The Low-FODMAP diet in the Irritable Bowel Syndrome: Is it currently an ineffective nutritional treatment? Symptomatic improvement
DOI:
https://doi.org/10.19230/jonnpr.1613Keywords:
Síndrome de Intestino Irritable, SII, dieta FODMAP, dieta baja en FODMAP, seguimiento dietéticoAbstract
Introductions: Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders in the population. It is a complex and multifactorial disease in which biological, psychological and social factors act at multiple levels on the disease. Diagnosed according to ROMA IV and characterized mainly by abdominal pain and change in bowel habits, it does not have a standard treatment, so it focuses on minimizing gastrointestinal symptoms. The FODMAP diet has been appeared as an effective treatment of IBS.
Objectives: The main objective of this study was to test the efficacy of the FODMAP diet in its different phases of nutrition therapy in order to reduce gastrointestinal symptoms and to increase quality of life.
Methods: A prospective experimental study with duration of twelve weeks was designed under one case, a 35-year-old woman suffering from IBS for 7 years. The dietary treatment was divided into three phases, which was being realised with 12 different diets, dietary education and dietary advice, assessment symptoms, quality of life, type of stool, diet adherence and satisfaction about the nutrition therapy.
Results: The gastrointestinal symptoms and quality of life improved in comparison to the start of the study, as well did the stool in outbreak crisis and routinely situations. By contrast, no relation between the reintroduced foods that produced symptoms with FODMAP’s content was found.
Conclusions: The nutritional treatment of FODMAP diet is an effective treatment for IBS because it reduces the gastrointestinal symptoms, increases the quality of life and the control of the patient towards the diet.
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References
Ribes Koninckx C, Sociedad Española de Gastroenterología H y NP. Tratamiento en gastroenterología, hepatología y nutrición pediátrica. 4ª ed. Madrid: Ergón; 2016.
Dugum M, Barco K, Garg S. Managing irritable bowel syndrome: The low-FODMAP diet. Cleve Clin J Med. 2016;83(9):655–62.
Rey E, Díaz-Rubio M. Síndrome del intestino irritable. En: Díaz-Rubio, Manuel, ed. Enfermedades funcionales digestivas ¿dónde está la frontera de nuestro conocimiento?. 1ª edición. Madrid: You & Us; 2009. p. 105-16.
Lovell RM, Ford AC. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–721.
Oświęcimska J, Szymlak A, Roczniak W, Girczys-Połedniok K, Kwiecień J. New insights into the pathogenesis and treatment of irritable bowel syndrome. Adv Med Sci. 2017;62(1):17–30.
Nanayakkara WS, Skidmore PM, O’Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol. 2016;9:131–42.
Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology [Internet]. 2016;150(6):1262–1279.
Soares RL. Irritable bowel syndrome: A clinical review. World J Gastroenterol. 2014;20(34):12144-60.
Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil [Internet]. 2011;17(2):131–9.
Soares RLS. Irritable bowel syndrome: A clinical review. World Journal of Gastroenterology. 2014;20(34):12144-60.
Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology. 2001;121(4):799–804.
Henström M, D’Amato M. Genetics of irritable bowel syndrome. Mol Cell Pediatr. 2016;3(1):7.
Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Irritable bowel syndrome: a microbiome-gut-brain axis disorder? World J Gastroenterol. 2014;20(39):14105–25.
Dupont HL. Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Aliment Pharmacol Ther. 2014;39(10):1033–42.
Katiraei P, Bultron G. Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome. World J Gastroenterol. 2011;17(23):2791–800.
Spiegel BMR. The burden of IBS: looking at metrics. Curr Gastroenterol Rep. 2009;11(4):265–9.
Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014;264(8):651–60.
Mykletun A, Jacka F, Williams L, Pasco J, Henry M, Nicholson GC, et al. Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol. 2010;10:88.
Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, et al. Guía de práctica clínica: síndrome del intestino irritable con estreñimiento y estreñimiento funcional en adultos: concepto, diagnóstico y continuidad asistencial. (Parte 1 de 2). Semer - Med Fam. 2017;43(1):43–56.
Tack J, Drossman DA. What’s new in Rome IV? Neurogastroenterol Motil. 2017;00:e13053.
Bellini M, Gambaccini D, Stasi C, Urbano MT, Marchi S, Usai-Satta P. Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy. World J Gastroenterol. 2014;20(27):8807–20.
Chey WD, Kurlander J, Eswaran S. Irritable Bowel Syndrome A Clinical Review. JAMA. 2015; 2015;313(9):949-58.
Talley NJ. Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol. 2003;98(4):750–8.
Monsbakken KW, Vandvik PO, Farup PG. Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences. Eur J Clin Nutr. 2006;60(5):667–72.
