J G
W ld J
nal f
Ga roen erolog
S bmi a Man crip : h p :// .f6p bli hing.com W ld J Ga en e l 2020 Febr ar 7; 26(5): 456-465
DOI: 10.3748/ jg. 26.i5.456 ISSN 1007-9327 (prin ) ISSN 2219-2840 (online)
MINIREVIEWS
D a d
c
a d
a: C
ca c
a
a d
a
c
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Marcella Pesce, Martina Cargiolli, Sara Cassarano, Barbara Polese, Barbara De Conno, Laura Aurino,
Nicola Mancino, Giovanni Sarnelli
ORCID b : Ma cella Pe ce (0000-0001-5996-4259); Ma i a Ca gi lli (0000-0001-9378-7882); Sa a Ca a a (0000-0002-0616-3711); Ba ba a P le e (0000-0001-5173-2453); Ba a a De C (0000-0001-6205-8513); La a A i (0000-0002-9060-2595); Nic la Ma ci (0000-0002-7940-1952); Gi a i Sa elli (0000-0002-1467-1134). A c b : Pe ce M and Sarnelli G concei ed he man crip and con rib ed o draf ing, cri ical re i ion and edi ing; Cargiolli M, Pole e B and Ca arano S carried o li era re re ie and anal i and con rib ed o ri ing he man crip . De Conno B, A rino L and Mancino N con rib ed o hi paper i h li era re re ie and anal i and edi ing; all a hor ga e final appro al of he paper.
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Ma c a P c , Ma a Ca , Sa a Ca a a , Ba ba a P , Ba ba a D C , La a
A , N c a Ma c , G a Sa , De a e f Cli ical Medici e a d S ge ,
Fede ic II U i e i f Na le , Na le 80131, I al
Ma c a P c , GI Ph i l g U i , U i e i C llege L d H i al, L d NW1 2BU,
U i ed Ki gd
C d a : Gi a i Sa elli, MD, PhD, A cia e P fe , De a e f
Cli ical Medici e a d S ge , Fede ic II U i e i f Na le , Via Pa i i 5, Na le 80131, I al . a elli@ i a.i
Ab ac
H per igilance and mp om an icipa ion, i ceral h per en i i i and ga rod odenal en orimo or abnormali ie acco n for he aried clinical pre en a ion of f nc ional d pep ia (FD) pa ien . Man pa ien recogni e meal a he main riggering fac or; h , die ar manip la ion of en repre en
he fir -line managemen ra eg in hi cohor of pa ien . None hele , carce q ali e idence ha been prod ced regarding he rela ion hip be een pecific food and/or macron rien and he on e of FD mp om , re l ing in
non-andardi ed n ri ional approache . Mo die ar ad i e are indeed empirical and of en lead o e cl ion die , reinforcing in pa ien he percep ion of being in oleran o food and elf-perpe a ing ome of he er mechani m
nderl ing d pep ia ph iopa holog (i.e., h per igilance and mp om an icipa ion). Clinician are of en ncer ain regarding he con rib ion of pecific food o d pep ia ph iopa holog and dedica ed profe ional (i.e., die i ian ) are onl a ailable in er iar referral e ing . Thi in rn, can re l in
n ri ionall nbalanced die and co ld e en enco rage re ric i e ea ing beha ior in e ere d pep ia. In hi re ie , e aim a e al a ing he rela ion hip be een die ar habi , macron rien and pecific food in de ermining FD mp om . We ill pro ide an o er ie of he e idence-ba ed n ri ional approach ha ho ld be p r ed in he e pa ien , pro iding clinician i h a al able ool in andardi ing n ri ional ad i e and di co raging pa ien from engaging in o indi crimina e food e cl ion . K d : F c i al d e ia; Die a habi ; F d i le a ce ; Fe e able
lig accha ide , di accha ide , accha ide a d l l ; Gl e - e i i i ; Die T A ( ) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Ma c c : In i ed man crip R c d: No ember 15, 2019 P - a d: No ember 15, 2019 F d c : December 12, 2019 R d: December 24, 2019 Acc d: Jan ar 19, 2020 A c : Jan ar 19, 2020 P b d : Febr ar 7, 2020 P-R : Trian af llo K, Li S S-Ed : Wang JL L-Ed : A E-Ed : Ma YJ
C : The ead he i e e f i di c i i a e e cl i die a d f d i le a ce e f e ei f ce i a ie i h f c i al d e ia (FD) he idea f bei g alle gic i le a f d . Ph icia a e f e ce ai ega di g he c ib i f ecific f d i FD a d he lack f g ideli e a d dedica ed die i ia ,
l i a el , lead c flic i g a d e e die a ad i e . He e, e ide a a h h i l gical-ba ed e ie f he a i e ca al ela i hi be ee ecific f d a d ge e a i i FD a d he ide a e ide ce-ba ed a da di ed die a a ach, a licable i cli ical ac ice. M i g f a d, i e a i al
g ideli e a e eage l a ai ed a da di e FD die a a age e .
