Introduction

A sedentary lifestyle, poor fiber intake and other unhealthy dietary habits have been associated with diverticular disease (DD). On the contrary, the Mediterranean Diet (MD), which involves factors such as consuming locally grown food products, family meals, conviviality, involvement in the preparation of meals, as well as high intake of vegetables, legumes, fruit and cereals, medium intake of fish, low intake of meat and saturated fat, high intake of unsaturated fat (particularly olive oil), a medium-low intake of dairy products (yogurt and cheese), and a moderate intake of wine, seems to protect against DD. Moreover, populations that follow the MD pattern show a 50% lower rate of cardiovascular mortality due to cardiovascular disease and show highest longevity. (1)

Aims & Methods

Aim: to compare adherence to MD as a whole and its different components in subjects with and without diverticular disease.

Materials and methods: all patients undergoing colonoscopy at our Endoscopy Unit of a Tertiary Hospital in Northeastern Italy from January to June 2022 were invited to participate in the study, completing three questionnaires including personal/medical history and medications, symptoms, physical activity questionnaire, and Medi-Lite (ML) questionnaire for the assessment of adherence to MD. Subjects were then divided in two groups based on the endoscopic diagnosis of diverticular disease (DD).

Results

A total of 3757 patients underwent colonoscopy at our center during the 6-month study period, 1112 of whom completed the questionnaires and therefore constituted the study population. Overweight (BMI>25 kg/cm²) was observed in 61% of males and 40.2% of females, and correlated inversely (OR<1) with higher education attainment, daily physical activity of at least 30 minutes, and, in females, the performance of a structured physical activity/sport for at least 60 minutes a week. Moreover, being married or widowed and consuming meals preferably at home, as opposed to consuming meals at restaurants or cafeterias, were significantly associated with overweight (OR>1), especially in female patients. In the overall population, normal weight was more frequently associated with consumption of meat, while in females, it is associated with greater consumption of raw vegetables. Overweight was more frequently associated with consumption of salami and cheese, especially in the female population, and it correlated with the presence of cardiovascular diseases (especially hypertension). DD was present in 400/1112 (35.9%) of subjects and this condition was significantly associated with (OR>1) male sex, older age (61-75 years), overweight (BMI>25 kg/cm²), cardiovascular disease, polypharmacy, cigarette smoking, alcohol use, cheese consumption, abdominal pain as the chief complaint, and lower education attainment. No correlation was found between DD and the MD score or its components. In patients with DD, abdominal pain was inversely and significantly associated with an elevated ML score (OR=0.085) and consumption of meat (OR=0,096) and legumes (OR=0,079) (p<0.05).

Conclusion

Subjects undergoing colonoscopy share similar dietary and lifestyle habits, while in the presence of DD, ingestion of certain products seems to have an impact on symptoms.

References

1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344.

Introduction

Functional dyspepsia (FD) is one of the most frequent disorders of the gut-brain interaction with a worldwide prevalence of around 7%.¹ Our group showed that a diet excluding fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) improved symptoms in the majority of FD patients.² FODMAPs have been studied in irritable bowel syndrome, where poor intestinal absorption may lead to osmotic effects and fermentation, contributing to symptoms. However, this has not been studied in FD to date. In this study, we assessed pathophysiological parameters after ingestion of mannitol and a control meal in FD patients and healthy volunteers (HV).

Aims & Methods

FD patients (N=11) that responded to the low FODMAP diet and showed symptom triggers by mannitol during reintroduction were recruited. Also, 11 HV participated in this trial. FD and HV had a similar age (47 (24-55) vs. 25 (21-46), p=0.14) and BMI (22 (21-31) vs. 23 (21-25), p=0.85), but FD cohort included more females (100% vs 55%, p=0.04). After an overnight fast, abdominal magnetic resonance imaging (MRI) was performed in patients and HV. MRI images, gastrointestinal (GI) symptoms and blood samples were collected at baseline and at six separate time points after a challenge meal (0, 15, 30, 45, 60, 120, 240 min). The meal was an oat porridge breakfast containing either mannitol or glucose, as a control, in a randomized, double blind cross-over fashion. MRI images were analyzed for gastric emptying T_1/2 (GE T_1/2), duodenal volume, small bowel water content (SBWC) and colonic gas volume. Blood samples were analyzed for glucose like peptide-1 (GLP-1), peptide YY (PYY), and GIP.

