Effekt av FODMAP-redusert kost hos pasienter med funksjonell dyspepsi

Transkript

1 Effekt av FODMAP-redusert kost hos pasienter med funksjonell dyspepsi - Symptomer og livskvalitet Klinisk ernæringsfysiolog Ingvild Thun Masteroppgave i Klinisk Ernæring

2 FUNKSJONELL DYSPEPSI Tilstedeværelse av dyspepsisymptomer med fravær av organisk sykdom som kan forklare symptomene

3 FUNKSJONELL DYSPEPSI Varierende prevalens 13-40% Få behandlingsmuligheter Uklar patofysiologi Abnorm akkomodasjon av magesekk? Overfølsomhet til distensjon

4 Fermenterbare Oligosakkarider Fruktaner + galaktaner Disakkarid Laktose Monosakkarid Fruktoseoverskudd And Polyoler Sukkeralkoholer

5 + ventrikkeltømming + nedre lukkemuskel i spiserøret Mikrobiota?

6 HENSIKT Kan 6 uker på dietten gi symptomlindring hos personer med funksjonell dyspepsi? Vil dette påvirke livskvalitet?

7 DELTAKERE OG METODER

8 INKLUSJONSKRITERIER ROMA III-kriteriene Ved IBS-diagnose: FD mest uttalt Utført gastroskopi Stabil medisinering år

9 DATAINNSAMLING FODMAP-inntak: 4 dagers kostregistrering Subjektive symptomer: VAS-skala (0-100) - Epigastriesmerter - Ubehagelig metthet - Kvalme Helserelatert livskvalitet: SF-36 - Fysisk og mental livskvalitet

10 RESULTATER

11 DEMOGRAFISKE DATA VED BASELINE Deltakere Antall (n) n = 11 Alder (gjennomsnitt ± SD) KMI (gjennomsnitt ± SD) 32,6 ± 12,9 21,35 ± 2,9

12 Paret t-test FODMAP-inntak

13 Resultat av subjektiv symptomscoring

14 FD-relaterte øvre magesmerter ved baseline, Epigastriesmerte 3 og 6 uker FD-relaterte smerter % ¾ Median p = 0, Baseline 3 uker 6 uker Intervensjonstid Friedman test ANOVA

15 Ubehagelig metthet ved baseline, Ubehagelig metthet 3 og 6 uker Ubehagelig metthet % ¾ Median p = 0, Baseline 3 uker 6 uker Intervensjonstid Friedman test ANOVA

16 Kvalme ved baseline, Kvalme3 og 6 uker Kvalme % ¾ Median p = 0,005 0 Baseline 3 uker 6 uker Intervensjonstid Repeated measures ANOVA

17 ANDRE SYMPTOMER Problemer med å fullføre måltid (p=0,01) Raping og/eller gassavgang (p=0,003) Halsbrann (p<0,0001)

18 Helserelatert livskvalitet

19 Fysisk helse (PCS score) SF-36 Fysisk helse ved baseline, 3 og 6 uker Fysisk SF-36 livskvalitet Baseline 3 uker 6 uker Intervensjonstid ¾ Median --- Gjennomssnittscore for normalbefolkning p < 0,0001 Friedman test ANOVA

20 Mental helse (MCS score) SF-36 Mental helse ved baseline, 3 og 6 uker Mental SF-36 livskvalitet Baseline 3 uker 6 uker Intervensjonstid ¾ Median --- Gjennomssnittscore for normalbefolkning p = 0,35 Repeated measures ANOVA

21 FDs påvirkning på livet % Repeated measures ANOVA

22 KONKLUSJON Deltakerne inntok signifikant mindre FODMAPs på dietten og opplevde bedring i FD-spesifikke symptomer, nedgang i gassproduksjon, samt en signifikant bedring av fysisk livskvalitet