C a : Pe ce M, Ca gi lli M, Ca a a S, P le e B, De C B, A i L, Ma ci N,
Sa elli G. Die a d f c i al d e ia: Cli ical c ela e a d he a e ic e ec i e .
W d J Ga e e 2020; 26(5): 456-465
URL: h :// . jg e .c /1007-9327/f ll/ 26/i5/456.h
DOI: h ://d .d i. g/10.3748/ jg. 26.i5.456
IN ROD C ION
C rren g ideline[1] define f nc ional d pep ia (FD) a a comple and m l ifac orial
condi ion charac eri ed b a broad pec r m of mp om cen ered in he ga rod odenal region. I i a highl pre alen di order, reaching pre alence a high a 40% of he general pop la ion in e ern co n rie [2] and i i charac eri ed b a
highl aried clinical pre en a ion, ranging from pper abdominal bloa ing o na ea and omi ing. The high degree of o erlap i h ga ro-e ophageal refl [3] and o her
f nc ional ga roin e inal di order (FGDI ) acco n for he comple i in ca egori ing d pep ic pa ien in o clinicall and pa hoph iological meaningf l
bgro p .
Tho gh, Rome cri eria[4,5] ha e iden ified o main bgro p ba ed on he
principal clinical pa ern: Epiga ric pain ndrome (EPS) and po prandial di re ndrome (PDS).
EPS i charac eri ed b he rec rrence of epiga ric pain or b rning, independen l from meal. On he con rar , PDS i neq i ocall rela ed o earl po -prandial on e of f llne or earl a ia ion. Ho e er, food inge ion eem o elici al o
meal-nrela ed mp om ch a pain or b rning in o er 75% of pa ien i h PDS; hence, a clear-c di inc ion be een he e o mp oma ic pre en a ion i challenging in
real- orld clinical prac ice[6]. D pep ia pa hoph iolog i he erogeneo and
comple and bo h cogni i e and beha ioral fac or , ch a an icipa ion and aro al, and/or ga ric en orimo or d f nc ion are ell-e abli hed fac or a pla in FD mp om ind c ion and percep ion[6,7]. A ide from he role of cen ral ner o em
and ga ric d f nc ion, increa ing e idence al o demon ra ed ha d odenal abnormali ie (d odenal h per en i i i and mall in e inal d mo ili ) and b le m co al inflamma ion (d odenal eo inophilia and ma cell infil ra ion) co ld al o pla a role in genera ing FD mp om [8-11].
Since he meal are recogni ed a rigger for a lea a b e of mp om , die ar and life le modifica ion of en repre en he fir line managemen in FD pa ien [12],
de pi e he can q ali e idence prod ced o far.
In hi re ie , e mmari e he c rren e idence regarding he role of die in FD, foc ing on he propo ed nderl ing pa hoph iological mechani m . We ill hen
e plore he c rren rea men ra egie in FD and he po ible f re arge ed die ar
rea men .
CALORIC IN AKE AND FD S MP OMS
Defec i e accommoda ion of he pro imal omach and dela ed ga ric emp ing are
recogni ed a o of he main mechani m implica ed in FD pa hogene i ; hence,
e eral die in e iga ed he po en ial role of caloric in ake and food in ake on
mp om de elopmen[13,14].
