Introduction

Patients with end-stage renal disease frequently experience gastrointestinal issues. Gastrointestinal symptoms (GI) in these patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The chronic inflammatory state is another factor contributing to the prevalence of various GI problems. Increased protein skeletal muscle breakdown, decreased appetite, and hypercatabolism are just a few of the detrimental impacts of inflammation.

Aims & Methods

17 peritoneal dialysis (PD) patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessments were conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to classify patient's stool. The dietary intake of PD patients was assessed using 7-day food diaries and analyzed with Prodi program (PRODI® 6.4 Expert program, Stuttgart, Deutschland). Body composition was measured with bio impedance spectroscopy. Routine blood analysis was performed.

Results

Among 17 patients undergoing PD, most of them were male (71.4 %) with average age of 53.07 ± 12.32 years. Average protein intake was 0.87 ± 0.39 g/ kg body weight per day and average fiber intake was 13.75 ± 7.25 g per day. They were inadequate according to the dietary guidelines for PD patients. Average dietary protein-fiber index was 6.86 ± 3.81 per day. Average PRAL value was 15.84 ± 13.44 for women and 6.52 ± 17.99 for men. Average dietary potassium intake was 1917.80 ± 790.08 mg per day which corresponds to the guidelines for peritoneal dialysis patients and average potassium serum value was 4.45 ± 0.42 mmol/L. GSRS questionnaire showed PD patients had minor to mild discomfort in abdominal pain, constipation and indigestion GI symptom cluster. Patients’ self-analysis of stool showed BSFS Types 3.23 ± 1.64 if BSFS Types 3-5 are defined as normal stools. Dietary potassium intake moderately to strongly correlated with dietary fiber intake (r=0.62, p=0.025). Serum value of IL-6 strongly correlated with dietary potassium intake (r=0.72, p=0.006) and moderately to strongly correlated with dietary fiber intake (r=0.6, p=0.034). The correlation between dietary potassium intake and serum hsCRP was significant (p=0.042). The correlation between Bristol stool consistency value and serum hsCRP was significant (p=0.0255). The correlation between total GSRS score and serum value of albumin was significant (p=0.0010), between total GSRS score and dietary potassium intake was significant (p=0.0015) and between total GSRS score and dietary protein-fiber index was significant (p=0.0403).

Conclusion

GI diseases in PD patients are comparatively understudied in the literature, despite having a significant impact on dialysis efficacy and the quality of life. Analysis of GSRS questionnaire showed that abdominal pain, constipation and indigestion caused minor to mild discomfort in PD patients. The analysis also showed that fiber intake, potassium intake and GI symptoms are significantly associated with inflammation markers and are important contributing factors to chronic inflammatory state in these patients. The evidence base of the impact of GI symptoms on PD patients is limited and further investigation of potential interventions such as medication use and changes in diet are required in future research.

Introduction

Ultra-processed foods (UPFs) have been linked to inflammatory bowel disease (IBD) incidence and progression(1)

Aims & Methods

We compared UPF and emulsifier intake in patients with IBD and healthy controls (HC) and examined their association with IBD-relevant outcomes.
Dietary intake was calculated from Food Frequency Questionnaires (FFQs) and food logs. Two 24-hour dietary recalls in patients with IBD were compared to two prospective logs from HC from an interventional study. Patients were recruited at the infusion unit and followed up for one year. For cross-sectional analysis, Kruskal Wallis with post-hoc Dunn test and Fisher exact test were used, as appropriate, to compare UPF and emulsifier intake, adjusted for multiple testing using Bonferroni. Kaplan–Meier survival analysis and log-rank tests were used to assess the association between tertiles of UPF and emulsifier intake and the incidence of IBD-related outcomes.

