Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management

Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with irritable bowel syndrome and fructose malabsorption. Tables detailing the content of fructose and fructans in foods were constructed. A dietary strategy comprising avoidance of foods containing substantial free fructose and short-chain fructans, limitation of the total dietary fructose load, encouragement of foods in which glucose was balanced with fructose, and co-ingestion of free glucose to balance excess free fructose was devised. Sixty-two consecutively referred patients with irritable bowel syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later. Response to the diet was defined as improvement of all symptoms by at least 5 points on a -10- to 10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently. Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs 36%; P<0.01), as was improvement in individual symptoms (P<0.01 for all symptoms). This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.     

Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial

Background: Manipulation of dietary fibre intake represents a longstanding treatment for patients with irritable bowel syndrome (IBS), particularly for those with constipation. Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms. Recent guidance on the management of irritable bowel syndrome (IBS) advises that linseeds may reduce wind and bloating, although there is limited clinical evidence to support this recommendation. The present pilot study aimed to compare the clinical effectiveness of: (i) whole linseeds versus ground linseeds; (ii) whole linseeds versus no linseeds; and (iii) ground linseeds versus no linseeds in the management of IBS symptoms. Methods: In an open randomised controlled trial, subjects with IBS (n = 40) were allocated to one of three intervention groups: two tablespoons of whole linseeds per day (n = 14), two tablespoons of ground linseeds per day (n = 13) and no linseeds as controls (n = 13). Symptom severity (primary outcome) and bowel habit were assessed before and after a 4‐week intervention and statistical differences between the groups were compared. Results: Thirty‐one subjects completed the present study. Between‐group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds (n = 11) versus ground linseeds (n = 11; P = 0.62), whole linseeds versus controls (n = 9; P = 0.12) and ground linseeds versus controls (P = 0.10). There were no significant changes in stool frequency or stool consistency for any of the groups. Conclusions: Linseeds may be useful in relief of IBS symptoms. Further research is needed to detect clear differences between the effects of whole and ground linseeds.     

马来酸曲美布丁治疗肠激惹综合征的疗效及安全性评价

目的探讨马来酸曲美布丁治疗肠激惹综合征的疗效及安全性。方法对本院收治的78例肠激惹综合征患者给予马来酸曲美布丁片进行治疗,评估治疗前后患者的症状评分,评价疗效与安全性。结果治疗后患者的症状明显改善P〈0.01,与治疗前比较具有统计学显著性差异;全部患者无严重不良反应发生,轻度不良反应发生率为19.23%。结论马来酸曲美布丁可有效改善患者肠激惹综合征的临床症状,是治疗肠激惹综合征的良好选择。     

Effects of a high-fiber diet on symptoms of irritable bowel syndrome: a randomized clinical trial

OBJECTIVE: We investigated the effects of dietary fiber on symptoms of irritable bowel syndrome. METHODS: A single-blind randomized clinical trial was designed. Fifty-six subjects with irritable bowel syndrome were prospectively and randomly assigned to one of two groups: group 1 received a diet containing 10.4 g/d of fiber and group 2 received a diet containing 30.5 g/d of fiber. Patients' body weights, nutritional intakes as assessed with 3-d written food records, and symptom scores were assessed at baseline and at 3 mo. RESULTS: There were no dropouts during the study. Total energy intake and the distribution of macronutrients were not significantly different between groups. Total dietary fiber intake did not reach recommended levels in either group but was higher in group 2 than in group 1 (25.95 +/- 2.12 g/d versus 6.06 +/- 2.7 g/d, P < 0.05). Initial fiber intake did not differ significantly between groups. Pain scores, bowel scores, and general scores improved in both groups (from baseline to 3 mo), and no significant differences were detected between groups. CONCLUSIONS: A modest fiber intake in patients with irritable bowel syndrome relieved symptoms, but this therapeutic benefit of fiber may have been due to a placebo effect because the results were similar in the low-fiber group.     

