肠易激综合征
腹泻
医学
内科学
双歧杆菌
胃肠病学
随机对照试验
临床终点
粪便
拟杆菌
食品科学
发酵
乳酸菌
细菌
生物
微生物学
遗传学
作者
Yawen Zhang,Lijun Feng,Xin Wang,Mark Fox,Liang Luo,Lijun Du,Binrui Chen,Xiaoli Chen,Huiqin He,Shuwen Zhu,Ziye Hu,Shujie Chen,Yanqin Long,Yubin Zhu,Li Xu,Yanyong Deng,Benjamin Misselwitz,Brian M. Lang,Bahtiyar Yılmaz,John J. Kim,Chung Owyang,Ning Dai
摘要
The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a ≥50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (∆6%; 95% CI: −13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides, and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: −0.1, 9.9; P = 0.05). An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention. This trial was registered at clinicaltrials.gov as NCT03304041.
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