Results

We included 186 subjects (65 HC, 59 Crohn’s disease (CD) and 62 ulcerative colitis (UC)). Median (IQR) age was 26 (23 - 33) years for HCs, and 41 (32 - 51) and 46 (35 - 55) years for CD and UC resp. We included 52 healthy females, and 25 and 24 females in the CD and UC cohort resp.
Assessing food logs, UPF intake was similar in all groups, but emulsifier intakes were higher in IBD compared to HC (Table 1). In both UC and CD, higher intakes of potassium alginate, oat gum, mono- and di-glycerides of fatty acids, as well as carrageenan and xanthan gum were seen, compared to HC. Intake of polyglycerol polyricinoleate was higher in CD compared to HC, while intake of guar gum was higher in UC compared to HC. The proportion of non-consumers of potassium alginate was higher in HC compared to IBD.
Compared to HC, soft drinks, meat, and butter intake was higher in patients with IBD. However, intake of breakfast cereals, legumes, meat substitutes, whole grain pasta and rice, and fiber was lower in UC and CD. Coffee, potato, deli meat, and sodium intake was higher in CD patients than HC, while nut and seed intake was lower. There was no correlation between serum CRP and intake of UPFs, emulsifiers, macronutrients or total energy.
Longitudinal analysis showed a trend towards increased UPF intake and more frequent emergency department (ED) visits (p=0.059) and surgery (p=0.064), but not for IBD-related hospitalization (p>0.1). For increased emulsifier intake, we report a trend towards an increase in IBD-related hospitalisation (p=0.056), but not for ED visits or surgery (p>0.1).

Conclusion

We show higher intakes of emulsifiers in patients with IBD compared to HC, with similar UPF intake. Longitudinal analysis trends towards a link between UPF and emulsifier intake and poorer IBD-related outcomes, emphasizing the need for larger cohorts. The increased intake of specific emulsifiers such as carrageenan and guar gum warrant further investigation into their role in the propagation and maintenance of gut inflammation, as well as their impact on IBD-relevant patient outcomes.

References

(1) Chen J & Wellens J, Kalla R, et al. Intake of Ultra-processed Foods Is Associated with an Increased Risk of Crohn's Disease: A Cross-sectional and Prospective Analysis of 187 154 Participants in the UK Biobank. J Crohns Colitis. 2023 Apr 19;17(4):535-552.

Disclosure

JW reports no conflicts of interest.
MD reports no conflicts of interest.
SH received consultancy fees from Ferring, Takeda.
ML reports no conflicts of interest.
JV received speaker’s fees from Janssen; consultancy fees from Ferring.
EDM reports no conflicts of interest.
EV reports no conflicts of interest.
MF received research grants from AbbVie, EG Pharma, Janssen, Pfizer, Takeda and Viatris; con-sultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, Merck Sharp and Dohme, MRM Health, Pfizer, Takeda and ThermoFisher; and speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris.
BV reports research support from Sossei Heptares/Nxera and Takeda. In addition, BV reports speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris, consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris, and stock options from Vagustim.
SV received financial support for research from AbbVie, J&J, Pfizer, Takeda and Galapagos; receives speakers’ and consultancy fees from AbbVie, Abivax, AbolerlsPharma, AgomAb, Alimentiv, Arena Pharmaceuticals, Astrazeneca, BioraTherapeutics, BMS, Boehringer Ingelheim, Celgene, Cytoki Pharma, Ferring, Galapagos, Genentech Roche, Gilead, GSK, lmidomics, Janssen, J&J, Lilly, Materia Prima, Mestag Therapeutics, Microbiotica, MiroBio, Morphic, MrMHealth, Pfizer, Progenity, Prometheus, Surrozen, Takeda, Theravance, Tillots Pharma AG, VectivBio, Ventyx, Zealand Pharma.
JS received financial support for research from Galapagos and Viatris; receives speakers’ fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos; and receives consultancy fees from Pfizer, Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia.

Introduction

Among patients with functional gastrointestinal disorders (FGID), food intake is often identified as a symptom trigger. Common foods known to cause gastrointestinal (GI) symptoms include fatty foods (1) and fermentable carbohydrates (FODMAPs) (2), but the evidence is limited and may vary among different FGID.

Aims & Methods

The aim of this study was to explore if certain foods are considered more tolerable, and which specific foods are identified as triggers of GI symptoms among participants with irritable bowel syndrome (IBS) and functional dyspepsia (FD). An online survey was conducted including n=537 participants from the Swedish general population with symptoms compatible with a functional bowel disorder. The survey included questions on demographics and an adapted food frequency questionnaire that assessed intakes of 38 different food items or aggregated food groups. For each food, participants had to answer whether or not they considered the specific food to be a trigger for GI symptoms.