Food intolerance and the Irritable Bowel Syndrome

Thirty-eight patients with particularly troublesome irritable bowel syndrome (IBS) were selected for trial on a 2-week exclusion diet. Eighteen patients improved dramatically and, with two exceptions, subsequently identified foods to which they were intolerant. Follow-up by postal questionnaire showed that at least 10 were still following their dietary restrictions 3–45 months later.
Twelve of the 16 food intolerant patients were intolerant to more than one food. Fifteen patients found their symptoms did not improve on the exclusion diet. Five patients refused to try or were unable to complete the exclusion diet. The use of an appropriate exclusion diet for selected patients with IBS is recommended.     

某校大学生饮食习惯对肠易激综合征的影响

目的 了解饮食对肠易激综合征的影响。方法 对2018年10月—2019年4月来校医院就诊的1 207名在校本科生进行问卷调查,问卷依据罗马Ⅳ诊断标准,数据分析采用SPSS 22.0卡方检验、单因素分析、Logistic多因素回归分析。结果 来校医院就诊的在校大学生中,肠易激综合征的患病率为5.1%(60/1207)。在单因素分析中,进食生冷(P=0.070)、高纤维(P=0.367)、乳制品(P=0.414)、果蔬(P=0.784)与肠易激综合征的患病差异无统计学意义。进食辛辣(P=0.002)、高脂饮食(P<0.001)与肠易激综合征的患病差异有统计学意义。进一步Logistic多因素回归分析显示,高频率进食高脂食物比低频率(≤1次/周)进食高脂食物更容易引起肠易激综合征。P值为0.003,OR:1.545。结论 本调查样本中,肠易激综合征的患病率为5.1%。肠易激综合征的患病与进食辛辣、高脂饮食有关。高频率的进食高脂食物是肠易激综合征患病的危险因素。基层医生应着重做好相关病人的饮食指导,尽量减少肠易激综合征被诱发。     

井下煤矿工人肠易激综合征患病现状分析

目的探讨煤矿井下工人肠易激综合征的患病现状及患病的危险因素,为煤矿工人胃肠疾病的研究提供流行病学资料。方法采用单纯随机抽样问卷方法进行肠易激综合征相关症状调查,根据结果决定是否进行结肠镜检查。结果肥城矿区井下作业煤矿工人肠易激综合征患病率为22.69%,矿区附近一般人群患病率为15.04%。两组患病率比较,差异有显著性(P<0.05)。结论井下作业煤矿工人肠易激综合征患病率高于一般人群。井下作业环境、心理障碍及不良生活习惯是患病的危险因素。     

Irritable bowel syndrome and dietary fiber.

The effects of an increase in dietary fiber include: (a) More frequent stools, (b) more voluminous stools, (c) an alteration in the fecal flora, (d) an increase in fecal sterol excretion, and, it appears likely, (e) a reduction in intraluminal pressures in the sigmoid colon. Epidemiologic data comparing global differences in prevalence of certain diseases with the fiber content of diets suggest that there may be a relationship between the two. With a certain amount of post-ad hoc reasoning, it can be shown that some of the known effects of fiber could account for differences in disease prevalence between populations. The prevalence of irritable bowel syndrome is so high that one is forced to concede the very real possibility that the environment, including the diet, may be responsible for symptoms that might not otherwise exist. It remains to be seen whether a marked increase in dietary fiber will prevent the symptoms of irritable bowel syndrome. It seems fairly certain that, given the preoccupation most of these individuals have with their bowel movements, the large bulky stools resulting from a high-fiber diet satisfy a very basic emotional need to "have a good BM" (meaning large), but whether this leads to better health remains to be proved.     

Chronic pelvic pain and irritable bowel syndrome

This article describes the common association between chronic pelvic pain and irritable bowel syndrome. The aim of the diagnosis and management of chronic pelvic pain and irritable bowel syndrome is to improve the quality of life of the patient. Methods of diagnosis, treatment and overall management for these two challenging conditions are outlined in this article.     