Tack e al[15] confirmed a po ible correla ion be een caloric in ake and ga ric
accommoda ion demon ra ing ha FD pa ien e hibi ed ignifican l higher a ie core compared o con rol , i h ma im m a ie reached a ignifican l lo er
caloric amo n in pa ien . Ho e er, hi ea ing beha ior doe no nece aril correla e i h a con i en eigh lo , a one o ld e pec[16-18].
F r hermore, Boeck aen e al[19] al o de cribed an impaired drinking capaci for
bo h a er and n rien liq id meal in FD pa ien compared o heal h ol n eer , e en ho gh no a ocia ion i h pecific mp om pa ern had emerged.
Thi e idence gge ha probabl meal ol me and ga ric di en ion co ld be
implica ed in riggering mp om , ra her han caloric in ake e e[19]. Therefore, he
con mp ion of mall and freq en meal ma be a rea onable ad ice in order o red ce FD mp om . Be ond he effec of caloric in ake and food amo n i elf, n rien compo i ion ho ld no be ndere ima ed.
N
RIEN COMPOSI ION AND FD S MP OMS
In he la decade, he in ere on he correla ion be een ph icochemical proper ie of macron rien and d pep ic mp om i gro ing. Indeed, food con mp ion can infl ence ga roin e inal f nc ion b mean of ei her mechanical or chemical
im la ion. A recen re ie , ema icall anal ing o er 6400 die , concl ded
ha hea and high fa food are o of he major pla er in FD[20].
Pro ein , carboh dra e and lipid co ld all be implica ed in mp om on e , b he la er eem o be he mo effec i e in elici ing he mp om . Al ho gh a high pro ein in ake ma ind ce an increa e of a ie in heal h bjec , li le i kno n abo he impac of high-pro ein meal on d pep ic mp om [21].
The role of carboh dra e on FD mp om i ill nclear, oo. In he cro
-ec ional d S d on he Epidemiolog of P chological, Alimen ar Heal h and
N ri ion , a large cohor of bjec ha been e al a ed o a e he po en ial effec of carboh dra e , in erm of gl cemic inde and load. The high gl cemic load
eemed o be a ocia ed i h an increa ed ri k of nin e iga ed chronic d pep ia and hear b rn, in male bjec i h normal bod eigh[22].
I i pla ible ha a high in ake of carboh dra e co ld ind ce PDS-like mp om d e o i po ible effec on ga ric f nd accommoda ion. F r hermore, a high gl cemic inde meal ph iologicall de ermine an increa e of gl cagon- like pep ide
1 and cholec okinin (CCK) relea e, hich can, in rn, dela ga ric emp ing and
ind ce prolonged a ie .
An anal i of recen li era re ho ed ha he mo common c lpri food , recogni ed b FD pa ien , appeared o be high in concen ra ion of ei her gl en
(grain/ hea prod c , akeo food , proce ed food ) or fermen able
oligo accharide , di accharide , mono accharide and pol ol (FODMAP ) (fr i , hea and grain prod c , of drink , proce ed food )[16,20].
FODMAP are a gro p of poorl ab orbed and o mo icall ac i e carboh dra e , na rall con ained in a ide arra of common food . D e o heir ph iological effec , FODMAP are idel accep ed a po en ial rigger for ga roin e inal mp om in f nc ional ga roin e inal di order , par ic larl in irri able bo el ndrome (IBS) and re id al f nc ional bo el mp om in inflamma or bo el di ea e[23-25]. The combina ion of abnormal ga prod c ion, ca ed b an increa ed
in e inal fermen a ion, and he l minal a er re en ion econdar o heir o mo ic ac i i , eem o enhance abdominal di en ion and o ind ce abdominal pain and bloa ing in pa ien i h al ered i ceral en i i i [24]. Be ide he e ell-kno n
effec , heir impac on FD ph iopa holog co ld be linked o q ali a i e change in microbiome compo i ion and/or on d odenal homeo a i econdar o an enhanced d odenal inflamma ion[24].
