Ahuja Amisha, Pelton Matt, Raval Sahil, Kesavarapu Keerthana
Department of Gastroenterology and Hepatology, Temple University Hospital, Philadelphia, Pennsylvania.
Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Gastro Hep Adv. 2023 Jul 5;2(6):860-872. doi: 10.1016/j.gastha.2023.06.010. eCollection 2023.
There remains a paucity of data on the efficacy of nutritional interventions in luminal gastrointestinal disorders. This review appraises the evidence supporting dietary modification in gastroesophageal reflux disease (GERD), irritable bowel syndrome, Celiac disease, and inflammatory bowel disease. Alhough the use of elimination diets; high fat/low carb; low fermentable oligosaccharides, disaccharides, monosaccharides and polyols; and lactose-free diets in GERD have been studied, the evidence supporting their efficacy remains weak and mixed. Patients with GERD should avoid eating within 3 hours of lying recumbent. Studied dietary interventions for disorders of gut-brain interaction include low fermentable oligosaccharides, disaccharides, monosaccharides and polyols and gluten-restricted and lactose-free diets. While all can be effective in carefully, individually selected patients, the evidence for each intervention remains low. In patients with inflammatory bowel disease, enteral nutrition is established in pediatric populations as useful in reducing inflammation and partial enteral nutrition has a growing evidence base for use in adults and children. Specific carbohydrate diets and the Crohn's disease exclusion diet show promising evidence but require further study to validate their efficacy prior to recommendation. Overall, the evidence supporting nutritional therapy across luminal gastrointestinal disorders is mixed and often weak, with few well-designed randomized controlled trials (RCTs) demonstrating consistent efficacy of interventions. RCTs, particularly cross-over RCTs, show potential to compare dietary interventions.
关于营养干预在管腔型胃肠道疾病中的疗效，目前数据仍然匮乏。本综述评估了支持在胃食管反流病（GERD）、肠易激综合征、乳糜泻和炎症性肠病中进行饮食调整的证据。尽管已经对GERD中使用排除饮食、高脂肪/低碳水化合物饮食、低可发酵寡糖、双糖、单糖和多元醇饮食以及无乳糖饮食进行了研究，但支持其疗效的证据仍然薄弱且参差不齐。GERD患者应避免在躺卧前3小时内进食。针对肠脑相互作用障碍的饮食干预研究包括低可发酵寡糖、双糖、单糖和多元醇饮食以及无麸质和无乳糖饮食。虽然所有这些干预措施在经过精心挑选的个体患者中都可能有效，但每种干预措施的证据仍然不足。在炎症性肠病患者中，肠内营养在儿科人群中已被证实有助于减轻炎症，部分肠内营养在成人和儿童中的应用证据也在不断增加。特定碳水化合物饮食和克罗恩病排除饮食显示出有前景的证据，但在推荐之前需要进一步研究以验证其疗效。总体而言，支持跨管腔型胃肠道疾病进行营养治疗的证据参差不齐且往往薄弱，很少有精心设计的随机对照试验（RCT）证明干预措施具有一致的疗效。随机对照试验，尤其是交叉随机对照试验，显示出比较饮食干预措施的潜力。
