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Nutritional Management of Gastrointestinal Diseases and Disorders

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 July 2019) | Viewed by 107300

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Prof. Dr. Magdy El-Salhy

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Guest Editor

1. Section for Gastroenterology, Department of Medicine, Stord Hospital, Box 4000, 54 09 Stord, Norway
2. Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway
3. National Centre for Functional Gastrointestinal Disorders, 5021 Berge, Norway
Interests: neurogastroenterology and the the enteroendocrine cells and enteric nervous system in particular as well as diet role in the management of gastrointestinal diseases and disorders

Special Issue Information

Dear Colleagues,

Nutrients is planning a Special Issue focusing on the “Nutritional management of gastrointestinal diseases and disorders”. Diet not only provides nutrition, but also affects several important functions of the body. The proportion of proteins, carbohydrates and fat in our diet control the type and the amount of gastrointestinal hormones released into the blood stream. These hormones regulate gastrointestinal motility, secretion, absorption, cell proliferation, appetite and local immune defense. The gastrointestinal hormones integrate and interact with the enteric, autonomic and central nervous system. Food intake also affects the intestinal microbiota, which is believed to play an important role in health and disease. The present issue represents an attempt to present the latest research on using dietary management to treat gastrointestinal diseases and disorders, and the possible mechanisms behind its effects.

Prof. Dr. Magdy El-Salhy
Guest Editor

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Keywords

Celiac disease
Inflammatory bowel disease
Irritable bowel syndrome
FODMAP

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Published Papers (11 papers)

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Editorial

Jump to: Research, Review

5 pages, 173 KiB

Open AccessEditorial

Nutritional Management of Gastrointestinal Diseases and Disorders

by Magdy El-Salhy

Nutrients 2019, 11(12), 3013; https://doi.org/10.3390/nu11123013 - 10 Dec 2019

Cited by 4 | Viewed by 4121

Abstract

Diet not only provides the nutrition necessary for energy and body growth and repair, but also affects and regulates several important functions of the body [...] Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

Research

Jump to: Editorial, Review

12 pages, 1139 KiB

Open AccessArticle

Effect of Structural Individual Low-FODMAP Dietary Advice vs. Brief Advice on a Commonly Recommended Diet on IBS Symptoms and Intestinal Gas Production

by Tanisa Patcharatrakul, Akarawut Juntrapirat, Narisorn Lakananurak and Sutep Gonlachanvit

Nutrients 2019, 11(12), 2856; https://doi.org/10.3390/nu11122856 - 21 Nov 2019

Cited by 47 | Viewed by 7063

Abstract

A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet has been recommended for irritable bowel syndrome (IBS) patients. This study compared the efficacy of two types of dietary advice: (1) brief advice on a commonly recommended diet (BRD), and (2) structural individual low-FODMAP dietary advice (SILFD). Patients with moderate-to-severe IBS were randomized to BRD or SILFD groups. Gastrointestinal symptoms, 7-day food diaries, and post-prandial breath samples were evaluated. The SILFD included (1) identifying high-FODMAP items from the diary, (2) replacing high-FODMAP items with low-FODMAP ones by choosing from the provided menu. The BRD included reducing traditionally recognized foods that cause bloating/abdominal pain and avoidance of large meals. Responders were defined as those experiencing a ≥30% decrease in the average of daily worst abdominal pain/discomfort after 4 weeks. Sixty-two patients (47 F, age 51 ± 14 years), BRD (n = 32) or SILFD (n = 30), completed the studies. Eighteen (60%) patients in SILFD vs. 9 (28%) in the BRD group fulfilled responder criteria (p = 0.001). Global IBS symptom severity significantly improved and the number of high-FODMAP items consumed was significantly decreased after SILFD compared to BRD. Post-prandial hydrogen (H₂) breath production after SILFD was significantly lower than was seen after BRD (p < 0.001). SILFD was more effective than BRD. This advice method significantly reduced FODMAP intake, improved IBS symptoms, and lowered intestinal H₂ production. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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11 pages, 2033 KiB