Results

FD patients exhibited more FD symptoms compared to HV after consuming both the glucose-rich meal (54 ± 10 vs 24 ± 7, p=0.02) and the mannitol-rich meal (64±13 vs 23±7, p=0.01). No differences were found for GE T_1/2 in FD and HV, as indicated in Table 1. Colonic gas volume was significantly increased in patients compared to HV. Duodenal volumes tended to increase more after intake of mannitol compared to glucose in both groups, but reached significance only in HV. SBWC was increased after mannitol in both HV (p=0.01) and FD (p=0.01). After intake of mannitol, postprandial GLP-1 levels were significantly lower in FD compared to HV, after 15 (p=0.02) and 30 min (p=0.001). Also, the AUC of GLP-1 was significantly lower in FD versus HV after mannitol (p=0.04), as well as after glucose-rich (p=0.04) meal. In FD, AUC of GIP levels was significantly lower after mannitol versus glucose (p=0.002). GI symptom scores did not correlate with PYY, GLP-1, and GIP levels. GLP-1 and GIP values did not correlate with GE T_1/2.

Conclusion

In this pilot study no difference in symptom triggering in FD was observed between mannitol and glucose (control) supplemented meals, but compared to HV the meals were associated with higher symptom burden, lower release of GLP-1 and GIP, and larger colonic gas volumes. The mechanisms underlying decreased peptide hormone release and their relevance to symptom generation deserve further studies.

References

1. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE, Dumitrascu DL, Fang X, Fukudo S, Kellow J, Okeke E, Quigley EMM, Schmulson M, Whorwell P, Archampong T, Adibi P, Andresen V, Benninga MA, Bonaz B, Bor S, Fernandez LB, Choi SC, Corazziari ES, Francisconi C, Hani A, Lazebnik L, Lee YY, Mulak A, Rahman MM, Santos J, Setshedi M, Syam AF, Vanner S, Wong RK, Lopez-Colombo A, Costa V, Dickman R, Kanazawa M, Keshteli AH, Khatun R, Maleki I, Poitras P, Pratap N, Stefanyuk O, Thomson S, Zeevenhooven J, Palsson OS. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi: 10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476.
2. Van den Houte K. et al. OUTCOME OF A LOW FODMAP ELIMINATION DIET WITH BLINDED REINTRODUCTION IN FUNCTIONAL DYSPEPSIA / POSTPRANDIAL DISTRESS SYNDROME. Under review Gut 2025

Introduction

Approximately 15-19% of patients suffering from irritable bowel syndrome (IBS) have an eating disorder (ED) based on a screening score or dietary assessment (1). Avoidant/restrictive food intake disorder (ARFID), a long-recognised eating disorder in children, is now recognised in adults. In a Swedish study, 13.2% of patients suffering from IBS reported severe dietary avoidance or restriction, suggestive of ARFID (2). A screening questionnaire for this disorder has recently been validated in French (NIAS-Fr, for Nine Item ARFID Screen in French) (3).

Aims & Methods

This study aims to assess the prevalence of ARFID in IBS in France, by comparing the NIAS-Fr questionnaire and the assessment by a specialised dietitian, and to look for links between its presence and the clinical phenotype of patients. This study was conducted between February and September 2024 in consecutive patients suffering from IBS and evaluated in a multidisciplinary day hospital structure. Clinical characteristics (age, gender, BMI, IBS subtype and its severity [IBS-SSS], presence of functional dyspepsia, diet and disease duration) and presence of ARFID (clinically or one abnormal NIAS-Fr subscale) were collected. A dietitian assessed the presence of “clinical ARFID”. The NIAS subscales allow for the diagnosis of patients as “picky eaters” (score ≥10), with “poor appetite” (score ≥9) and/or with a “fear of eating” (score ≥10). Patients with a history of ED diagnosed by a psychiatrist and/or an abnormal ED screening score (SCOFF ≥ 3 and/or global EDE-Q8 ≥ 4.0) were excluded from the analysis.

