과민성 장증후군의 최근 동향: 식이와 과민성 장증후군 = Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome

다국어 초록 (Multilingual Abstract)

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS. (Korean J Gastroenterol 2014;64:142-147)

참고문헌 (Reference)

1 최명규, "과민성 장증후군의 치료" 대한소화기학회 47 (47): 125-130, 2006

2 이풍렬, "과민성 장증후군의 정의와 역학" 대한소화기학회 47 (47): 94-100, 2006

3 권중구, "과민성 장증후군 치료에 관한 임상진료지침" 대한소화기학회 57 (57): 82-99, 2011

4 Marcason W, "What is the FODMAP diet?" 112 : 1696-, 2012

5 Manning AP, "Towards positive diagnosis of the irritable bowel" 2 : 653-654, 1978

6 Heizer WD, "The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review" 109 : 1204-1214, 2009

7 Drossman DA, "The functional gastrointestinal disorders and the Rome III process" 130 : 1377-1390, 2006

8 Shepherd SJ, "Short-chain carbohydrates and functional gastrointestinal disorders" 108 : 707-717, 2013

9 Naliboff BD, "Sex-related differences in IBS patients: central processing of visceral stimuli" 124 : 1738-1747, 2003

10 Camilleri M, "Serotonin-transporter polymorphism pharmacogenetics in diarrhea-predominant irritable bowel syndrome" 123 : 425-432, 2002

11 Janssen P, "Review article: the role of gastric motility in the control of food intake" 33 : 880-894, 2011

12 Biesiekierski JR, "Quantification of fructans, galacto-oligosacharides and other short-chain carbohydrates in processed grains and cereals" 24 : 154-176, 2011

13 Croagh C, "Pilot study on the effect of reducing dietary FODMAP intake on bowel function in patients without a colon" 13 : 1522-1528, 2007

14 Monsbakken KW, "Perceived food intolerance in subjects with irritable bowel syndrome--etiology, prevalence and consequences" 60 : 667-672, 2006

15 Barbara G, "New pathophysiological mechanisms in irritable bowel syndrome" 20 (20): 1-9, 2004

16 Ong DK, "Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome" 25 : 1366-1373, 2010

17 Cann PA, "Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns" 24 : 405-411, 1983

18 Fukudo S, "Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome" 42 : 845-849, 1998

19 Biesiekierski JR, "Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial" 106 : 508-514, 2011

20 Bischoff S, "Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives" 128 : 1089-1113, 2005

21 Shepherd SJ, "Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management" 106 : 1631-1639, 2006

22 Eswaran S, "Food: the forgotten factor in the irritable bowel syndrome" 40 : 141-162, 2011

23 Atkinson W, "Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial" 53 : 1459-1464, 2004

24 Gibson PR, "Food choice as a key management strategy for functional gastrointestinal symptoms" 107 : 657-666, 2012

25 Farré R, "Food and symptom generation in functional gastrointestinal disorders: physiological aspects" 108 : 698-706, 2013

26 Eswaran S, "Fiber and functional gastrointestinal disorders" 108 : 718-727, 2013

27 Barrett JS, "Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?" 5 : 261-268, 2012

28 Staudacher HM, "Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome" 142 : 1510-1518, 2012

29 Barrett JS, "Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms" 28 : 300-306, 2013

30 Gibson PR, "Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach" 25 : 252-258, 2010

31 Pimentel M, "Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome" 95 : 3503-3506, 2000

32 Shepherd SJ, "Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence" 6 : 765-771, 2008

33 Boettcher E, "Dietary proteins and functional gastrointestinal disorders" 108 : 728-736, 2013

34 Barrett JS, "Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon" 31 : 874-882, 2010

35 Feinle-Bisset C, "Dietary lipids and functional gastrointestinal disorders" 108 : 737-747, 2013

36 Moon W, "Dietary factors in functional gastrointestinal disorders" 13 : 1-7, 2007

37 Staudacher HM, "Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome" 24 : 487-495, 2011

38 Clausen MR, "Comparison of diarrhea induced by ingestion of fructooligosaccharide Idolax and disaccharide lactulose: role of osmolarity versus fermentation of malabsorbed carbohydrate" 43 : 2696-2707, 1998

39 Sutep Gonlachanvit, "Are Rice and Spicy Diet Good for Functional Gastrointestinal Disorders?" 대한소화기 기능성질환∙운동학회 16 (16): 131-138, 2010

40 Kellow JE, "Applied principles of neurogastroenterology: physiology/motility sensation" 130 : 1412-1420, 2006

41 Mertz H, "Altered rectal perception is a biological marker of patients with irritable bowel syndrome" 109 : 40-52, 1995

42 Drossman DA, "AGA technical review on irritable bowel syndrome" 123 : 2108-2131, 2002

43 Halmos EP, "A diet low in FODMAPs reduces symptoms of irritable bowel syndrome" 146 : 67-75, 2014