Open AccessArticle

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients

by Sittikorn Linlawan, Tanisa Patcharatrakul, Nicha Somlaw and Sutep Gonlachanvit

Nutrients 2019, 11(9), 2061; https://doi.org/10.3390/nu11092061 - 3 Sep 2019

Cited by 14 | Viewed by 4425

Abstract

The aim of this study is to evaluate the effect of rice, mung bean, and wheat noodle ingestion on intestinal gas production and postprandial gastrointestinal (GI) symptoms in non-constipation irritable bowel syndrome (IBS) patients. Methods: Twenty patients (13 F, 46 ± 11 y) underwent 8 h breath test studies and GI symptom evaluations after standard rice, wheat, or mung bean noodle meals at 8:00 a.m. in a randomized crossover study with a 1-week washout period. The same meal was ingested at 12:00 p.m. Results: The H₂ and CH₄ concentration in the breath samples were similar at baseline (rice:wheat:mung bean, H₂ = 3.6 ± 0.5:4.1 ± 0.5:4.0 ± 0.7 ppm, CH₄ = 1.3 ± 0.3:2.1 ± 0.4:1.9 ± 0.4 ppm, p > 0.05). Beginning at the fifth hour after breakfast, H₂ and CH₄ concentrations significantly increased after wheat compared to rice and mung bean (8 h AUC H₂ = 4120 ± 2622:2267 ± 1780:2356 ± 1722, AUC CH₄ = 1617 ± 1127:946 ± 664:943 ± 584 ppm-min, respectively) (p < 0.05). Bloating and satiety scores significantly increased after wheat compared to rice (p < 0.05), and increased but did not reach statistical significance compared to mung bean (p > 0.05). A higher bloating score after wheat compared to rice and mung bean was observed clearly after lunch but not after breakfast. Conclusion: Wheat ingestion produced more intestinal gas and more bloating and satiety scores compared to rice and mung bean, especially after lunch. This provides insight into the role of intestinal gas in the development of bloating symptoms in IBS. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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15 pages, 564 KiB

Open AccessCommunication

Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review

by Hanna Fjeldheim Dale, Stella Hellgren Rasmussen, Özgün Ömer Asiller and Gülen Arslan Lied

Nutrients 2019, 11(9), 2048; https://doi.org/10.3390/nu11092048 - 2 Sep 2019

Cited by 106 | Viewed by 29787

Abstract

Irritable bowel syndrome (IBS) is a frequent functional gastrointestinal disorder, and alterations in the gut microbiota composition contributes to symptom generation. The exact mechanisms of probiotics in the human body are not fully understood, but probiotic supplements are thought to improve IBS symptoms through manipulation of the gut microbiota. The aim of this systematic review was to assess the latest randomized controlled trials (RCTs) evaluating the effect of probiotic supplementation on symptoms in IBS patients. A literature search was conducted in Medline (PubMed) until March 2019. RCTs published within the last five years evaluating effects of probiotic supplements on IBS symptoms were eligible. The search identified in total 35 studies, of which 11 met the inclusion criteria and were included in the systematic review. Seven studies (63.6%) reported that supplementation with probiotics in IBS patients significantly improved symptoms compared to placebo, whereas the remaining four studies (36.4%) did not report any significant improvement in symptoms after probiotic supplementation. Of note, three studies evaluated the effect of a mono-strain supplement, whereas the remaining eight trials used a multi-strain probiotic. Overall, the beneficial effects were more distinct in the trials using multi-strain supplements with an intervention of 8 weeks or more, suggesting that multi-strain probiotics supplemented over a period of time have the potential to improve IBS symptoms. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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10 pages, 516 KiB

Open AccessArticle

Bacillus spp. Spores—A Promising Treatment Option for Patients with Irritable Bowel Syndrome

by Adrian Catinean, Adriana Maria Neag, Andreea Nita, Mihaela Buzea and Anca Dana Buzoianu