23 Median FODMAP-Intake (grams) Galaktaner Inntak over 4 dager Fruktaner Polyoler Fruktose Galaktaner Galactans 100 Fruktaner Fructans Polyoler Polyols 80 Fruktoseoverskudd (excess) Fructose Laktose Lactose 60 Laktose FODMAP-Intake (grams) Epigastric pain VAS % Baseline 3 uker 6 uker REFERENCES Postprandial fullness VAS % Nausea VAS % Poster number P Ropert A, Cherbut C, Roze Cet al. Colonic fermentation and proximal gastric tone in humans. Gastroenterology 1996;111: Gibson, P.R. og Shepherd, S.J., Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol, (2): p Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol Apr;11(4): Halmos, E.P., et al., A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, (1): p e5 Referanser - Barrett, J.S., et al., Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther, (8): p Gibson, P.R. and S.J. Shepherd, Personal view: food for thought-- western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther, (12): p Shepherd, S.J. and P.R. Gibson, Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc, (10): p Gibson, P.R. and S.J. Shepherd, Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol, (2): p Halmos, E.P., et al., A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, (1): p e5. - Simren, M. et al., Intestinal microbiota in functional bowel disorders: a Rome foundation Report. ut : Piche, T., et al. Modulation by colonic fermentation of LES function in humans. Am J Physiol Gastrointest Liver Physiol 278: G578 G584, Cuche, G., et al. Ileal short-chain fatty acids inhibit gastric motility by a humoral pathway. Am J Physiol Gastrointest Liver Physiol 279: G925 G930, Ropert, A. et al., Colonic Fermentation and Proximal Gastric Tone in Humans GASTROENTEROLOGY 1996;111: CONCLUSION The FODMAP-restricted diet significantly improved the FD-related symptoms epigastric pain, postprandial fullness and nausea. Problems with flatulence, belching, finishing a portion of food, heartburn and tiredness also improved significantly. Quality of life (SF-36 ) total score for physical health significantly improved, no significant change in mental health. FODM AP-RESTRI CT ED DI ET AND EFFECTS ON FUNCTIONAL DY SPEPSI A I ngvild Thun, Jan G. H atlebakk, M ette E. M or ken, Gudrun E. K ahrs Clinical Institute 1 (K1), University of Bergen, Department of Clinical Nutrition and Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway. Gram INTRODUCTION FODMAPs (fermentable oligo-, di-, monosaccharides and polyols) is carbohydrates poorly absorbed in the small intestine, some will therefore serve as substrate for colonic fermentation. Studies show effect of a diet low in FODMAPs on symptoms of irritable bowel syndrome (IBS) but none conducted on patients with functional dyspepsia (FD). We aimed to see if a 6-week diet low in FODMAPs would have an effect on symptoms (epigastric pain, postprandial fullness and nausea) and quality of life (QoL) physical and psychological score. METHODS 11 patients with FD, according to the ROME III-criteria, were included in the study (8F/3M, age 32,4±12,2y). They were instructed and followed up closely by a dietician during a 6-week diet. FD-symptoms (VAS 0-100) and QoL (SF-36 ) collected at baseline, 3 and 6 weeks. FODMAP-intake (grams) was calculated at baseline and at 6 weeks using 4-day food records. Results were compared using t-tests and one-way ANOVA. Compliance and diets degree of challenge was presented in a questionnaire (VAS 0-100). 4-dagers kostregistrering ved baseline FODMAP-intake at baseline, divided in each FODMAP-group. Galaktaner Fruktaner Polyoler Fruktose+ Laktose FD-relaterte smerter % FD-relaterte smerter % RESULTS There was a significant reduction in FODMAP-intake (mean from 13,3g to 0,8g, p=0,0001). High compliance to the diet was reported (mean 90,4%) and it was somewhat challenging (mean 50,6%). Epigastric pain (median 54 to 0%, p=0,0006), postprandial fullness (median 52 to 0%, p=0,0001) and nausea (mean 47,6 to 20%, p=0,005) significantly improved from baseline to 6weeks. QoL for physical health significantly improved (p<0,0001), no significant improvement in psychological health (p=0,35). FODMAP-intake significantly improved from FD-relaterte baseline to 6 weeks. øvre magesmerter ved FD-relaterte baseline, øvre magesmerter 3 og 6 uker ved 100 baseline, 3 og 6 uker Baseline 3 uker 6 uker Epigastric pain significantly improved from baseline to 6 weeks. Intervensjonstid Intervensjonstid! Median! Median p = 0,0006 p = 0,0006 Ubehagelig metthet % Kvalme % Ubehagelig metthet ved baseline, 3 og 6 uker Baseline 3 uker 6 uker Postprandial Intervensjonstid fullness significantly improved from baseline to 6 weeks. Kvalme ved baseline, 3 og 6 uker Baseline 3 uker 6 uker Nausea significantly Intervensjonstid improved from baseline to 6 weeks.! Median p = 0,0001! Median p = 0,005