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Advisor(s)
Abstract(s)
O Síndrome do Intestino Irritável (SII) é uma doença funcional do trato gastrointestinal definida de acordo com o seu padrão de sintomas (dor ou desconforto abdominal recorrente associada a alterações dos hábitos intestinais), a sua natureza crónica e ausência de doença orgânica detetável. Embora a SII não constitui uma condição com risco de vida, tem uma prevalência elevada e reduz marcadamente a qualidade de vida do doente.
O SII é frequentemente categorizado em subtipos de acordo com o padrão intestinal predominante e o diagnóstico é baseado em dados clínicos, a partir de critérios estabelecidos, os chamados Critérios de Roma III. Um dos principais problemas do SII é a falta de opções terapêuticas eficazes. Estão disponíveis estratégias não farmacológicas (educação para a saúde, confiança na relação estabelecida com o profissional de saúde, mudanças da dieta e do estilo de vida) e farmacológicas (são mais complexas e devido à heterogeneidade do SII não existe nenhum tratamento padrão). Terapias alimentares estão a ganhar popularidade e nos últimos anos, uma dieta com baixo teor em hidratos de carbono de cadeia curta fermentáveis, conhecidos coletivamente por FODMAPs (Oligossacarídeos, dissacarídeos, monossacarídeos e polióis fermentáveis), tem sido defendida.
O mecanismo pelo qual os alimentos ricos em FODMAPs causam sintomas gastrointestinais em doentes com SII é complexo e depende da capacidade que cada indivíduo tem de digerir e absorver os diferentes hidratos de carbono de cadeia curta fermentáveis.
Devido à associação entre FODMAPs e sintomas do SII, foram elaboradas as dietas de baixo teor destes hidratos de carbono. Estas dietas, primeiramente desenvolvidas na Austrália, substituem todos os alimentos com um elevado teor em FODMAPs por alimentos com baixo teor a partir dos mesmos grupos. O objectivo da dieta não é de excluir por completo FODMAPs mas sim ajustar o consumo a um nível que seja possível controlar os sintomas. No entanto, apesar de um crescente corpo de evidências que apoiam o uso de uma dieta com baixo teor em FODMAPs em doentes com SII, muitas perguntas sobre esta dieta ainda necessitam de ser respondidas (como por exemplo tipo exato de alimentos utilizados e estudados, quantidade de alimentos, efeito aditivo, dados e segurança a longo prazo) e mais estudos são necessários para abordar estas questões.
Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract defined according to its pattern of symptoms (abdominal pain or discomfort associated with recurrent changes in bowel habits), its chronic nature and the absence of detectable organic disease. Although IBS is not a life-threatening condition, has a high prevalence and markedly reduces the patient's quality of life. IBS is frequently categorized in subtypes according to the predominant intestinal pattern and the diagnosis is based on clinical data, from established criteria, the so-called Rome III Criteria. One of the main problems of IBS is the lack of effective therapeutic options. Non-pharmacological strategies are available (health education, trust in the relationship established with the health professional, change of diet and lifestyle) as well as pharmacological (which are more complex and due to the heterogeneity of IBS there is no standard treatment). Dietary therapies are gaining popularity and more recently, a diet low in fermentable short-chain carbohydrates, collectively known as FODMAPs (oligosaccharides, disaccharides, monosaccharides and polyols fermentable), has been defended. The mechanism by which foods rich in FODMAPs cause gastrointestinal symptoms in patients with IBS is complex and it depends on each individual's ability to digest and absorb the different fermentable short-chain carbohydrates. Due to the association between FODMAPs and symptoms of IBS, diets low in these carbohydrates have been created. These diets, first developed in Australia, substitute all foods with a high content of FODMAPs for other foods with lower levels from the same dietary group. The objective of the diet is not to completely exclude FODMAPs but to adjust their consumption to a level that allows the control of symptoms. However, despite a growing body of evidence supporting the implementation of a diet low in FODMAPs in patients with IBS, many questions regarding this diet still need to be answered (e.g. the exact type of foods to be used and studied, quantity of food, additive effect, data and long-term safety) and more studies are necessary to address these issues.
Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract defined according to its pattern of symptoms (abdominal pain or discomfort associated with recurrent changes in bowel habits), its chronic nature and the absence of detectable organic disease. Although IBS is not a life-threatening condition, has a high prevalence and markedly reduces the patient's quality of life. IBS is frequently categorized in subtypes according to the predominant intestinal pattern and the diagnosis is based on clinical data, from established criteria, the so-called Rome III Criteria. One of the main problems of IBS is the lack of effective therapeutic options. Non-pharmacological strategies are available (health education, trust in the relationship established with the health professional, change of diet and lifestyle) as well as pharmacological (which are more complex and due to the heterogeneity of IBS there is no standard treatment). Dietary therapies are gaining popularity and more recently, a diet low in fermentable short-chain carbohydrates, collectively known as FODMAPs (oligosaccharides, disaccharides, monosaccharides and polyols fermentable), has been defended. The mechanism by which foods rich in FODMAPs cause gastrointestinal symptoms in patients with IBS is complex and it depends on each individual's ability to digest and absorb the different fermentable short-chain carbohydrates. Due to the association between FODMAPs and symptoms of IBS, diets low in these carbohydrates have been created. These diets, first developed in Australia, substitute all foods with a high content of FODMAPs for other foods with lower levels from the same dietary group. The objective of the diet is not to completely exclude FODMAPs but to adjust their consumption to a level that allows the control of symptoms. However, despite a growing body of evidence supporting the implementation of a diet low in FODMAPs in patients with IBS, many questions regarding this diet still need to be answered (e.g. the exact type of foods to be used and studied, quantity of food, additive effect, data and long-term safety) and more studies are necessary to address these issues.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Keywords
Síndrome do intestino Irritável Sintomas gastrointestinais Oligossacarídeos Dissacarídeos Monossacarídeos Hidratos de carbono de cadeia curta