Role of FODMAPs in Patients With Irritable Bowel Syndrome: A Review.

Irritable bowel syndrome (IBS) is a condition characterized by abdominal pain, bloating, flatus, and altered bowel habits. The role of dietary components in inducing IBS symptoms is difficult to explore. To date, foods are not considered a cause but rather symptom-triggering factors. Particular interest has been given to the so-called FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols). We aimed to summarize the evidence from the most common approaches to manage suspected food intolerance in IBS, with a particular interest in the role of FODMAPs and the effects of a low FODMAP diet. We reviewed literature, consulting PubMed and Medline by using the search terms FODMAP(s), fructose, lactose, fructans, galactans, polyols (sorbitol, mannitol, maltitol, xylitol, erythritol, polydextrose, and isomalt), irritable bowel syndrome, and functional gastrointestinal symptoms. FODMAP-restricted diets have been used for a long time to manage patients with IBS. The innovation in the so-called FODMAP concept is that a global restriction should have a more consistent effect than a limited one in preventing abdominal distension. Even though all the potential low FODMAP diets provide good relief of symptoms in many patients, there is just a little relief in others. Several studies highlight the role of low FODMAP diets to improve symptoms in patients with IBS. The evidence on this dietary approach supports the hypothesis that a low FODMAP diet should be the first dietary approach. However, many points remain to be clarified, including the evaluation of possibly significant nutrition concerns

Food allergy in irritable bowel syndrome: the case of non-celiac wheat sensitivity.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, having a prevalence of 12%-30% in the general population. Most patients with IBS attribute their symptoms to adverse food reactions. We review the role of diet in the pathogenesis of IBS and the importance of dietary factors in the management of these patients. The MEDLINE electronic database (1966 to Jan 2015) was searched using the following keywords: "food", "diet", "food allergy", "food hypersensitivity", "food intolerance", "IBS", "epidemiology", "pathogenesis", "pathophysiology", "diagnosis", "treatment". We found 153 eligible papers; 80 were excluded because: not written in English, exclusive biochemical and experimental research, case reports, reviews, and research otherwise not relevant to our specific interest. We selected 73 papers: 43 original papers, 26 reviews and 4 letters to the editor. These papers focused on IBS pathogenesis, the association between IBS and atopy, and between IBS and food allergy, the relationship between IBS and non-celiac wheat sensitivity, the role of diet in IBS. Pending further scientific evidence, a cautious approach is advisable but the concept of food allergy should be included as a possible cause of IBS, and a dietary approach may have a place in the routine clinical management of IBS

From Food Map to FODMAP in Irritable Bowel Sindrome.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases in the general population, with a prevalence ranging from 12 % to 30 %, mainly affecting younger patients (i.e., <50 years of age) and women [1]. As in other chronic functional gastrointestinal disorders, abdominal discomfort or pain, abnormal bowel habits, and often bloating and abdominal distension are the main clinical features. Their diagnosis is based on symptom patterns (i.e., the Rome III criteria), which also allow categorization in diarrhea-predominant (D-IBS), constipation-predominant (C-IBS), mixed diarrhea and constipation (M-IBS), and unclassified (U-IBS) IBS [2]. Symptom severity ranges from tolerable to severe, both between different patients and in the same patient, affecting patients’ quality of life considerably as in some major chronic diseases [3]. Depending on whether diarrhea or constipation is the predominant disorder, antispasmodics, antidepressants, and medications modifying bowel habit represent the main conventional IBS treatments. Unfortunately, most patients report long-term inadequacy of current drug therapy and a tendency to seek a variety of alternative remedies, especially of a dietary nature (up to 65 % of them attribute their symptoms to adverse food reactions) [4]. However, the relationship between IBS symptoms and diet is still controversial, because of research quality and low number of scientific studies [5]. This represents a glaring gap that needs to be addressed

Osteodystrophy in chronic liver diseases.

Osteoporosis and osteomalacy are, to date, among the most common metabolic disease in the world. Recently, association between metabolic bone diseases and chronic liver diseases has been increasingly reported, inducing many authors to create a new nosographic entity known as "hepatic osteodystrophy". The importance of such a condition is, moreover, further increased by morbidity of these two diseases, which greatly reduce patients quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this, early identification of high-risk patients should be routinely performed by measuring Bone Mass Density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: from hypogonadism to use of corticosteroid drugs, from genetic factors to interferon therapy. To date, few studies have been conducted, and all with a small number of patients, in order to establish definitive conclusions about the possible treatment, but some evidences are beginning to emerge about the safety and efficacy of bisphosphonates