GASTROENTEROLOGY Diet and IBS patients
The conference also provided new insights into dietary interventions for patients with IBS. A low-FODMAP diet is now an established treatment for people with IBS, but the diet is controversial and challenging to follow, and not all sufferers have a positive response to the intervention.
Scientists at UEG Week announced that bacterial profiles in the faeces differ between people who do and do not respond to a low-FODMAP diet, allowing doctors to predict who might benefit most from using the diet. Presenting their findings for the first time at the opening session of UEG Week 2016, Dr Sean Bennet from the University of Gothenburg in Sweden, told delegates that, in the right people, a low-FODMAP diet can be highly effective, but identifying those individuals is currently impossible. “A low-FODMAP diet has been shown in a recent clinical trial to significantly reduce the symptoms of IBS in around half of the people who tried it,” he said.6
this is a very demanding diet that requires the exclusion of entire food groups, so we have been looking at ways to predict who will gain the greatest benefit from trying it.” So what is the low-FODMAP diet?
Dietary interventions are considered to be first-line treatments for patients with IBS. A ‘traditional’ IBS diet focuses on optimising eating patterns and reducing the intake of specific foodstuffs that are known to worsen symptoms in some people.6
The low-
FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) diet requires restriction of certain carbohydrates, including foods such as wheat, barley, onion and legumes, foods rich in free fructose (including many fruits), and artificially sweetened products.6 “We know that the low-FODMAP diet is effective in many IBS patients, 6,7
“Unfortunately,
but we also
know that the diet can alter the composition of the gut bacteria,” said Dr Bennet.8 “We wanted to compare the effects of the ‘traditional’ and low-FODMAP diets on the gut bacteria and see whether the bacterial profiles can be used to predict patient response to each treatment.”
The study presented by Dr Bennet and colleagues9
involved an analysis of data from 61 patients with moderately severe or severe IBS symptoms who took part in a previous clinical trial.6
In that trial, patients followed
a ‘traditional’ or low-FODMAP diet for four weeks, with faecal samples collected before and after the dietary interventions. Bacterial profiling of the samples found differences in the impact of each diet on the gut bacteria composition and also revealed that the faecal bacterial profiles differed between patients who responded to the low-FODMAP diet and those who did not. “Patients who did not respond to the low-FODMAP diet were found to have more abnormalities in their gut bacterial profiles before they started the diet than those who responded to the diet,” said Dr Bennet.
“This raises the possibility that faecal bacterial profiling could be undertaken before dietary interventions are considered. “Being able to predict if a patient is unlikely to respond to a low-FODMAP diet means that other therapies could be discussed earlier, and these patients could be spared a demanding diet that might have no effect on, or even worsen, their symptoms.”
Young adults with IBD: new programme
Also presented at the conference was a pioneering new programme that could have a significant impact on the quality of life of young adults living with inflammatory bowel disease (IBD). Experts believe that the programme could help combat the poor and, in some cases, life-threatening care offered to young IBD patients across Europe. IBD can be an extremely debilitating condition and one of the key issues concerning clinicians is the transition from paediatric to adult care.10
and, with the incidence of paediatric IBD currently rising,11
This is fraught with difficulty many young people enter
adult care with extreme and complex forms of the disease which is often mismanaged.10 The lack of support and effective management during the transition can have
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severe consequences for both the individual and the healthcare system. 12 The Berliner Transitions Programme (BTP), established in Germany, has reported its first successes in the safe and effective transition of childhood IBD patients into adult care. The programme lasts two years for each child and involves close collaboration between paediatricians and adult care colleagues. Professor Britta Siegmund, a member of the BTP Task Force discussed the encouraging findings at UEG Week 2016: “Following the success of results in other disease areas, IBD was incorporated into the programme two years ago. Transitioning programmes are initiated in the paediatric setting and involve a gradual process aimed at building the young person’s understanding of their condition to help prepare them and their families for a move into adult care. So far, our experience demonstrates that the young people who have taken part have arrived into adult care very positively.” One in four cases of IBD are diagnosed during childhood and over 50% of sufferers believe that IBD negatively effects their education.13
“With the change of care
occurring at such a crucial age for our patients, it highlights the importance of a
FEBRUARY 2017
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