Self-Reported Food Intolerance in Chronic Inflammatory Bowel Disease

Medical Dept., Roskilde County Hospital in Køge (RASK), Denmark.
Scandinavian Journal of Gastroenterology (Impact Factor: 2.36). 06/1997; 32(6):569-71. DOI: 10.3109/00365529709025101
Source: PubMed


Although suggested, it has never been convincingly documented that food sensitivity is of pathogenetic importance in chronic inflammatory bowel disease. However, many patients may relate their gastrointestinal symptoms to specific food items ingested and may restrict their diet accordingly.
A questionnaire was sent to all patients with chronic inflammatory bowel disease who attended the outpatient clinic, Medical Dept., Roskilde County Hospital in Køge, Denmark, in the year 1993. The patients were asked whether they had problems with any particular food item and, if so, to describe the symptoms experienced from it. A control group of 70 healthy persons were included.
Among 189 patients, 132 (70%) responded. One hundred and thirty had completed the questionnaire, 52 males and 78 females aged 13-89 years (median, 43 years). Fifty-three (41%) had Crohn's disease (CD), 69 (53%) ulcerative colitis (UC), and 8 (6%) unclassified colitis. Forty-one patients (31 CD, 10 UC) were-operated on; 51 (19 CD, 32 UC) had disease activity. Sixty-five per cent of the patients and 14% of the controls reported being intolerant to one or more food items (P < 0.0001). The intolerance covered a wide range of food products. The commonest symptoms among patients were diarrhoea, abdominal pain, and meteorism and among controls, regurgitation. Food intolerance was equally common in CD (66%) and UC (64%) and was not related to previous operation, disease activity or disease location.
Most patients with chronic inflammatory bowel intolerance disease feel intolerant to different food items and may restrict their diet accordingly. The frequency and pattern of food intolerance did not differ between patients with CD and UC. The food intolerance was probably unspecific rather than of pathogenetic importance.

