A recent development in the treatment of irritable bowel syndrome (IBS) has been the low fermentable Oligo-, di-, monosaccharides and polyols (FODMAP) diet. This involves the restriction of FODMAPs, i.e. a diet that is low in foods such as wheat, onions, beans, many fruits and sorbitol. Controlled trials show benefit in the treatment of IBS and an uncontrolled study of 52 patients with CD and 20 with UC reported symptomatic improvement. It is thought that reducing passage of fermentable fibre into the caecum results in less distension, discomfort or diarrhoea. Controlled trials are needed in IBD and care needs to be taken that patients following this diet do not restrict their fruit and vegetable intakes too severely. It is worth noting that most/all prebiotics are FODMAPs. A low-FODMAP diet may be worth trying in patients with IBD who have ��IBS-type�� symptoms such as bloating or Luminespib
watery diarrhoea that have persisted despite appropriate treatments for underlying active IBD or bile salt malabsorption. Key data from the published interventional studies are summarised in Table?1. There has been approximately fourfold rise in IBD incidence in Western Europe over the last 40?years and a fourfold increase in Japan in 15?years.[59, 60] Although possible explanations for the increase could include increased hygiene in infancy and greater exposure to antibiotics, there is also circumstantial evidence to implicate dietary changes. Shoda et?al. studied the correlation between dietary changes selleck chemicals
and the incidence of CD in Japan from 1966 to 1985. By univariate analysis, the increased incidence of CD was strongly correlated (P?<?0.001) with increased intake of total fat (r?=?0.919), animal fat (r?=?0.880), n-6 polyunsaturated fatty acids (PUFAs; r?=?0.883), animal protein (r?=?0.908), milk protein (r?=?0.924) and the ratio of n-6 to n-3 fatty acid intake (r?=?0.792). There was weaker correlation with intake of total protein (r?=?0.482, P?<?0.05). There was no correlation with intake of fish protein (r?=?0.055, P?>?0.1) and inverse correlation with intake of vegetable protein (r?=??0.941, P?<?0.001). Multivariate analysis showed that increased intake of animal protein was the strongest independent factor. A separate study from <a href="http://www.selleckchem.com/products/azd-1208.html
">AZD1208 Japan identified consumption of margarine as a significant risk factor (P for trend?=?0.005) for development of UC. An Italian study also showed high consumption of margarine to be strongly associated with risk for UC [OR 21.37 (2.32�C196.6)], but not CD. Case�Ccontrol studies of dietary intake in patients with CD have largely been based on retrospective recall of pre-illness diet and need to be interpreted with caution. Nevertheless, a systematic review that included 19 studies reporting pre-illness diet in IBD showed a very consistent reporting of high pre-illness intake of refined sugar amongst patients with CD.