Irritable Bowel Disease (Week 4 GI) Flashcards
What is IBS?
A chronic disorder characterized by abdominal pain or discomfort associated with disordered defecation.
When does a person receive formal evaluation for IBS?
Symptoms ongoing at least 6 months beforehand
What is the diagnostic criteria for IBS?
Must include both of the following
1). Abdominal discomfort or pain should be present at least 3 days per months for 3 months and should be associated with 2 or more of the following at least 25% of the time
* Improvement with defecation
* Onset associated with change in stool frequency of stool.
* Onset associated with a change in form (appearance) of stool.
2). No evidence of inflammatory, anatomic, metabolic, or neoplastic process that explains the patient’s symptoms
* rule out ohter diseases
3). Phenotypic expressions:
* diarrhea predominant
* constipation predominant
* or mixed.
IBS cause
unknown
IBS prevalence
10-30% (US, Canada)
* largest ambulatory problem in adults and children, can be very painful but difficult to solve
What are some associations with IBS?
- ↓ fibre and ↑ refined CHO intake
- prolonged bowel transit time
- stressful lifestyle
- irregular eating/ bowel habits
- laxative abuse
pathophysiology of IBS
CRH = cortico-tropin releasing hormone
What are some nutritional factors in the pathogenesis of IBS?
Adverse reactions to specific types of foods
* most common: alcohol, caffeine containing beverages and foods (chocolate, coffee) → potential efficacy of elimination diets.
* gluten intolerance (conflicting evidence) → some may have CD some may have non-CD gluten intolerance
* potential lactose intolerance
* potential fructose malabsorption
* potential others: fatty foods, high in simple sugars, spices
Individual variation
What is the purpose of nutrition care for IBS?
- To prevent or minimize gastrointestinal symptoms
- To promote normal bowel function
What is the nutrition care for IBS?
- Integration with other factors
- fibre therapy
- small frequent meals
- relaxed eating environment
What other factors should nutrition care for IBS be integrated with?
- stress management: increase cortisol can lead to further inflammation
- drug therapy: consider potential GI side effects, herbal remedy use
- lifestyle modications: bowel habits and acitivity, variable amoung individuals
- elimination of irritants identifed by patient
How is fibre therapy used for IBS?
- start on low dose of fibre and increase gradually to 15-25-35 g/d usually with diet bran or psyllium (controversy)
- reduce simple CHO and sugar alcohols (FODMAP diets)
monitor results and ensure adequate fluid
What does FODMAP stand for?
- Fermentable
- Oligo-,
- Di-, and
- Monosaccharides
- And
- Polyols
What are FODMAPS?
Group of short chain CHO that share common features
* rapidly absorbed in the SI
* rapidly fermented by colonic bacteria
* increase water delivery into the bowel due to their high osmolarity
What are common potential FODMAPS? and there
* physiological effects?
* common symptoms?
- potential FODMAPS: lactose, fructans, polyols, excess fructose, GOS
- physiological effects: gas production, water delivery to lumen, luminal distention
- common symptoms: excess flatus, abdominal pain, abdominal bloating, altered bowel motility
Fruits and fruit products with high FODMAPs
Veg and Veg products with high FODMAPs
Milk products with high FODMAPs
Legumes, nuts and seeds with high FODMAPs
Grain and starch-based foods with high FODMAPs
Other foods with high FODMAPs
Efficacy of FODMAP diet
Some preliminary data to show efficacious to reducing GI symptomology (including a few RCT). More work needs to be done.
Adherence to FODMAP diet
Adherence appears reasonable
* need to consider impact on micronutrient intake
* Can be somewhat complicated to teach.
* Requires a strategy and well educated consumer
How does FODMAP diet help IBS?
Not a preventative diet; but rather used as a mode to ‘manage symptoms”.
How does the FODMAP diet work?
Elimination Diet (IB evidence)
1. Diet therapy is to eliminate all FODMAPs for trial period (1-2 weeks)
2. Restore FODMAPS to diet one class at a time.
3. Monitor symptoms to reintroductions, modified as needed. No set protocol and is really led by the clinician.
What makes the FODMAP diet difficult to assess?
Variability in approaches