On he con rar , he role of lipid in FD ha been be er charac eri ed. I ha been demon ra ed ha a high fa -meal can ind ce grea er na ea, pain and f llne bo h re pec o a lo -calorie meal and an eq icaloric meal, high in carboh dra e for he
ame ol me. The main mechani m b hich fa food co ld e acerba e FD
mp om are rela ed o dela ed ga ric emp ing and h per en i i i o
ga roin e inal hormone[26].
I i kno n ha an in rad odenal lipid inf ion can increa e he en i i i of he pro imal omach o di en ion, probabl d e o a fa pecific effec on CCK relea e[26].
Indeed, he admini ra ion of a CCK-A recep or an agoni eem o o er rn he inhibi ion of ga ric mo ili and emp ing ca ed b he inge ion of a high-fa meal[26-28].
SPECIFIC FOODS
empirical and di er ified, ome ca al rela ion hip be een pecific c lpri food
and mp om ha e been demon ra ed. The re ro pec i e na re of mo die and
he lack of a andardi ed me hod o erif he food- mp om a ocia ion acco n for he diffic l in dra ing p an l ima e li of c lpri or beneficial food . Some of
he mo freq en l repor ed riggering food are fa and acidic food , hea
prod c and e eral pe of fr i ch a a ermelon and fr i j ice[16,24,29-31]. De pi e
he kno n e idence abo fa food , almond eem no o aggra a e FD mp om
a e pec ed[29]. Thi effec migh be rela ed o he high con en of r p ophan, a
ero onin prec r or. Sero onin (5-h dro r p amine) i a ke ne ro ran mi er
in ol ed in he reg la ion of ga roin e inal mo ili and en or f nc ion. Indeed, he im la ion of ero oninergic 5-HT1 and 5-HT4 recep or ind ce ga ric moo h m cle con rac ion , enhancing ga ric emp ing and eem o impro e abdominal mp om in FD pa ien [32,33]. The c lpri effec of pepper and chili ma be media ed
b i main ac i e ingredien , cap aicin. Indeed, hi alkaloid can e acerba e FD mp om ind cing h peralge ia, hro gh he ac i a ion of he ran ien recep or po en ial anilloid b pe 1 (TRPV1) recep or , e pre ed on en or afferen ne ron [34-36]. None hele , chronic cap aicin admini ra ion co ld lead o TRPV1
do nreg la ion and red ce i ceral h per en i i i . Effec i el , in a mall- i ed (30 FD bjec ) randomi ed con rol rial o er placebo, red pepper po der (Cap ic m
ann m) ignifican l impro ed o erall mp om core , incl ding epiga ric pain,
f llne , and na ea[37]. Cap aicin i he paradigma ic e ample of ho comple i he
in erpla be een food inge ion and FD mp om , i h n rien ha can be a
bo h beneficial or c lpri food , depending on he compen a or do nreg la ion of i ceral nocicep or .
The pre alen d pep ia b pe al o eem o pla a role in predic ing he re pon e o die ar in er en ion . Being pre alen l meal-rela ed, PDS b pe ha
been he mo died pa ern for n ri ional in er en ion in FD. In a recen r e on
1304 Chine e FD pa ien , he a hor fo nd ha nheal hier die ar habi , ch a dining irreg larl , ha ing nigh nack , kipping breakfa , and dining o , ere more freq en l a ocia ed i h FD. The a hor al o e al a ed he impac of pecific die ar habi and d pep ia b pe , concl ding ha , al ho gh here a a large degree of o erlap; cer ain food , ch a alcohol and coffee, ere a ocia ed i h
EPS-FD[38]. Onl fe o her die ha e anal ed he impac of die on he pre alen
mp om pa ern, re ealing po ible link be een he con mp ion of pecific food and epiga ric b rning (coffee, pepper, chocola e and onion ), f llne (red mea ,
hea prod c , bean , fried food , ee , chocola e) and bloa ing (carbona ed
drink , onion , banana , milk)[16,20].
A fac or ha ha o be aken in o acco n i he lack of effec i e me hod o a e
po en ial food in olerance and allergie in mo die . The effec on FD mp om
co ld ac all be infl enced b he pre ence of gl en or lac o e in olerance[31].
F r her die are needed o deepen hi a pec .
