的最新文献,并为其在临床实践中的应用提供实用建议。
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