Results

Of the 95 patients with IBS according to Rome IV, 55 (57.9%) had at least one positive NIAS-Fr subscale, with 10 (10.5%) having an abnormal “picky eater” subscale, 16 (16.8%) an abnormal “poor appetite” subscale, and 49 (51.6%) an abnormal “fear of eating” subscale. Of these 95 patients, 15 were excluded from the analysis because of a history of eating disorders or an abnormal screening score. We therefore included 80 patients for analysis (77.5% women; mean age 48.5 ± 16.8 years, BMI 22.6 ± 4.6 kg/m²; 40.0% IBS-D, 38.8% IBS-C, and 20.0% IBS-M; 51.3% had associated dyspepsia; 62.5% were on a special diet at the time of assessment). The mean IBS-SSS score was 319.5 ± 88.2 points (severe forms in 61.2%). Among these 80 patients, 43 (53.8%) had at least one positive NIAS-Fr subscale, including 10.0% of "picky eaters," 16.3% of "poor appetite," and 48.8% of "fear of eating." Patients with at least one positive NIAS-Fr subscale had more frequent functional dyspepsia than those with a negative NIAS (65.1 vs. 35.1%, p = 0.013), but there were no differences in the other parameters assessed. According to the dietitian's assessment, 19 (23.8%) patients in our cohort had clinical ARFID, i.e., 44.2% of those with at least one positive NIAS-Fr subscale. In an IBS population, the specificity of the NIAS-Fr questionnaire for diagnosing clinical ARFID was 55.8% (95% CI: 41.1-69.6). None of the assessed parameters distinguished patients with and without clinical ARFID (p > 0.05).

Conclusion

ARFID symptoms are found in more than half of IBS patients treated in a tertiary care centre based on an abnormal NIAS-Fr screening questionnaire, after excluding other eating disorders. These patients frequently have associated functional dyspepsia and a normal BMI. Based on a dietary assessment, clinical ARFID is found in approximately one-quarter of IBS patients. The specificity of the NIAS-Fr in IBS is too low to allow a diagnosis of ARFID in this population.

References

(1) Wuestenberghs et coll. Intérêt du dépistage des troubles du comportement alimentaire au cours du syndrome de l’intestin irritable. JFHOD 2024 (number 000694)
(2) Melchior et coll. Food Avoidance and Restriction in Irritable Bowel Syndrome: Relevance for Symptoms, Quality of Life and Nutrient Intake. Clin Gastroenterol Hepatol. 2022;20(6):1290-1298.e4.
(3) Van Ouytsel et coll. Translation of the nine item avoidant/restrictive food intake disorder screen (NIAS) questionnaire in French (NIAS-Fr). Neurogastroenterology & Motility 2024 ; 36 (4) : e14757.

Disclosure

Nothing to disclose.

Introduction

Chronic hepatitis, primarily caused by HBV, HCV, or HDV infections, remains a silent yet progressive condition leading to advanced hepatic fibrosis and cirrhosis. Non-invasive assessment tools, such as the FIB-4 score, play a crucial role in early-stage risk stratification. Emerging evidence suggests a potential interaction between gut microbiota alterations-particularly Small Intestinal Bacterial Overgrowth (SIBO)-and liver function, mediated through the gut-liver axis.

Aims & Methods

Aim: To evaluate the association between SIBO status and FIB-4 scores among patients with chronic hepatitis, and to assess whether SIBO positivity serves as an independent marker of hepatic fibrosis severity.
Methods: We retrospectively analyzed clinical and biochemical data from 122 patients with confirmed viral hepatitis. Parameters included age, gender, liver enzyme levels (ALT, AST, ALP, GGT), SIBO breath test results, and viral titers. FIB-4 scores were calculated using standard formulas. Patients were grouped based on SIBO status (positive vs. negative). Boxplot analysis and correlation metrics were used to visualize and quantify associations.

Results

Patients with SIBO positivity exhibited significantly higher median FIB-4 scores (1.87) compared to those who were SIBO-negative (1.23), (p < 0.05). The boxplot analysis underscored a wider interquartile range and rightward skew in SIBO-positive individuals. A moderate positive correlation (Spearman's rho = 0.41) was observed between viral titers and FIB-4 levels, indicating a synergistic impact of microbial overgrowth and viral load on liver fibrosis progression.

Conclusion

SIBO positivity appears to correlate with elevated FIB-4 scores in chronic hepatitis patients, suggesting microbial dysbiosis as a potential contributor to fibrotic burden. Incorporating gut health assessment into routine liver disease screening may enhance early detection of high-risk individuals. Further prospective studies are recommended to explore causality and therapeutic modulation of the gut-liver axis.