Irritable bowel syndrome (IBS), with its key features of abdominal pain and disturbed bowel habit, is thought by both patients and clinicians to be strongly influenced by diet. However, the complexities of diet have made identifying specific food intolerances difficult. Eating disorders can masquerade as IBS and may need specialist treatment. While typical food allergy is readily distinguished from IBS, the mechanisms of gut-specific adverse reactions to food are only just being defined. These may include gut-specific mast cell activation as well as non-specific activation by stressors and certain foods. Visceral hypersensitivity, in some cases mediated by mast cell activation, plays a key part in making otherwise innocuous gut stimuli painful. Rapidly fermented poorly absorbed carbohydrates produce gaseous distension as well as short-chain fatty acids and lowering of colonic pH which may cause symptoms in IBS patients. Limiting intake of these in low FODMAP and related diets has proven popular and apparently successful in many patients. Existing diet, colonic microbiota and their metabolic products may be helpful in predicting who will respond. Wheat intolerance may reflect the fact that wheat is often a major source of dietary FODMAPs. It may also be either a forme fruste of coeliac disease or non-specific immune activation. Wheat exclusion can be successful in some of these patients. More research is needed to fully understand the mechanisms of food intolerances and how to best ameliorate them in a personalised medicine approach to diet in IBS.
Up to 20% of people worldwide develop gastrointestinal symptoms following a meal1, leading to decreased quality of life, substantial morbidity and high medical costs. Although the interest of both the scientific and lay communities in this issue has increased markedly in recent years, with the worldwide introduction of gluten-free and other diets, the underlying mechanisms of food-induced abdominal complaints remain largely unknown. Here we show that a bacterial infection and bacterial toxins ca...
Background: Whole apples produce greater satiety than processed apples, but the underlying mechanisms remain unclear. Objective: Our aim was to assess the intragastric processing of apple preparations and the associated small and large bowel contents using MRI. Methods: An open label , 3-way crossover, randomized, controlled trial. 18 healthy adults [mean ± SD age, 25±4y; BMI(kg/m 2), 22.7±3.5] underwent serial MR scans on 3 occasions separated by 7d, after consumption of isocaloric (178 kcal) p...
A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet (LFD) is a possible therapy for irritable bowel syndrome (IBS). This study investigates the short- and long-term efficacy and nutritional adequacy of an LFD and the patients' long-term acceptability. Patients' adherence and ability to perceive the "trigger" foods were also evaluated. Seventy-three IBS patients were given an LFD (T0) and after 2 months (T1), 68 started the reintroduction phase. At the end...
Unspecific gastrointestinal symptoms associated with milk consumption are common. In addition to lactose, also other components of milk may be involved. We studied whether the partial hydrolysation of milk proteins would affect gastrointestinal symptoms in subjects with functional gastrointestinal disorders. In a randomised, placebo-controlled crossover intervention, subjects (n = 41) were given ordinary or hydrolysed high-protein, lactose-free milkshakes (500 mL, 50 g protein) to be consumed da...
BACKGROUND Restriction of dietary FODMAP intake can alleviate symptoms in patients with irritable bowel syndrome. Because many FODMAPs have prebiotic actions, there is concern that their dietary restriction leads to dysbiosis with health consequences, and their intake is being encouraged by addition to foods and via supplements. AIMS To examine the hazards and benefits of high and low FODMAP intake. METHODS Current literature was reviewed and alternative hypotheses formulated. RESULTS Low FODMAP...
#1Agata Stróżyk(Medical University of Warsaw)H-Index: 1
#2Andrea Horvath(Medical University of Warsaw)H-Index: 20
Last. Hania Szajewska(Medical University of Warsaw)H-Index: 85
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OBJECTIVE: To summarize evidence on the efficacy and safety of the use of extensively hydrolyzed formulas (EHFs) for the treatment of children with cow's milk allergy (CMA). DESIGN: Systematic review of randomized controlled trials (RCTs) per PRISMA guidelines. The risk of bias of included RCTs was assessed using the Cochrane Collaboration's risk of bias tool. In general, a narrative synthesis of the findings was performed. When sufficient data were available, a meta-analysis using the random-ef...
Summary Background & Aims ; Ileus following abdominal surgery is a common postoperative complication. It is a source of considerable morbidity to patients and prolongs hospital stay. There is limited evidence to support the use of coffee to promote resolution of post-operative ileus. Methods ; We performed a systematic review, a risk of bias assessment, and meta-analysis of randomised controlled trials that compared the effect of coffee consumption with control intervention on gastrointestinal m...
#1Olafur S. Palsson(UNC: University of North Carolina at Chapel Hill)H-Index: 50
#2William E. Whitehead(UNC: University of North Carolina at Chapel Hill)H-Index: 102
Last. Magnus Simrén(UNC: University of North Carolina at Chapel Hill)H-Index: 78
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Abstract Background & Aims Little is known about the population prevalence or demographic distributions of Rome IV functional bowel disorders (FBDs) or their effects on quality of life. We examined these in a multi-national survey. Methods We analyzed data from a population-based survey of adults in the United States, Canada, and United Kingdom (5931 valid responders; 49.2% female; mean age, 47.4 years; range, 18–92 years). The survey included the Rome IV Diagnostic Questionnaire, Rome III irrit...
INTRODUCTION: Abdominal pain is a cardinal feature of irritable bowel syndrome (IBS); however, differences in abdominal pain among IBS subtypes remain unknown. We aimed to characterize abdominal pain symptoms among established IBS subtypes using data from the National Gastrointestinal (GI) Survey. METHODS: Individuals participating in the National GI Survey completed National Institutes of Health GI Patient-Reported Outcomes Measurement Information System (GI-PROMIS) questionnaires. Adults meeti...
Recently in Gut and elsewhere,1–3 rare and common hypomorphic sucrase-isomaltase ( SI ) gene variants have been linked to an increased risk of IBS. Similar to congenital SI deficiency (a form of carbohydrate malabsorption caused by homozygous SI loss-of-function mutations),4 reduced SI enzymatic activity may trigger IBS symptoms via colonic accumulation of undigested disaccharides from starch and sucrose, resulting in fermentation with gas production and osmotic diarrhoea. This information holds...
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new ev...