Analogo l o he c lpri food , er fe da a i a ailable abo p a i e
beneficial food and mo of he e die ha e in e iga ed herbal pplemen ,
of en ed a complemen ar and al erna i e rea men [39,40]. In par ic lar, cara a
eed , apple, q ince and rock cand eem o ha e beneficial effec on FD mp om [15,20,29]. Oil e rac of bo h peppermin (Men ha piperi a) and cara a eed
(Car m car i), a ingle pplemen or in combina ion[41] ha e been pro en beneficial
in rea ing FD mp om , b li le i kno n abo heir ph iological ac i i . The an ieme ic ac ion of men hol and peppermin oil eem o be rela ed o an allo eric effec on 5-HT 3 recep or ; ho e er, hi ma be clinicall irrele an [42]. Peppermin
oil ha been radi ionall ed in FD and IBS d e o i cholere ic ac ion and pa mol ic effec in he e ophag , lo er omach and d odenal b lb and colonic pa m d ring bari m enema[43]. In e eral rial , peppermin and cara a oil ere
fo nd o be more effec i e han placebo in impro ing d pep ic mp om , i h an a erage decrea ed in en i of epiga ric pain compared o placebo[44].
F r hermore, he con mp ion of rice eem o be afe and ell olera ed b FD pa ien [45,46]. One co ld pec la e ha he lo er con en of gl en and FODMAP
compared o hea and grain prod c co ld be in ol ed in hi fa orable effec , b here are no e idence demon ra ing hi a ocia ion o da e.
Ano her emerging beneficial ac or i ginger, hank o i an i-inflamma or and an ieme ic proper ie and i ac ion on ga roin e inal mo ili [46]. The main
pol phenolic componen of ginger, gingerol and hogaol , ha e an inhibi or effec on cholinergic M3 and ero onergic 5-HT3 recep or impro ing ga ric mo ili , red cing na ea and omi ing and ind cing an accelera ion of ga ric emp ing[47-51].
De pi e he increa ing kno ledge of i ph iological effec , in a mall- i ed open d , in ol ing 11 FD pa ien , Ginger had no impac on ga ric en a ion, d pep ic mp om or g pep ide /hormone , hile i di pla ed prokine ic effec [50]. Table 1
mp om .
N
RI IONAL APPROACH
In c rren clinical prac ice, die ar mea re are of en pro ided b ph ician ra her
han n ri ioni or die ician and are freq en l no ppor ed b rong cien ific
e idence or are no ema icall died[52].
No andardi ed n ri ional g ideline for FD are a ailable, o da e.
Thi reflec he poor me hodolog and q ali e idence and he con iderable he erogenei in die ar a e men me hodolog (food freq enc q e ionnaire , 24-h recall me 24-hod ) and o come mea re (ga roin e inal mp om core , ga rod odenal mo ili , ga ric emp ing ra e e c.), ob er ed in p bli hed food-ba ed rial[20]. Mo die al o fail o e cl de he mo common food in olerance
(i.e. lac o e in olerance) and/or are co n r or region- pecific, e po ing o an in erpre a ion bia of p bli hed re l .
A recen r e from China fo nd a po i i e a ocia ion be een d pep ia and irreg lar ea ing habi ( kipping meal , dining o e c.), regardle of FD pheno pe[38].
According o he abo e, i i rea onable o ad ice he con mp ion of maller and more freq en meal d ring he da . Moreo er, a red c ion of pic , ho ,
acid-im la ing and high-fa food eem o be effec i e in a bgro p of pa ien .
D e o i efficac in red cing abdominal mp om a pain, fla lence and bloa ing a die ician-led lo -FODMAP die can be no con idered a a iable fir -line herap in IBS[53]. De pi e he kno n pa hogenic and clinical o erlap i h IBS
c rren l , here i lack of e idence demon ra ing he effec of a FODMAP red c ion in FD[54,55]. Onl one recen A ia ic re ie e amined he fea ible role of lo
-FODMAP die in he managemen of FD[56]. In 2017, Tan[56] pec la e on e eral
e pec ed mechani m of ac ion b hich a red c ion of he e carboh dra e co ld impro e d pep ic mp om . Specificall , he red c ion of bo h in e inal fermen a ion and o mo ic load co ld correla e i h a decrea ed im la ion of mechanorecep or . On he o her hand, a decrea ed prod c ion of hor chain fa acid co ld ei her red ce chemorecep or im la ion or mod la e imm ne re pon e.
