Popular diets and nutritional assessment in the management of irritable bowel syndrome in inflammatory bowel disease: an overview of current evidence.

There is an increasing interest in using popular diets to manage inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn disease. These conditions are often associated with nutritional deficiencies, protein­energy malnutrition, micronutrient malnutrition, altered body composition, and sarcopenia. While dietary interventions can be supportive in treating intestinal symptoms of adult IBD patients, it is important to note that current guidelines from major scientific societies do not recommend any specific dietary interventions in this field. This review aims to provide a summary of the current evidence on dietary­nutritional management for patients with IBD, specifically when the disease appears to be in remission, but the patient continues to experience irritable bowel syndrome (IBS) symptoms or functional gastrointestinal symptoms. We focus on vital aspects, such as malnutrition and sarcopenia definitions, screening, and nutritional assessment. We then discuss in detail the most popular diets used for IBD management over the years, characterizing each one in terms of effects on gut inflammation, IBS­like symptoms, and potential risk of malnutrition. These diets include a low­fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet, a gluten­free diet, a Mediterranean diet, and a plant­based diet. To date, current evidence does not conclusively establish the optimal diet for patients with IBS, suggesting that personalized dietary approaches may be the best strategy.

Gastrointestinal motility disorder assessment in systemic sclerosis.

OBJECTIVES: SSc is a clinically heterogeneous and generalized disease, characterized by thickness of the connective tissue of the skin and internal organs, such as the digestive tract, impairing gastrointestinal (GI) motility. Our aim is to evaluate retrospectively abnormalities of oesophageal motility, gastric emptying, oro-cecal transit time (OCTT) and small intestine bacterial overgrowth (SIBO) in a large cohort of SSc patients. METHODS: Ninety-nine SSc patients were included in the study. Forty-two patients underwent oesophageal conventional manometry, 45 performed a [(13)C]octanoic acid breath test to measure gastric emptying time and all 99 patients performed a lactulose breath test in order to evaluate OCTT and SIBO. Data were compared with healthy controls. RESULTS: In SSc patients, median lower oesophageal sphincter (LOS) pressure [14 mmHg (25th-75th; 8-19) vs 24 mmHg (19-28); P < 0.01] and median wave amplitude [30 mmHg (16-70) vs 72 mmHg (48-96); P < 0.01] were lower than in controls. Oesophageal involvement, defined as reduced LOS pressure and ineffective oesophageal motility pattern, was encountered in 70% of SSc patients. A delayed gastric emptying time was present in 38% of SSc patients: mean t½ was 141 ± 79 min vs 90 ± 40 min of controls (P < 0.01). Also, OCTT was significantly delayed in SSc: median OCTT was 160 min (25th-75th; 135-180) vs 105 min (25th-75th; 90-135) of controls (P < 0.01). SIBO was observed in 46% of SSc compared with 5% of controls (P < 0.01). CONCLUSION: GI involvement is very frequent in SSc patients. Oesophagus and small bowel are more frequently impaired, whereas delayed gastric emptying is less common.