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      Low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols diet and irritable bowel syndrome in Asia

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          Abstract

          Functional bowel disorders, including irritable bowel syndrome (IBS), are a chronic condition that can significantly reduce patients’ quality of life. Therefore, this paper will review the roles of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols (FODMAP) diet in treating IBS, particularly in an Asian setting. About 20% of the general population is diagnosed with IBS. However, there are limited effective medical therapies available for treating IBS. Therefore, IBS presents a major challenge to the health‐care providers. Recently, there is an increasing interest in the use of a diet low in FODMAP for the treatment of IBS. A low FODMAP diet can decrease the delivery of readily fermentable substrates to the small intestine and colon, thereby improving functional gastrointestinal symptoms.

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          Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.

          Rebecca M. Lovell, Alexander Ford (2012)
          Many cross-sectional surveys have reported the prevalence of irritable bowel syndrome (IBS), but there have been no recent systematic review of data from all studies to determine its global prevalence and risk factors. MEDLINE, EMBASE, and EMBASE Classic were searched (until October 2011) to identify population-based studies that reported the prevalence of IBS in adults (≥15 years old); IBS was defined by using specific symptom-based criteria or questionnaires. The prevalence of IBS was extracted for all studies and based on the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Of the 390 citations evaluated, 81 reported the prevalence of IBS in 80 separate study populations containing 260,960 subjects. Pooled prevalence in all studies was 11.2% (95% CI, 9.8%-12.8%). The prevalence varied according to country (from 1.1% to 45.0%) and criteria used to define IBS. The greatest prevalence values were calculated when ≥3 Manning criteria were used (14%; 95% CI, 10.0%-17.0%); by using the Rome I and Rome II criteria, prevalence values were 8.8% (95% CI, 6.8%-11.2%) and 9.4% (95% CI, 7.8%-11.1%), respectively. The prevalence was higher for women than men (OR, 1.67; 95% CI, 1.53-1.82) and lower for individuals older than 50 years, compared with those younger than 50 (OR, 0.75; 95% CI, 0.62-0.92). There was no effect of socioeconomic status, but only 4 studies reported these data. The prevalence of IBS varies among countries, as well as criteria used to define its presence. Women are at slightly higher risk for IBS than men. The effects of socioeconomic status have not been well described. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
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            Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome.

            Peter Whorwell, Linda Altringer, Jorge Morel … (2006)
            Probiotic bacteria exhibit a variety of properties, including immunomodulatory activity, which are unique to a particular strain. Thus, not all species will necessarily have the same therapeutic potential in a particular condition. We have preliminary evidence that Bifidobacterium infantis 35624 may have utility in irritable bowel syndrome (IBS). This study was designed to confirm the efficacy of the probiotic bacteria B. infantis 35624 in a large-scale, multicenter, clinical trial of women with IBS. A second objective of the study was to determine the optimal dosage of probiotic for administration in an encapsulated formulation. After a 2-wk baseline, 362 primary care IBS patients, with any bowel habit subtype, were randomized to either placebo or freeze-dried, encapsulated B. infantis at a dose of 1 x 10(6), 1 x 10(8), or 1 x 10(10), cfu/mL for 4 wk. IBS symptoms were monitored daily and scored on to a 6-point Likert scale with the primary outcome variable being abdominal pain or discomfort. A composite symptom score, the subject's global assessment of IBS symptom relief, and measures of quality of life (using the IBS-QOL instrument) were also recorded. B. infantis 35624 at a dose of 1 x 10(8) cfu was significantly superior to placebo and all other bifidobacterium doses for the primary efficacy variable of abdominal pain as well as the composite score and scores for bloating, bowel dysfunction, incomplete evacuation, straining, and the passage of gas at the end of the 4-wk study. The improvement in global symptom assessment exceeded placebo by more than 20% (p < 0.02). Two other doses of probiotic (1 x 10(6) and 1 x 10(10)) were not significantly different from placebo; of these, the 1 x 10(10) dose was associated with significant formulation problems. No significant adverse events were recorded. B. infantis 35624 is a probiotic that specifically relieves many of the symptoms of IBS. At a dosage level of 1 x 10(8) cfu, it can be delivered by a capsule making it stable, convenient to administer, and amenable to widespread use. The lack of benefits observed with the other dosage levels of the probiotic highlight the need for clinical data in the final dosage form and dose of probiotic before these products should be used in practice.
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              Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome.