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    • "It is much more difficult to pinpoint trigger foods in the case of food intolerance. Many published studies report specific food intolerances according to patient questionnaires [Ballegaard et al. 1997; Niec et al. 1998]. This is unreliable methodology given the mix of foods included in meals and snacks and the likelihood of pinpointing the wrong culprit. "
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    ABSTRACT: Food intolerance in irritable bowel syndrome (IBS) is increasingly being recognized, with patients convinced that diet plays a role in symptom induction. Evidence is building to implicate fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the onset of abdominal pain, bloating, wind and altered bowel habit through their fermentation and osmotic effects. Hypersensitivity to normal levels of luminal distension is known to occur in patients with IBS, with consideration of food chemical intolerance likely to answer many questions about this physiological process. This paper summarizes the evidence and application of the most common approaches to managing food intolerance in IBS: the low-FODMAP diet, the elimination diet for food chemical sensitivity and others including possible noncoeliac gluten intolerance.
    Full-text · Article · Jul 2012 · Therapeutic Advances in Gastroenterology
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    • "However, sub-optimal dietary Fe intake has not been widely considered as a potential contributor to ID in CD, and yet deserves attention because food aversions and self-reported food intolerance are common in this patient group (Ballegaard et al. 1997; Mishkin, 1997). Thus patients often alter their diet to reduce abdominal symptoms, such as pain and diarrhoea (Ballegaard et al. 1997). A number of studies have evaluated dietary Fe intake in inflammatory bowel disease (Hodges et al. 1984; Gee et al. 1985a,b; Imes et al. 1987; Geerling et al. 1998), but have generally involved small numbers, lacked appropriate control groups and often had insufficient specificity or selectivity to estimate Fe intakes with any confidence. "
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    ABSTRACT: Patients with Crohn's disease (CD) often experience Fe deficiency (ID) and frequently alter their diet to relieve abdominal symptoms. The present study set out to assess whether patients with CD have dietary habits that lead to low Fe intakes and/or reduced bioavailable Fe compared with control subjects. Patients with asymptomatic CD were matched to controls (n 91/group). Dietary intakes of Fe and contributions from different food groups were compared using a 7 d food diary. Promoters and inhibitors of non-haem Fe absorption were investigated and a recently published algorithm was applied to assess bioavailable Fe. Fewer patients than controls met the reference nutrient intake for Fe (32% CD patients v. 42% controls). Overall, patients had significantly lower mean Fe intakes (by 2.3 mg/d) and Fe density (by 0.26 mg/MJ (1.1 mg/1000 kcal)) compared with controls (both P<0.001). Differences were mainly due to a preference among CD patients for low-fibre non-Fe fortified cereals, particularly breakfast cereals. In particular, control subjects had higher Fe intakes than matched CD subjects for men (P<0.001) and women less than 50 years (P=0.03). Intakes of both ascorbic acid (P<0.001) and phytic acid (P<0.01), but not animal tissue (P=1.0), were lower in patients with CD, but these had no overall effect on the predicted percentage of bioavailable Fe. Thus total bioavailable Fe was reduced in patients with CD due to lower intakes (P<0.01). Dietary Fe intakes are low in CD patients, which may contribute to an increased risk of ID and anaemia. Changing dietary advice may compromise perceived symptoms of the disease so the need for Fe supplementation should be carefully considered.
    Full-text · Article · Jan 2004 · British Journal Of Nutrition
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    ABSTRACT: RESUMEN Introducción: Los pacientes con enfermedad inflamatoria crónica intestinal (EII), enfermedad de Crohn y colitis ulcerosa presentan lesiones en el epitelio intestinal de carácter inflamatorio. Estas lesiones afectan al intestino grueso en la colitis ulcerosa y a cualquier parte del tracto digestivo en la enfermedad de Crohn. En este tipo de enfermos se ha visto que existe una menor absorción de nutrientes, sobre todo en la enfermedad de Crohn, entre ellos la lactosa (el azúcar de la leche). Hipótesis de trabajo: los pacientes con enfermead inflamatoria tienen mayor prevalencia de malabsorción de lactosa y de fructosa. Pacientes y métodos: se valoró la gravedad de la enfermedad inflamatoria mediante los índices de Truelove-Witts y el CDAI, la extensión de la enfermedad, el patrón fenotípico y la existencia o no de válvula ileocecal en la enfermedad de Crohn. Se realizaron pruebas de absorción a 156 pacientes con enfermedad inflamatoria (71 colitis ulcerosa y 86 con enfermedad de Crohn) y a 41 voluntarios sanos mediante test del aliento de hidrógeno, se recogió mediante un cuestionario la presencia de síntomas durante la prueba y en las 24h posteriores y se realizó una analítica completa con maracadores para enfermedad celíaca con valoración de parámetros nutritivos y de parámetros inflamatorios. Resultados y conclusiones: la prevalencia de malabsorción de lactosa en los enfermos de EII es similar a la de la población general sana y no está influenciada por la localización, actividad inflamatoria, fenotipo ni por la ausencia de válvula ileocecal. La intolerancia a la lactosa es más frecuente en pacientes con colitis ulcerosa que en los sujetos sanos tanto durante el test como en las 24h posteriores, también en los pacientes con afectación izquierda extensa y pancolitis. En la enfermedad de Crohn la intolerancia a lactosa es superior a la población sana sólo en las 24h posteriores al test, y es más prevalente en las localizaciones del íleon terminal y la ileo-colónica, y en los patrones inflamatorio y estenosante. La prevalencia de malabsorción de fructosa es similar a la de la población sana en los pacientes con colitis ulcerosa y mayor en los de enfermedad de Crohn tanto respecto a los sujetos sanos como a colitis ulcerosa, también en las localizaciones: tracto digestivo superior ielo-colon y colon. La intolerancia a fructosa en los enfermos durante el test es similar a la de la población general sana, pero es superior en las 24h posteriores, en la colitis ulcerosa esta prevalencia aparece en las localizaciones distal e izquierda-extensa y en los pacientes sin activiad inflamatoria y en la enfermedad de Crohn en el tracto GI alto, íleon terminal e íleo-colon, en los tres fenotipos, y en pacientes con y sin actividad inflamatoria. Los pacientes con EII refieren síntomas sin existir malabsorción con mayor frecuencia. La prevalencia de sobrecrecimiento bacteriano en los pacientes con colitis ulcerosa es similar a la población sana, excepto en la pancolitis y cuando existe actividad, en la enfermedad de Crohn es superior para el grupo completo y para las localizaciones Tracto GI alto, íleon terminal e ileocolon, patrones estenosante y penetrante, en fase de remisión y en ausencia de válvula ileocecal. El tiempo de tránsito orocecal es similar a la población sana en los pacientes con enfermedad de Crohn, mientras que está enlentecido en los pacientes con colitis ulcerosa, en la localización izquierda extensa y tanto si hay como no actividad inflamatoria. __________________________________________________________________________________________________ Introduction: There are specific foods or groups of foods that can be linked to the aggravation of inflammatory bowel disease (IBD). Foods commonly identified by IBD patients (Ulcerative colitis and Crohns disease) as causing symptoms on reintroduction, rechallenge, and double-blind challenge, include milk, peanuts, citrus fruits, wheat, eggs, fish, etc. IBD is controversially discussed as an independent risk factor for lactose malabsorption. Some data show lactose intolerance in 40% to 70% of patients with Crohns disease (CD), whereas a prevalence of lactose intolerance seems not to be increased in patients with ulcerative colitis (UC). Lactose maldigestion may be influenced by bacterial overgrowth and increased small bowel transit time. Hypothesis: Patients with IBD show lactose and/or fructose malabsorption frequently than healthy people. Patients and methods: 156 patients with IBD (86 with CD and 71 with UC) and 41 controls were included prospectively in the study. The diagnosis of IBD was based on findings of characteristic radiologic, endoscopic, and microscopic features. Disease activity was determined using the CDAI and the Truelove index for CD and UC, respectively. Blood was drawn to determine concentrations of inflammatory markers, hemoglobin and Celiac disease markers. Lactose, fructose and lactulose hydrogen breath test were carried out to all subjects. All individuals completed a symptom score where were asked about their subjective experience with diarrhea, bloating, flatulence and abdominal distension after ingestion of each sugar. Results and conclusions: The prevalence of lactose malabsorption in patients with IBD was similar to that of healthy group and was not influenced by location, inflammatory activity, Vienas phenotype or previous ileocolic resection. Lactose intolerance occurred more often among patients than among controls both during the test and in the next 24h. Fructose malabsorption was similar in UC patients and controls, but was increased in CD patients with respect to both groups. Patients show fructose intolerance 24h after the test more often than controls while patients and controls intolerance during the test was similar. The prevalence of bacterial overgrowth in patients with UC and controls was similar while was increased in CD patients. Orocecal transit time was slower in UC patients.
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