To da e, he increa ing e idence ho ing an implica ion of hea -con aining food in ind cing FD mp om, led e eral a hor o in e iga e he effec of gl en-free regimen in FD pa ien [30,31,57,58]. Ho e er, he gl en-free die re l in a marked
red c ion of die ar FODMAP a ell, offering po en ial in erpre a ion bia e [59]. A
pecific in e iga ion on he differen ial impac of gl en and FODMAP re ric ion on FD mp om i nece ar o clarif he mechani m b hich he e n rien co ld ac on FD pa hogene i .
Taking o acco n he beneficial effec of ginger men ioned abo e, i co ld be rea onable o enco rage i addi ion o die . Ho e er, he effec i ene of ginger ac ion eem o be do e-rela ed and infl enced b he in abili and he ea e of o ida ion pical of pol phenolic compo nd and heir differen bioa ailabili . Indeed, gingerol and hogaol concen ra ion rongl differ ba ed on prod c pe (fre h, dr , gro nd, cr alli ed )[60]. The role of die ar manip la ion and pecific
food in FD pa hoph iolog i mmari ed in Fig re 1.
CONCL SION
A pre en , googling he en rie d pep ia AND die lead o o er 2570000 hi , i ne ing he p blic in ere on hi opic. Thi combined i h he lack of andardi ed die ar g ideline for FD, he ne en informa ion pro ided b
peciali and he a diff ion of no alida ed n ri ional ad ice re l in an
increa ingl freq en endenc of pa ien o elf-manage heir mp om . FD pa ien of en end o elf-diagno e i h food in olerance and arbi raril re ric heir die ,
olel on he ba i of heir per onal e perience or anecdo al informa ion from q e ionable o rce . The e impro i ed elimina ion die are of en n ri ionall
nbalanced and, if prolonged, co ld herefore ca e n ri ional deficiencie . F r hermore, long- erm e cl ion die co ld enhance an ie o ard ha food, increa ing i ceral h peralge ia and con rib ing o mp om an icipa ion.
Thi improper loop lead f nc ional pa ien o perpe a e he e ea ing-a oidan beha ior and o erroneo l con ince hem el e of being in oleran o pecific
rigger food [61-63].
In pi e of he gro ing p blic in ere and pre ing req e for andardi ed
die ar ad i e from pa ien , er fe randomi ed con rolled rial ere incl ded in he pre en re ie and mo a ailable e idence repre en e rapola ion from
Tab 1 R c c d a d c b c a d a F d Ac c S d c a ac c O c a P d c a ac E c R .
Fa food Lipid Cro - ec ional d (4 heal h bjec ); Lo igl mide Lo igl mide pl fa
Ga roin e inal con rac ile ac i i (manome r )
Increa ed CCK
relea e (1) H per en i i io ga roin e inal hormone ; (2) Dela ed ga ric emp ing; and (3) S mp om e acerba ion [27] Randomi ed cro o er d (20 FD pa ien ); D odenal inf ion of aline lipid
ol ion
Ga ric ol me mea remen (ga ric baro a )
[28]
Almond Tr p ophan Cro - ec ional d (384 FD pa ien ); S mp om correla ion i h he in ake of 114 differen food Ga roin e inal mp om mea remen (VAS)
Indirec im la ion of ero oninergic 5-HT1 and 5-HT4 recep or
(1) Impro ed ga ric emp ing; and (2) S mp om impro emen [29] Do ble-blind RCT o er placebo; Tando pirone placebo [33]
Pepper and Chili Cap aicin Cro - ec ional d (121 FD pa ien ); S mp om genera ion according o TRPV1 geno pe and he in ake of pic food
TRPV1
pol morphi m (on blood ample )
Reg la ion of TRPV1 recep or
(1) H peralge ia (ac e