Nutrients 2019, 11(9), 1968; https://doi.org/10.3390/nu11091968 - 21 Aug 2019

Cited by 30 | Viewed by 13725

Abstract

Dysbiosis is a condition that can cause various clinical disorders, from gastrointestinal problems to allergies or even cancer. Resetting the microbiota using antibiotics and/or probiotics could be a possible therapy for many diseases. The aim of this study was to evaluate the effects of three treatment regimens in patients with irritable bowel syndrome (IBS). The regimens were short-term rifaximin treatment (10 days) followed by either a nutraceutical agent (G1) or a low- Fermentable, Oligo-, Di-, Monosaccharide and Polyol (FODMAP) diet (24 days) (G3) or treatment with MegaSporeBiotic a mixture of spores of five Bacillus spp. for medium-term (34 days) (G2). Ninety patients with IBS without constipation were enrolled and divided into three groups (G1, G2, G3). Patients in G1 and G3 were evaluated over four visits (baseline/first day (V1), 10 days (V2), 34 days (V3), 60 days (V4)), and, those in G2 over three visits (V1, V3, V4). Severity score, quality of life, and parameters from the rectal volume sensation test were determined. The results demonstrated that patients treated with MegaSporeBiotic, compared with those treated with rifaximin followed by nutraceutical or low-FODMAP diet, had similar severity scores and rectal volume sensation test results for all parameters tested and statistically significant improvement in measurements of quality of life. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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15 pages, 3181 KiB

Open AccessCommunication

Diet in Irritable Bowel Syndrome (IBS): Interaction with Gut Microbiota and Gut Hormones

by Magdy El-Salhy, Jan Gunnar Hatlebakk and Trygve Hausken

Nutrients 2019, 11(8), 1824; https://doi.org/10.3390/nu11081824 - 7 Aug 2019

Cited by 103 | Viewed by 14690

Abstract

Diet plays an important role not only in the pathophysiology of irritable bowel syndrome (IBS), but also as a tool that improves symptoms and quality of life. The effects of diet seem to be a result of an interaction with the gut bacteria and the gut endocrine cells. The density of gut endocrine cells is low in IBS patients, and it is believed that this abnormality is the direct cause of the symptoms seen in IBS patients. The low density of gut endocrine cells is probably caused by a low number of stem cells and low differentiation progeny toward endocrine cells. A low fermentable oligo-, di-, monosaccharide, and polyol (FODMAP) diet and fecal microbiota transplantation (FMT) restore the gut endocrine cells to the level of healthy subjects. It has been suggested that our diet acts as a prebiotic that favors the growth of a certain types of bacteria. Diet also acts as a substrate for gut bacteria fermentation, which results in several by-products. These by-products might act on the stem cells in such a way that the gut stem cells decrease, and consequently, endocrine cell numbers decrease. Changing to a low-FODMAP diet or changing the gut bacteria through FMT improves IBS symptoms and restores the density of endocrine cells. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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13 pages, 1069 KiB

Open AccessArticle

Effects of a Cod Protein Hydrolysate Supplement on Symptoms, Gut Integrity Markers and Fecal Fermentation in Patients with Irritable Bowel Syndrome

by Hanna Fjeldheim Dale, Caroline Jensen, Trygve Hausken, Jan Gunnar Hatlebakk, Ingeborg Brønstad, Jørgen Valeur, Dag Arne Lihaug Hoff and Gülen Arslan Lied

