摘要
Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders worldwide. While the pathogenesis is not clearly understood, current research points to the role of the gut microbiome and alterations in the diversity of the microbiota. Probiotics, prebiotics, and low FODMAP diet are therapeutic means associated with modification of the gut microbiome for the alleviation of IBS symptoms. This narrative review assesses the current evidence on the efficacy of these treatment options based on findings from recent systematic reviews and meta-analyses published from October 2013 to October 2018. There is a general agreement in the 11 included systematic reviews and meta-analyses that probiotic therapy is safe and can be effective in improving overall IBS symptom scores and abdominal pain in the general IBS population. Nonetheless, conflicting findings remain and no recommendation on the specific species/strains or combination can be made. Short-term restriction of FODMAP in the diet can improve IBS symptoms as per the findings of 7 systematic reviews and meta-analyses, even though the quality of the evidence remains questionable. Inappropriate use of the low FODMAP diet can potentially impact health negatively. As such, a low FODMAP diet is only recommended as a second line treatment guided by qualified clinicians with specialized training. Despite preclinical studies of some prebiotics demonstrated the potential use in improving gut microbiome and intestinal inflammatory response, the beneficial effect of prebiotics for IBS remains theoretical. Two systematic reviews found no evidence to support the clinical use of prebiotics for IBS.
摘要译文
肠易激综合征（IBS）是全世界最常见的功能性胃肠病症之一。虽然发病机制尚不清楚，但目前的研究指出了肠道微生物组的作用和微生物群多样性的变化。益生菌，益生元和低FODMAP饮食是与肠道微生物组的修饰相关的治疗手段，用于缓解IBS症状。这篇叙述性评论基于2013年10月至2018年10月发表的最新系统评价和荟萃分析的结果，评估了目前关于这些治疗方案疗效的证据。在11项包括系统评价和益生菌的荟萃分析中有一个普遍的一致意见。治疗是安全的，并且可以有效地改善一般IBS人群中的整体IBS症状评分和腹痛。尽管如此，仍存在相互矛盾的发现，并且不能就特定物种/菌株或组合提出建议。根据7项系统评价和荟萃分析的结果，饮食中FODMAP的短期限制可以改善IBS症状，即使证据的质量仍然存在疑问。不恰当地使用低FODMAP饮食可能会对健康产生负面影响。因此，低FODMAP饮食仅被推荐为由经过专业培训的合格临床医生指导的二线治疗。尽管一些益生元的临床前研究表明它可能用于改善肠道微生物组和肠道炎症反应，但益生元对IBS的有益作用仍然是理论上的。两项系统评价未发现任何证据支持益生元用于IBS的临床应用。
Soo LiangOoi;DianneCorrea;Sok CheonPak;. Probiotics, prebiotics, and low FODMAP diet for irritable bowel syndrome – What is the current evidence?[J]. Complementary Therapies in Medicine, 2019,43: 73-80