Low FODMAP Diet for Functional Gastrointestinal Symptoms in Quiescent Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials.
Low FODMAP Diet for Functional Gastrointestinal Symptoms in Quiescent Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials.
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低FODMAP饮食治疗静止期炎症性肠病的功能性胃肠道症状：一项随机对照试验的系统评价。
DOI：
10.3390/nu12123648
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发表时间：
2020-11-27
期刊：
影响因子：
5.9
通讯作者：
Bogdanos DP
中科院分区：
文献类型：
--
作者：
Grammatikopoulou MG;Goulis DG;Gkiouras K;Nigdelis MP;Papageorgiou ST;Papamitsou T;Forbes A;Bogdanos DP
低FODMAP饮食(LFD)被认为可以缓解炎症性肠病(IBD)患者的功能性胃肠疾病(FGD)症状。该研究的目的是系统地回顾随机对照试验(RCT)评估LFD对IBD和FGD患者的有效性的文献。搜索了四个数据库，但由于方法和结果的异质性，没有进行荟萃分析。四个随机对照试验符合标准，其中三个在其偏见评估风险方面有一些担忧。所有干预措施都将LFD与“典型”或虚假饮食进行比较，持续时间从21天到6周不等。在两个随机对照试验中，生活质量得到了改善，而在第三个试验中，基于不同的评估工具，发现了不一致的结果。粪便分析显示，大多数变量(粪便重量、pH值、水分含量、基因计数和肠道转运时间)没有显著差异，而关于粪便频率和短链脂肪酸浓度的结果不一致。干预组和对照组的粪便钙保护素、C反应蛋白或T细胞表型水平没有差异。两项随机对照试验报告腹痛减轻，而关于疼痛持续时间和腹胀的结果不一致。在一项试验中，LFD参与者的能量摄入量显著减少。关于肠道微生物区系，没有注意到差异。观察到相当程度的方法和结果的异质性，并伴随着结果的不一致。现有的数据不足以证明LFD可以缓解FGD症状的说法，尽管它可能为安慰剂反应铺平道路。
A low FODMAP diet (LFD) has been hypothesized to relieve symptoms of functional gastrointestinal disorders (FGD) in patients with inflammatory bowel disease (IBD). The aim of the study was to systematically review the literature for randomized controlled trials (RCTs) assessing the effectiveness of the LFD in patients with IBD and FGD. Four databases were searched, but a meta-analysis was not performed due to methodological and outcomes heterogeneity. Four RCTs fulfilled the criteria, with three having some concerns in their risk of bias assessment. All interventions compared the LFDs against a “typical” or sham diet, spanning in duration from 21 days to 6 weeks. Quality of life was improved in two RCTs, while revealing inconsistent findings in the third trial, based on different assessment tools. The fecal assays revealed non-significant findings for most variables (fecal weight, pH, water content, gene count, and gut transit time) and inconsistent findings concerning stool frequency and short-chain fatty acids concentration. Levels of fecal calprotectin, CRP, or T-cell phenotype did not differ between intervention and comparator arms. Two RCTs reported a reduction in abdominal pain, while results concerning pain duration and bloating were inconsistent. In one trial, energy intake was considerably reduced among LFD participants. Regarding gut microbiota, no differences were noted. A considerable degree of methodological and outcome heterogeneity was observed, paired with results inconsistency. The available data are not sufficient to justify the claim that an LFD induces relief of FGD symptoms, although it may pave the way to a placebo response.
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