Results

Among the respondents, a total of 220 participants with IBS and/or FD (mean age 34.7 years, body mass index 26.8 kg/m², women: 78.2%) were included in the analyses, of whom n=128 fulfilled criteria for FD and n=136 for IBS. Foods that were least commonly reported to cause GI symptoms included hard bread, fish and shellfish, berries, nuts, and seeds (Figure). The most frequently reported food triggers included pizza, crisps, confectionery, candy, ice cream, white bread, dairy, french fries, pie, and sausages. White bread, more often than whole grain bread, was reported to cause GI symptoms. Most vegetables and fruits were well tolerated in FD. A few FODMAP-rich vegetables, such as onion, garlic, beans, lentils, cauliflower and cabbage were more often reported as food triggers in IBS compared with FD. Having overlapping IBS and FD increased the prevalence of foods that were considered to cause symptoms.

Conclusion

In individuals with IBS and/or FD, foods traditionally associated with a healthy dietary pattern were less commonly reported to cause GI symptoms, whereas foods associated with western food/junk food were more commonly reported to cause GI symptoms. Promoting healthy food choices seem compatible with dietary treatment of patients with IBS and FD.

References

1, Feinle-Bisset C, Azpiroz F. Dietary and lifestyle factors in functional dyspepsia. Nature reviews Gastroenterology & hepatology. 2013 Mar;10(3):150-7.
2. van Lanen AS, de Bree A, Greyling A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. European journal of nutrition. 2021 Sep;60:3505-22.

Introduction

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children. These disorders, including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are increasingly prevalent in the pediatric population. Understanding dietary patterns in affected children is crucial for developing preventive and therapeutic strategies.

Aims & Methods

The aim is to study eating behavior disorders in children with functional gastrointestinal disorders and to analyze the diet of children with combined functional gastrointestinal pathology.
Materials and methods: 110 children aged 6 to 18 with functional gastrointestinal disorders were examined. Patients were divided into two groups: 44 with a combination of symptoms of functional dyspepsia and irritable bowel syndrome and 66 with functional dyspepsia. The control group consisted of 30 practically healthy children. The diagnosis of functional dyspepsia and irritable bowel syndrome was established on the basis of clinical symptoms according to the Rome IV criteria (2016). In order to detect a violation of the nutritional regime, children were interviewed according to a questionnaire developed by us. They also studied the food preferences of schoolchildren using the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children's nutrition in Ukraine.

Results

The frequency of eating disorders (absence of breakfast or full lunch at school, reduced number of meals) in children with functional disorders is higher than in healthy children. In children with overlap syndrome, these disorders were detected statistically significantly more often than in children with isolated functional dyspepsia. In children with functional disorders, the frequency of consumption of vegetables, cereals and cereal products is lower than in healthy children, and the consumption of meat, sausages and confectionery, fast food, chips, nuts, seeds, energy and sweet carbonated drinks, and fruit juices is higher. In children with a combination of functional dyspepsia and irritable bowel syndrome, the frequency of consumption of vegetables, cereals, and grain products is lower, and the consumption of confectionery, fast food, energy and sweet carbonated drinks is higher than in children with functional dyspepsia.
We conducted an analysis of nutrition in children with a combined pathology of functional dyspepsia (FD) and irritable bowel syndrome (IBS) (see table below).

Conclusion

Violation of the regime and quality of nutrition is a risk factor for the formation of functional gastrointestinal disorders in children, which must be taken into account in treatment.

References

Chouliaras G, Kondyli C, Bouzios I, Spyropoulos N, Chrousos GP, Roma-Giannikou E. Dietary Habits and Abdominal Pain-related Functional Gastrointestinal Disorders: A School-based, Cross-sectional Analysis in Greek Children and Adolescents. J Neurogastroenterol Motil 2019; 25:113-122. https://doi.org/10.5056/jnm17113
Alatas, F. S., Salsabila, K., Amalia, N., & Hanafi, G. (2022). Functional gastrointestinal disorders and nutritional status in junior high school students. Paediatrica Indonesiana, 62(4), 243-8. https://doi.org/10.14238/pi62.4.2022.243-8
Katsagoni CN, Karagianni V-M, Papadopoulou A. Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies. Nutrients. 2023; 15(12):2708. https://doi.org/10.3390/nu15122708