admini ra ion); and (2) Red ced i ceral h per en i i i (chronic admini ra ion) [35] Randomi ed cro o er d (20 IBS-D pa ien ); S andard meal
pic meal chili
Ga roin e inal mp om mea remen (VAS)
[36] Do ble-blind rial o er placebo (30 FD pa ien ); Pepper placebo Ga roin e inal mp om mea remen (VAS)
[37]
Peppermin and
Cara a oil Cro -o er heal h bjec );d (6 Peppermin cara a oil combina ion (en eric non en eric coa ed cap le )
Ga rod odenal mo ili
(manome ric d )
Allo eric effec on
5-HT3 recep or (1) An ieme ic,Cholere ic and pa mol ic ac ion; and (2) S mp om impro emen [41] Randomi ed, do ble-blind rial o er placebo (96 FD pa ien ); Peppermin cara a oil placebo Ga roin e inal mp om mea remen (VAS)
[44]
Ginger Gingerol and
Shogaol Do ble-blind rialo er placebo (24 heal h bjec ); Ginger placebo
Ga ric emp ing
(US) Inhibi ion ofcholinergic M3 and ero oninergic 5-HT3 recep or
(1) Enhanced ga ric emp ing; (2) Impro ed ga ric mo ili ; (3) Red ced na ea and
omi ing; and (4) ed ced inflamma ion [47] Randomi ed, do ble-blind rial o er placebo 126 FD pa ien ); inger placebo Ga roin e inal mp om core (VAS) [48] RCT o er placebo (11 FD pa ien ); inger placebo Ga roin e inal mp om (VAS) Ga ric emp ing (US), circ la ing hormone (GLP-1, mo ilin and ghrelin)
FODMAP FOS, GOS, Lac o e, Fr c o e (e ce ), Pol ol
Randomi ed cro o er d (30 IBS pa ien and 8 heal h bjec ); LFD A ralian die Ga roin e inal mp om core (VAS) Increa ed in e inal fermen a ion Increa ed o mo ic load (1) Abnormal ga prod c ion; (2) L minal a er re en ion and abdominal di en ion; (3) S mp om
e acerba ion; and (4) Enhanced d odenal inflamma ion
[25]
5-HT1: 5-h dro r p amine b pe 1; 5-HT4: 5-h dro r p amine b pe 4; CCK: Cholec okinin; FD: F nc ional d pep ia; FODMAP : Fermen able oligo accharide , di accharide , mono accharide and pol ol ; FOS: Fr c o-oligo accharide ; GOS: Galac o-oligo accharide ; LFD: Lo fodmap die ; M3: M carinic recep or b pe 3; TRPV1: Tran ien recep or po en ial anilloid b pe 1; GLP1: Gl cagon-like pep ide 1, US: Ul ra o nd, GI: Ga roin e inal; VAS: Vi al analog e cale.
ob er a ional die . Complica ing he ma er f r her and he high degree of
o erlap be een FD, ga ro-e ophageal refl di ea e and IBS. For in ance, he
effec of a lo -FODMAP die in FD co ld be o er hado ed b he o erlap i h IBS mp om , nder- or o er-e ima ing he effec of hi die ar approach in FD pa ien [56].
Taking in o acco n he abo e con idera ion , i i i al o p r e a niform and e idence-ba ed n ri ional approach in he managemen of FD pa ien and o de ign
high-q ali die e al a ing he impac of n ri ional in er en ion. The gro ing
n mber of mobile and mar phone-ba ed app , de igned o collec die ar da a and o objec i el record n ri ional in er en ion , offer he po ibili o o ercome he c rren limi a ion .
Therefore, ell- r c red and andardi ed g ideline are eagerl a ai ed in order o andardi e he n ri ional approach and a i f FD pa ien nme clinical need .
F 1
F 1 R d a a a a d c c d c a d a a . ASIC : Acid- en ing ion channel ; CCK: Cholec okinin; FD: F nc ional d e ia; FODMAP : Fe men able oligo accha ide , di accha ide , mono accha ide and ol ol ; TRPA: T an ien ece o o en ial ank in; TRPV: T an ien ece o o en ial anilloid.
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