Novel therapeutic approaches in the treatment of irritable bowel syndrome

The treatment of irritable bowel syndrome due to the heterogeneous clinical symptoms and coexisting psychiatric disorders is still controversial. Although several agents with different mechanisms of action are widely used in clinical practice, there are only few drugs available with strong evidence of their efficacy, safety and tolerability at present. The etiology of irritable bowel syndrome is considered to be multifactorial: experimental and clinical research on visceral hypersensitivity, motility and brain-gut axis involving its neurotransmitters and receptors created the foundation of novel therapeutic approaches. Albeit nowadays several drugs (alosetron, tegaserod) have been registered in a few countries for the treatment of irritable bowel syndrome, further large clinical trials are required related to the new chemical entities.     

黛力新联合培菲康治疗腹泻型肠易激综合征疗效观察

[目的]观察黛力新联合培菲康对腹泻型肠易激综合征患者的疗效,探讨选择性胃肠道钙通道拮抗剂与抗焦虑、抗抑郁在腹泻型肠易激综合征患者中的作用。[方法]将60例腹泻型肠易激综合征患者随机分为两组,治疗组30例给予黛力新联合培菲康治疗,对照组30例给予培菲康治疗,比较治疗后疗效。[结果]黛力新联合培菲康治疗组总有效率90%,单用培菲康对照组总有效率70%,差异有统计学意义。[结论]黛力新联合培菲康能有效改善腹泻型肠易激综合征患者的临床症状。     

Response of patients with irritable bowel syndrome and lactase deficiency using unfermented acidophilus milk

Acidophilus milk has been reported to help patients with irritable bowel syndrome by correcting the "imbalance of flora" and to be tolerated better by lactase-deficient subjects by providing bacterial lactase in the small intestine. In a double-blind randomized study, 61 lactase-sufficient patients with irritable bowel syndrome each ingested 240 ml of milk three times a day for 2 wk and the same amount of acidophilus milk for an additional 2 wk. The degree of symptoms during the two milk-drinking periods was the same as during the control periods. Also, 18 lactase-deficient patients ingested unaltered milk for 1 wk and acidophilus milk for 1 additional wk. There was no difference in the degree of tolerance to the two varieties of milk. In summary, patients with irritable bowel syndrome were not helped by the ingestion of acidophilus milk, and lactase-deficient patients were as intolerant to acidophilus milk as to unaltered milk.     

Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia

Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of ‘trigger’ foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.     

The irritable bowel: a pathological or a psychological syndrome?

The irritable bowel syndrome is discussed together with some of its theories, methods of investigation and various treatment regimens. Eight case histories are reported. In each patient, symptoms appeared to be precipitated by situations interpreted by that patient as stressful. A programme of prospective desensitization using hypnosis is described. Where symptoms of depression were additionally present, antidepressant medication was prescribed. This was subsequently phased out as and when indicated. Where patients had been taking antidiarrhoeal or antispasmodic drugs, various stool bulking agents or benzodiazepines, these were also slowly discontinued as treatment progressed. Cases were followed up from 3 months to 12 years. In 2 cases recurrence of symptoms was again successfully treated. There was no recurrence of any of the bowel symptoms in any other patient. The results support the view that the irritable bowel syndrome is psychogenic in origin.     

Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders.

