Diet and Nutritional Management in Functional Gastrointestinal Disorder: Irritable Bowel Syndrome / 대한내과학회지

ABSTRACT

Irritable bowel syndrome (IBS) is a multifactorial disorder with the pathogenesis of abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with dietary and lifestyle modification, fiber supplementation, pharmacological and psychological therapy. Carbohydrates have a range of foods regularly consumed including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates 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 of the beginning of gastrointestinal symptoms. This made the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. All dietary poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, so a concept has been developed to regard them collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and to evaluate a dietary approach that restricts them all. Based on observational and comparative studies and on randomized-controlled trials, FODMAPs trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for symptoms of IBS. In Korea, the strategy of Korean diet for Korean patients with IBS needs apposite to the Korean cases.