Saito YA, Locke GR, Weaver AL, Zinsmeister AR, Talley NJ. Diet and Functional Gastrointestinal Disorders: A Population-Based Case-Control Study. Am J Gastroenterol. 2005;100(12):2743–8.
Boeckxstaens G, Camilleri M, Sifrim D, Houghton LA, Elsenbruch S, Lindberg G, et al. Fundamentals of Neurogastroenterology: Physiology/Motility – Sensation. Gastroenterology. 2016;150(6):1292– 1304.e2.
Irritable bowel syndrome in adults: diagnosis and management | Guidance and guidelines | NICE. [citado 2017 May 17]; Disponible en: https://www.nice.org.uk/guidance/cg61/chapter/1-Recommendations#dietary-andlifestyle-advice
Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology (Australia). Blackwell Publishing Asia. 2010;25(2):252–8.
Shepherd SJ, Lomer MCE, Gibson PR. Short-Chain Carbohydrates and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013;108(5):707–17.
Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology. 2014;146(1):67–75.e5.
Jáuregui Lobera I, Santed MA, Bolaños Ríos P. Impact of functional dyspepsia on quality of life in eating disorder patients: the role of thought-shape fusion. Nutr Hosp. 2011;26:1363–71.
Feixas i Viaplana G, Evans C, Trujillo A, Saúl Gutiérrez LÁ, Botella L, Corbella S, et al. Revista de psicoterapia. LA VERSIÓN ESPAÑOLA DEL CORE-OM: Clinical Outcomes in Routine Evaluation - Outcome Measure. Revista de Psicoterapia. 2012;23(89):109-135.
Maagaard L, Ankersen D V, Végh Z, Burisch J, Jensen L, Pedersen N, et al. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol. 2016;22(15):4009–19.
Pedersen N, Andersen NN, Végh Z, Jensen L, Ankersen DV, Felding M, et al. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol. 2014;20(43):16215–26.
Lewis SJ, Heaton KW. Stool Form Scale as a Useful Guide to Intestinal Transit Time. Scand J Gastroenterol. 1997;32(9):920–4.
Low FODMAP iPhone app [Internet]. Monash University CRICOS; [última actualización 20 june 2017; citado 13 julio 2017]; Disponible en: http://www.med.monash.edu/cecs/gastro/fodmap/iphone-app.html
de Roest RH, Dobbs BR, Chapman BA, Batman B, O’Brien LA, Leeper JA, et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract . 2013;67(9):895–903.
Shepherd S, Parker F, Muir J, Gibson P. Dietary Triggers of Abdominal Symptoms in Patients With Irritable Bowel Syndrome: Randomized Placebo-Controlled Evidence. Clin Gastroenterol Hepatol. 2008;6(7):765– 71.
Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25(8):1366–73.
Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31(8):874–82.
Macfarlane GT, Steed H, Macfarlane S. Bacterial metabolism and health-related effects of galactooligosaccharides and other prebiotics. J Appl Microbiol. 2007;104(2):305-44.
Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology. 2014;146(1):67–75.e5.
Eswaran S, Muir J, Chey WD. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013;108(5):718–27.
Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012;5(4):261–8.
Makharia A, Catassi C, Makharia GK. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma. Nutrients. 2015;7(12):10417–26.
Shahbazkhani B, Sadeghi A, Malekzadeh R, Khatavi F, Etemadi M, Kalantri E, et al. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients. 2015;7(6):4542–54.
Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, et al. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Am J Gastroenterol. 2011;106(3):508–14.
Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR, et al. A Very Low-Carbohydrate Diet Improves Symptoms and Quality of Life in Diarrhea-Predominant Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2009;7(6):706–708.e1.
Muir JG, Rose R, Rosella O, Liels K, Barrett JS, Shepherd SJ, et al. Measurement of Short-Chain Carbohydrates in Common Australian Vegetables and Fruits by High-Performance Liquid Chromatography (HPLC). J Agric Food Chem. 2009;57(2):554–65.
Biesiekierski JR, Rosella O, Rose R, Liels K, Barrett JS, Shepherd SJ, et al. Quantification of fructans, galactooligosacharides and other short- chain carbohydrates in processed grains and cereals. J Hum Nutr Diet. 2011;24(2):154–76.
Staudacher HM, Lomer MCE, Anderson JL, Barrett JS, Muir JG, Irving PM, et al. Fermentable Carbohydrate Restriction Reduces Luminal Bifidobacteria and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome. J Nutr. 2012;142(8):1510–8.
Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012;18(30):4012.
McKenzie YA, Thompson J, Gulia P, Lomer MCE. British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):576–92
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