              Derrick K Ong, Shaylyn Mitchell, Jacqueline S Barrett … (2010)
              Reduction of short-chain poorly absorbed carbohydrates (FODMAPs) in the diet reduces symptoms of irritable bowel syndrome (IBS). In the present study, we aimed to compare the patterns of breath hydrogen and methane and symptoms produced in response to diets that differed only in FODMAP content. Fifteen healthy subjects and 15 with IBS (Rome III criteria) undertook a single-blind, crossover intervention trial involving consuming provided diets that were either low (9 g/day) or high (50 g/day) in FODMAPs for 2 days. Food and gastrointestinal symptom diaries were kept and breath samples collected hourly over 14 h on day 2 of each diet. Higher levels of breath hydrogen were produced over the entire day with the high FODMAP diet for healthy volunteers (181 +/- 77 ppm.14 h vs 43 +/- 18; mean +/- SD P < 0.0001) and patients with IBS (242 +/- 79 vs 62 +/- 23; P < 0.0001), who had higher levels during each dietary period than the controls (P < 0.05). Breath methane, produced by 10 subjects within each group, was reduced with the high FODMAP intake in healthy subjects (47 +/- 29 vs 109 +/- 77; P = 0.043), but was not different in patients with IBS (126 +/- 153 vs 86 +/- 72). Gastrointestinal symptoms and lethargy were significantly induced by the high FODMAP diet in patients with IBS, while only increased flatus production was reported by healthy volunteers. Dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS, influence the amount of methane produced, and induce gastrointestinal and systemic symptoms experienced by patients with IBS. The results offer mechanisms underlying the efficacy of the low FODMAP diet in IBS.
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                Author and article information

                Contributors
                Zheng Feei Ma:
                ORCID: https://orcid.org/0000-0002-7276-2229
                zhengfeei.ma@xjtlu.edu.cn
                Journal
                Journal ID (nlm-ta): JGH Open
                Journal ID (iso-abbrev): JGH Open
                Journal ID (doi): 10.1002/(ISSN)2397-9070
                Journal ID (publisher-id): JGH3
                Title: JGH Open: An Open Access Journal of Gastroenterology and Hepatology
                Publisher: Wiley Publishing Asia Pty Ltd (Melbourne )
                ISSN (Electronic): 2397-9070
                Publication date (Electronic): 28 December 2018
                Publication date Collection: April 2019
                Volume: 3
                Issue: 2 ( doiID: 10.1002/jgh3.v3.2 )
                Pages: 173-178
                Affiliations
                [ 1 ] Division of Medicine School of Life and Medical Sciences, University College London London UK
                [ 2 ] Department of Health and Environmental Sciences Xi'an Jiaotong‐Liverpool University Suzhou China
                [ 3 ] School of Medical Sciences, Universiti Sains Malaysia Kota Bharu Malaysia
                [ 4 ] Department of Food Science University of Otago Dunedin New Zealand
                [ 5 ] Department of Clinical Nutrition The First People's Hospital of Wujiang District Suzhou China
                [ 6 ] Department of Respiratory and Critical Care Medicine The Second People's Hospital of Wuhu Wuhu China
                [ 7 ] Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
                Author notes
                [*] [* ] Correspondence

                Zheng Feei Ma, Department of Health and Environmental Sciences, Xiʼan Jiatong‐Liverpool University, Suzhou 215123, China. Email: zhengfeei.ma@ 123456xjtlu.edu.cn

                [†]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-7276-2229
                Article
                Publisher ID: JGH312125
                DOI: 10.1002/jgh3.12125
                PMC ID: 6487812
                PubMed ID: 31061894
                SO-VID: 340f579b-f184-4c17-8892-300c8e1c24d4
                Copyright © © 2018 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 04 November 2018
                Date accepted : 07 November 2018
                Page count
                Figures: 4, Tables: 1, Pages: 7, Words: 5709
                Categories
                Subject: Review Article
                Subject: Review Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id jgh312125
                cover-date April 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:29.04.2019

                Keywords: asian,fermentable oligosaccharides, disaccharides, monosaccharides, and polypols,gastrointestinal,irritable bowel syndrome
                Data availability:
                Keywords: asian, fermentable oligosaccharides, disaccharides, monosaccharides, and polypols, gastrointestinal, irritable bowel syndrome

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