Nutrients 2019, 11(7), 1635; https://doi.org/10.3390/nu11071635 - 17 Jul 2019

Cited by 14 | Viewed by 4862

Abstract

Peptides from fish may beneficially affect several metabolic outcomes, including gut health and inflammation. The effect of fish peptides in subjects with irritable bowel syndrome (IBS) has not previously been investigated, hence this study aimed to evaluate the effect of a cod protein hydrolysate (CPH) supplement on symptom severity, gut integrity markers and fecal fermentation in IBS-patients. A double-blind, randomized parallel-intervention with six weeks of supplementation with 2.5 g CPH (n = 13) or placebo (n = 15) was conducted. The outcomes were evaluated at baseline and the end of the study. The primary outcomes were symptom severity evaluated by the IBS severity scoring system (IBS-SSS) and quality of life. The secondary outcomes included gut integrity markers and pro-inflammatory cytokines in serum, fecal fermentation measured by concentration of short-chain fatty acids (SCFAs) and fecal calprotectin. The groups were comparable at baseline. The total IBS-SSS-scores were reduced in both the CPH-group (298 ± 69 to 236 ± 106, p = 0.081) and the placebo-group (295 ± 107 to 202 ± 103, p = 0.005), but the end of study-scores did not differ (p = 0.395). The concentrations of serum markers and SCFAs did not change for any of the groups. The baseline measures for the whole group showed that the total SCFA concentrations were inversely correlated with the total IBS-SSS-score (r = −0.527, p = 0.004). Our study showed that a low dose of CPH taken daily by IBS-patients for six weeks did not affect symptom severity, gut integrity markers or fecal fermentation when compared to the placebo group. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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10 pages, 5126 KiB

Open AccessArticle

Increasing the Dose and/or Repeating Faecal Microbiota Transplantation (FMT) Increases the Response in Patients with Irritable Bowel Syndrome (IBS)

by Magdy El-Salhy, Trygve Hausken and Jan Gunnar Hatlebakk

Nutrients 2019, 11(6), 1415; https://doi.org/10.3390/nu11061415 - 24 Jun 2019

Cited by 45 | Viewed by 6855

Abstract

Background: Faecal microbiome transplantation (FMT) appears to be an effective method for treating irritable bowel syndrome (IBS) patients. However, it is not clear if a high transplant dose and/or repeating FMT are/is needed to ensure a response. The present study was undertaken to clarify this matter. Methods: Ten IBS patients who did not respond to a 30-g transplant subsequently received a 60-g transplant into the duodenum via a gastroscope. The patients provided faecal samples before and 1 month after FMT. They completed five questionnaires measuring symptoms, fatigue and quality of life at baseline and then at 2 weeks, 1 month and 3 months after FMT. The dysbiosis index (DI) was measured using the GA-map Dysbiosis Test^®. Results: Seven patients (70%) responded to the 60-g transplant, with significant clinical improvements in the abdominal symptoms, fatigue and quality of life in 57%, 80% and 67% of these patients. The 60-g transplant also reduced the DI. Conclusion: FMT is an effective treatment for IBS. A high-dose transplant and/or repeated FMT increase the response rate and the intensity of the effects of FMT. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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14 pages, 1113 KiB

Open AccessArticle

Effect of Postoperative Oral Intake on Prognosis for Esophageal Cancer

by Genya Okada, Chika Momoki, Daiki Habu, Chisako Kambara, Tamotsu Fujii, Yasunori Matsuda, Shigeru Lee and Harushi Osugi

Nutrients 2019, 11(6), 1338; https://doi.org/10.3390/nu11061338 - 14 Jun 2019

Cited by 15 | Viewed by 7526

Abstract

Background: Patients undergoing surgery for esophageal cancer are at risk of prolonged hospital stay for postoperative malnutrition. Postoperative early oral feeing is a part of the “enhanced recovery after surgery protocol” for coping with this risk. However, the usefulness of early oral intake during perioperatively is questionable. Methods: In total, 117 patients treated surgically for esophageal cancer were analyzed in the study. We assessed the oral energy sufficiency rate per nutritional requirement (oral-E/NR) at the fourth week postoperatively and classified the patients into two groups: Poor oral intake group (POI group; <25% oral-E/NR) and the control group (≥25% oral-E/NR). We analyzed the relationship among postoperative oral intake and prognoses. Results: The POI group had worse postoperative nutritional status and a lower survival rate than the control group. In a multivariate analysis, <25% oral-E/NR was one of the independent factors contributing to negative outcomes postoperatively (adjusted hazard ratio: 2.70, 95% confidence interval: 1.30–5.61). Conclusions: In patients undergoing surgery for esophageal cancer, poor postoperative oral intake negatively affected not only on their postoperative nutritional status but also their overall prognosis. It is necessary to improve the adequacy of oral intake postoperatively for patients with esophageal cancer. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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17 pages, 564 KiB