Functional gastrointestinal disorders, including the irritable bowel syndrome, account for up to 40% of referrals to gastroenterologists, but accurate data on the natural history of these disorders in the general population are lacking. Using a reliable and valid questionnaire, the authors estimated the onset and disappearance of symptoms consistent with functional gastrointestinal disorders. An age- and sex-stratified random sample of 1,021 eligible residents of Olmsted County, Minnesota, aged 30-64 years were initially mailed the questionnaire; 82% responded (n = 835). In a remailing to responders 12-20 months later, 83% responded again (n = 690). The age- and sex-adjusted prevalence rates per 100 for irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent dyspepsia were 18.1 (95% confidence interval (CI) 15.1-21.1), 14.7 (95% CI 11.9-17.4), 7.3 (95% CI 5.3-9.3), and 14.1 (95% CI 11.5-16.8), respectively, on the second mailing. Symptoms were not significantly associated with nonresponse to the second mailing; moreover, the estimated prevalence rates were not significantly different from the first mailing. Among the 582 subjects free of the irritable bowel syndrome on the first survey, 9% developed symptoms during 795 person-years of follow-up, while 38% of the 108 who initially had the irritable bowel syndrome did not meet the criteria after 146 person-years of follow-up. Similar onset and disappearance rates were observed for the other main symptom categories. While functional gastrointestinal symptoms are common in middle-aged persons and overall prevalence appears relatively stable over 12-20 months, substantial turnover is implied by the observed onset and disappearance rates; several potential sources of bias do not seem to account for this variation.     

GPs' explanatory models for irritable bowel syndrome: a mismatch with patient models?

Background. Inconsistencies in doctors’ views about causesand treatment of irritable bowel syndrome (IBS) lead to frustrationfor doctors and in doctor–patient interactions. Diagnosisby GPs does not correspond well to established diagnostic criteria. Objective. To understand GPs’ explanatory models (EMs)and management strategies for IBS. Methods. Qualitative, semi-structured interviews with 30 GPs(15 from the UK and 15 from The Netherlands). Results. Diagnosing IBS in primary care is a complex process,involving symptoms, tests, history and risk calculation. GPswere uncertain about the aetiology of IBS, but often viewedit as a consequence of disordered bowel activity in responseto stress, which was viewed as a function of people's responsesto their environment. GPs tend to diagnose IBS by exclusion,rather than with formal diagnostic criteria. They endeavouredto present the IBS diagnosis to their patients in a way thatthey would accept, fearing that many would not be satisfiedwith a diagnosis that had no apparent physical cause. GPs focusedon managing symptoms and reassuring patients. Many GPs feltthat patients needed to take the responsibility for managingtheir IBS and for minimizing its impact on their daily lives.However, the GPs had limited awareness of the extent to whichIBS affected their patients’ daily lives. Conclusions. GPs’ diagnostic procedures and EMs for IBSare at odds with patient expectations and current guidelines.Shared discussion of what patients believe to be triggers forsymptoms, ways of coping with symptoms and the role of medicationmay be helpful. Keywords. Explanatory model, GP perception, irritable bowel syndrome, primary care, qualitative.     

Motility of the sigmoid in irritable bowel syndrome and colonic diverticulosis

The results of pressure recording in patients with irritable bowel syndrome, diverticulosis and diverticulosis with pain were compared with the results in control subjects. The motility showed variable higher values in patients with irritable bowel syndrome. The motility was clearly higher in patients with diverticulosis and in patients with diverticulosis with pain. The patients with irritable bowel syndrome were younger than the patients in the two groups with diverticulosis. These findings are consistent with the hypothesis that the irritable bowel syndrome is an aetiologic factor in diverticulosis.     

肠易激综合征患者胃肠运动功能的临床研究

目的：对16例肠易激综合征（IBS）患者胃肠运动功能进行临床分析,为临床研究肠易激综合征的发病机制及临床药物治疗提供理论依据。方法：对16例肠易激综合征患者进行食管动态pH监测、胃电检测和呼吸氢试验分析。结果：肠易激综合征患者进餐前、后胃电变化较对照组明显（t＝-8.437,t＝-7.126;P〈0.01）,胃电变异指数、肠道传递时间与对照组有显著性差异（t＝-2.312,t＝-1.694,t＝-9.163,t＝-7.894;P〈0.01）。结论：肠易激综合征患者消化吸收及肠道运动功能异常可能是由于肠道电生理活动异常而引起。