低 FODMAP 饮食改善腹泻型肠易激综合征患者临床症 状及心理状况研究进展

韦 晶雅¹, 梁 启月¹, 裴 久敏¹, 刘 柳青²
1、安徽中医药大学第一临床医学院
2、安徽中医药大学中医学院

摘要

目的：探究低FODMAP饮食对腹泻型肠易激综合征（IBS-D）患者的临床症状及心理状况的影响。方法：通
过文献梳理与分析，研究低FODMAP饮食对胃肠道功能的影响及临床效果，探讨低FODMAP饮食对IBS-D患者临床症状的
改善以及相关作用机制及对IBS-D患者心理状况的影响。结果：通过分析与总结归纳，本文初步理清了FODMAP饮食是由
于低聚糖、双糖、单糖和多元醇对胃肠道功能不同程度的影响而引起IBS-D患者症状，低FODMAP饮食能有效改善IBS-D
患者的腹部症状、排便习惯与相关生化指标。同时，低FODMAP饮食对IBS-D患者的心理状况也有调节作用。结论：低
FODMAP饮食对IBS-D患者的临床症状缓解有着明确的益处，对其心理状况也有一定的改善作用，值得临床合理推广以及
进一步研究。

关键词

IBS-D；低FODMAP饮食；临床症状；心理状况

参考

[1] Lacy B E,Fermín Mearin,Chang L,et al.Bowel Disorders[J]. Gastroenterology, 2016,150(6):1393-1407.

[2] E n c k P, A z i z Q , B a r b a r a G , e t a l . I r r i t a b l e bowel syndrome[J]. Nature Reviews Disease Primers, 2016,2(1):16014.

[3] Sperber A D,Dan D,Fukudo S,et al.The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies:a Rome Foundation working team literature review[J]. Gut, 2017,66(6):1075-1082.

[4] 姚欣 , 杨云生 , 赵卡冰等 . 罗马 Ⅲ 标准研究肠易激综合征临床特点及亚型[J].世界华人消化杂志,2008(05):563-566.

[5] 孙大娟 , 迟莉丽 , 梁峻尉等 . 焦虑状态与 IBS-D 的相关性研究及中药复方的干预作用 [J]. 光明中医 ,2018,33 (17):2473-2475.

[6] 张华南 , 朱杰 , 于立芹等 . 功能性低聚糖对急性便秘模型小鼠通便功能的影响 [J]. 中国药业 ,2022,31(18):44-48.

[7] Ong D K,Mitchell S B,Barrett J S,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):1366-1373.

[8] 李东丹 , 闫洁 , 杨艳玲 . 乳糖不耐受及饮食营养管理[J]. 中国实用儿科杂志 ,2022,37(10):758-763.

[9] Pawowska K,Umawska W,Barbara Iwańczak.Prevalence of Lactose Malabsorption and Lactose Intolerance in Pediatric Patients with Selected Gastrointestinal Diseases [J]. Advances in Clinical and Experimental Medicine, 2015,24(5):863-871.

[10] Shepherd SJ,Lomer MC,Gibson PR.Short-chain carbohydrates and functional gastrointestinal disorders[J]. Am J Gastroenterol. 2013;108(5):707-717.

[11] 朱雷 , 杨伟 . 乳果糖口服液治疗便秘型肠易激综合征的效果及对胃肠道激素水平的影响 [J]. 中国药物与临床 ,2020,20(20):3446-3448.

[12] M u r r a y K , Wi l k i n s o n - S m i t h V, H o a d C , e t al.Differential effects of FODMAPs(fermentable oligo-,di-,mono-saccharides and polyols)on small and large intestinal contents in healthy subjects shown by MRI [J]. Am J Gastroenterol, 2014,109(1):110-9.

[13] 张颖 , 保志军 , 张赣生等 . 乳果糖口服液治疗功能性便秘疗效的系统评价 [J]. 中国老年学杂志 ,2015,35 (22):6470-6473.

[14] Staudacher HM,Nevin AN,Duff C,et al.Epigastric symptom response to low FODMAP dietary advice compared with standard dietetic advice in individuals with functional dyspepsia[J]. Neurogastroenterol Motil, 2021,33(11):e14148.

[15] Gravina AG,Dallio M,Romeo M,et al.Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome:A Real Life Evaluation of a Large Follow-Up Observation[J]. Nutrients, 2020,12(4):928.

[16] Zahedi MJ,Behrouz V,Azimi M.Low fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome:A randomized controlled trial[J]. Gastroenterol Hepatol, 2018,33(6):1192-1199.

[17] Wang J,Yang P,Zhang L,et al.A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients:A Systematic Review and Meta-Analysis[J]. Frontiers in nutrition, 2021,8:683191.

[18] 杜佳欣 . 肠道菌群组成影响低 FODMAPs 饮食治疗 IBS 患者的临床疗效 [D]. 山东大学 ,2016.

[19] Masuy I,Van Oudenhove L,Tack J,Biesiekierski JR.Effect of intragastric FODMAP infusion on upper gastrointestinal motility,gastrointestinal,and psychological symptoms in irritable bowel syndrome vs healthy controls[J]. Neurogastroenterol Motil. 2018;30(1):e13167.

[20] Tominaga K,Kirikae T,Nakano M.Lipopoly saccharide(LPS)-induced IL-6 production by embryonic fibroblasts isolated and cloned from LPS-responsive andLPShyporesponsive mice[J]. Mol Immunol. 1997,34(16-17): 1147-1156.

[21] Stevens B R,Goel R,Seungbum K,et al.Increased human intestinal barrier permeability plasma biomarkers zonulin and FABP2 correlated with plasma LPS and altered gut microbiome in anxiety or depression[J].Gut,2018,67(8):1555-1557.

[22] Prospero L,Riezzo G,Linsalata M,et al.Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet:The Role of the Intestinal Barrier [J]. Nutrients, 2021,13(7):2469.

[23] Peters S L,Yao C K,Philpott H,et al.Randomised clinical trial:the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome.[J]. Alimentary Pharmacology and Therapeutics, 2016,44(5):447-459.

[24] Kortlever TL,Ten Bokkel Huinink S,Offereins M,et al.Low-FODMAP Diet Is Associated With Improved Quality of Life in IBS Patients-A ProspectiveObservationalStudy[J]. Nutr Clin Pract, 2019,34(4):623-630.

[25] Cingolani A,Paduano D,Vecchiarelli V,et al.Feasibility of Low Fermentable Oligosaccharide,Disaccharide,Monosaccharide,and Polyol Diet and Its Effects on Quality of Life in an Italian Cohort[J]. Nutrients. 2020,12(3):716.

[26] Lacy B E,Pimentel M,Brenner D M,et al.ACG Clinical Guideline:Management of Irritable Bowel Syndrome [J]. The American Journal of Gastroenterology,2021,116(1):17-44.