Open AccessArticle

Irregular Dietary Habits with a High Intake of Cereals and Sweets Are Associated with More Severe Gastrointestinal Symptoms in IBS Patients

by Clara Nilholm, Ewa Larsson, Bodil Roth, Rita Gustafsson and Bodil Ohlsson

Nutrients 2019, 11(6), 1279; https://doi.org/10.3390/nu11061279 - 5 Jun 2019

Cited by 42 | Viewed by 6295

Abstract

Dietary advice constitutes one of the first choices of treatment for irritable bowel syndrome (IBS). We have recognized an increased prevalence of sucrase-isomaltase (SI) gene variants in IBS patients, possibly rendering starch- and sucrose-intolerance. The aims were to examine participants’ dietary habits at baseline, to correlate habits with gastrointestinal (GI) symptoms and blood levels of minerals and vitamins, and to examine the effect of a starch- and sucrose-reduced diet (SSRD) on GI symptoms. In the study 105 IBS patients (82 women, 46.06 ± 13.11 years), irritable bowel syndrome-symptom severity scale (IBS-SSS)>175, were randomized to SSRD for 2 weeks or continued ordinary eating habits. Blood samples, visual analog scale for irritable bowel syndrome (VAS-IBS), IBS-SSS, and 4-day food diaries were collected at baseline and after 2 weeks. Patients with irregular dietary habits exhibited higher IBS-SSS than patients with regular habits (p = 0.029). Women already on a diet had lower ferritin levels than others (p = 0.029). The intervention led to 66.3% of patients being responders, with differences in the change of IBS-SSS (p < 0.001), abdominal pain (p = 0.001), diarrhea (p = 0.002), bloating and flatulence (p = 0.005), psychological well-being (p = 0.048), and intestinal symptoms’ influence on daily life (p < 0.001), compared to controls. Decreased intake of cereals and sweets/soft drinks correlated with decreased scores. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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Review

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19 pages, 775 KiB

Open AccessReview

Influence of Growth Hormone and Glutamine on Intestinal Stem Cells: A Narrative Review

by Yun Chen, Ya-Hui Tsai, Bor-Jiun Tseng and Sheng-Hong Tseng

Nutrients 2019, 11(8), 1941; https://doi.org/10.3390/nu11081941 - 17 Aug 2019

Cited by 27 | Viewed by 6736

Abstract

Growth hormone (GH) and glutamine (Gln) stimulate the growth of the intestinal mucosa. GH activates the proliferation of intestinal stem cells (ISCs), enhances the formation of crypt organoids, increases ISC stemness markers in the intestinal organoids, and drives the differentiation of ISCs into Paneth cells and enterocytes. Gln enhances the proliferation of ISCs and increases crypt organoid formation; however, it mainly acts on the post-proliferation activity of ISCs to maintain the stability of crypt organoids and the intestinal mucosa, as well as to stimulate the differentiation of ISCs into goblet cells and possibly Paneth cells and enteroendocrine cells. Since GH and Gln have differential effects on ISCs. Their use in combination may have synergistic effects on ISCs. In this review, we summarize the evidence of the actions of GH and/or Gln on crypt cells and ISCs in the literature. Overall, most studies demonstrated that GH and Gln in combination exerted synergistic effects to activate the proliferation of crypt cells and ISCs and enhance crypt organoid formation and mucosal growth. This treatment influenced the proliferation of ISCs to a similar degree as GH treatment alone and the differentiation of ISCs to a similar degree as Gln treatment alone. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Diseases and Disorders)

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