Gastrointestinal Disorders

Gastrointestinal disorders include a series of conditions such as

• Irritable bowel syndrome
• Inflammatory bowel disease

Gastrointestinal diseases may result from the deficiency or excess of specific nutrients. Individuals with digestive problems are often diagnosed based on symptoms such as

• Dyspepsia
• Heartburn
• Chest burn
• Abdominal pain
• Chronic diarrhea
• Constipation

Diet plays an important role not only in the growth and development of an individual but also regulates several important functions of the body. The proportion of carbohydrates, proteins and fats in our diet determine and control the number of gastrointestinal hormones released in the bloodstream. These hormones regulate various functions such as motility, secretion and absorption, appetite, and local immune defences¹.

A diet high in cereals and sweets is associated with severe gastrointestinal symptoms in irritable bowel syndrome patients².

An open-label study conducted by Nilholm et al found that 66.3% of individuals with irritable bowel syndrome responded to a diet low in starch and sucrose³.

The prevalence of irritable bowel syndrome is lower in Asia compared to that of the Western world due to the complex foods in Asia consisting of fermented products.

In a study carried out on 30 patients with IBS and functional abdominal bloating it was found that after a period of two months the response to Low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet was positive in controlling overall symptoms such as abdominal pain, bloating, diarrhea, flatulence, nausea, and fatigue in over 70% of the patients. Besides that, the constipation problem was controlled in about 48% of patients⁴.

Inflammatory bowel disease is an autoimmune disorder that causes inflammation of the small and large intestine. It encompasses major forms such as Crohn's disease and ulcerative colitis.

While Crohn's disease is characterized by inflammation of any part of the gastrointestinal tract, in ulcerative colitis inflammation is localized to only the large intestine.

Due to rapid industrialization and westernization, there is a significant increase in the number of cases of inflammatory bowel disease every year.

An innovative approach proposed by Rotem Sigall-Boneh called the CD exclusion diet offers promising results. A study was conducted on 45 patients in the year 2014. In this, all the patients received one-half calories from enteral nutrition and one-half calories from an exclusion diet which avoided gluten, dairy products, gluten-free baked goods, and bread animal fats, processed meats, products containing emulsifiers, canned goods, and all packaged products. After a thorough analysis, it was found that there was remission in 70% of patients and remarkable normalization of C reactive protein in 70% of the individuals. Similarly in a parallel study of seven patients, it was observed that six patients who received only a CDED diet without any formula had a clinical remission with a solid diet alone^5,6.

Fiber plays an important role in the reduction of flares caused by inflammatory bowel disease. A cohort study conducted by Brotherton et al included 1139 patients with Crohn's Disease and 489 patients with Ulcerative Disease and was assessed for a period of 6 months. It was found that there was a 40% reduction in the risk of flare among patients whose fiber intake was greater than 23g/day compared to the patients whose fiber intake was less than 10g/day. It was also observed that 30% of patients who avoided high fiber foods were more prone to flares⁷.

Tests for digestive problems include colonoscopy, upper GI endoscopy, capsule endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound, percutaneous endoscopic gastrostomy⁸.

REFERENCES:

1. 1.El-Salhy M, Hatlebakk JG, Hausken T,Diet in Irritable Bowel Syndrome (IBS): Interaction with Gut Microbiota and Gut Hormones ,Nutrients. 2019 Aug 7; 11(8)

2. El -Salhy M, Patcharatrakul T, Hatlebakk JG, Hausken T, Gilja OH, Gonlachanvit S,Chromogranin A cell density in the large intestine of Asian and European patients with irritable bowel syndrome, Scand J Gastroenterol. 2017 Jun - Jul; 52(6-7):691-697.

3. Nilholm C, Larsson E, Roth B, Gustafsson R, Ohlsson B, Irregular Dietary Habits with a High Intake of Cereals and Sweets Are Associated with More Severe Gastrointestinal Symptoms in IBS Patients. Nutrients. 2019 Jun 5; 11(6).

4. Sigall-Boneh R, Pfeffer-Gik T, Segal I, Zangen T, Boaz M, Levine A Partial enteral nutrition with a Crohn's disease exclusion diet is effective for induction of remission in children and young adults with Crohn's disease Inflamm Bowel Dis. 2014 Aug; 20(8):1353-60.

5. Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, Cohen S, Peleg S, Shamaly H, On A, Millman P, AbramsL, Ziv-Baran T, Grant S, Abitbol G, Dunn KA, Bielawski JP, Van Limbergen Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial J Gastroenterology. 2019 Aug; 157(2):440-450.

6. Brotherton CS, Martin CA, Long MD, Kappelman MD, Sandler RS. Avoidance of fiber is associated with a greater risk of Crohn's disease flare in a 6-month period. Clin Gastroenterol Hepatol. 2016;14(8):1130-1136.

7. Jose Walter Huaman, Ana Felip, Elena Guedea, Marta Jansana, Sebastian Videla. The diet low in fermentable carbohydrates short-chain polyols improves symptoms in patients with functional gastrointestinal disorders in Spain. Gastroenterol Hepatol,2015Mar;38(3):113-22.

8. American Society for Gastrointestinal Endoscopy