Gastroenterology

Gastroenterology

Volume 155, Issue 4, October 2018, Pages 1004-1007
Gastroenterology

Original Research
Brief Report
Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders

https://doi.org/10.1053/j.gastro.2018.06.045Get rights and content

Prebiotics and diets low in fermentable oligo-, di-, mono-saccharides and polyols (low-FODMAP diet) might reduce symptoms in patients with functional gastrointestinal disorders, despite reports that some nonabsorbable, fermentable meal products (prebiotics) provide substrates for colonic bacteria and thereby increase gas production. We performed a randomized, parallel, double-blind study of patients with functional gastrointestinal disorders with flatulence. We compared the effects of a prebiotic supplement (2.8 g/d Bimuno containing 1.37 g beta-galactooligosaccharide) plus a placebo (Mediterranean-type diet (prebiotic group, n = 19) vs a placebo supplement (2.8 g xylose) plus a diet low in FODMAP (low-FODMAP group, n = 21) for 4 weeks; patients were then followed for 2 weeks. The primary outcome was effects on composition of the fecal microbiota, analyzed by 16S sequencing. Secondary outcomes were intestinal gas production and digestive sensations. After 4 weeks, we observed opposite effects on microbiota in each group, particularly in relation to the abundance of Bifidobacterium sequences (increase in the prebiotic group and decrease in the low-FODMAP group; P = .042), and Bilophila wadsworthia (decrease in the prebiotic group and increase in the low-FODMAP group; P = .050). After 4 weeks, both groups had statistically significant reductions in all symptom scores, except reductions in flatulence and borborygmi were not significant in the prebiotic group. Although the decrease in symptoms persisted for 2 weeks after patients discontinued prebiotic supplementation, symptoms reappeared immediately after patients discontinued the low-FODMAP diet. Intermittent prebiotic administration might therefore be an alternative to dietary restrictions for patients with functional gut symptoms. ClinicalTrials.gov no.: NCT02210572.

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Acknowledgments

The authors thank Gloria Santaliestra for secretarial assistance. We acknowledge the American Journal Experts for English editing of the manuscript (Certificate Verification Key: 2B02-9D8E-A5F0-B802-AAAC and 92D8-7D40-7C38-F2C6-A150) funded by grant SAF 2016-76648-R (Spain). Guarantor of the article is Fernando Azpiroz.

Author contributions: JWH: randomization of participants (generation of allocation sequence and assignation of participants to interventions), study management, conduction of

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Conflicts of interest These authors disclose the following: Jelena Vulevic and George Tzortzis are employees of Clasado; Glen Gibson, Francisco Guarner, and Fernando Azpiroz served as advisory board members for Clasado. The remaining authors disclose no conflicts.

Funding This study was supported in part by a grant from Clasado Biosciences (Channel Islands) and the Spanish Ministry of Economy and Competitiveness (Dirección General de Investigación Científica y Técnica, SAF 2016-76648-R); Ciberehd is funded by the Instituto de Salud Carlos III.

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