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[Irritable bowel syndrome and low FODMAP diet °ú¹Î¼º ÀåÁõÈıº°ú ÀúÆ÷µå¸Ê ½Ä»ç]

1. Low FODMAP Diet. ÀúÆ÷µå¸Ê ½Ä»ç

2. Overlap of IBS and IBD

3. °­ÀÇ¿Í Åä·Ð

4. FAQs

5. References


1. Low FODMAP Diet. ÀúÆ÷µå¸Ê ½Ä»ç

2022-5-5 Medigate News 'Æ÷µå¸Ê À½½Ä - ±×°ÍÀÌ ¾Ë°í ½Í´Ù'¸¦ Âü°íÇϱ⠹ٶø´Ï´Ù. ÀÌ·± À̾߱Ⱑ ¼Ò°³µÇ¾î ÀÖ¾ú½À´Ï´Ù.

ÃÖ±Ù ¹æ¹®ÇÑ ÇÑ ¿©ÀÚ È¯ÀÚ´Â ´ëÇк´¿ø¿¡¼­ °Ë»ç¸¦ ´Ù Çصµ ÀÌ»óÀÌ ¾ø¾î¼­ °ú¹Î¼ºÀåÁõÈıºÀ» Áø´Ü¹Þ¾Ò´Ù°í Çϸ鼭, º»ÀÎÀÌ ½Å°æÀ» ½á¼­ À½½Äµµ °Ç°­ÇÏ°Ô ¸Ô°í Àִµ¥µµ °¡½º°¡ Â÷°í ¹è°¡ ¾ÆÇÁ´Ù°í ´ä´äÇÔÀ» È£¼ÒÇß´Ù. ¿©±â Àú±â¼­ ¾àÀ» ¸Ô¾îµµ È¿°ú°¡ ¾ø´Ù°í Çϱ淡 ¾î¶»°Ô °Ç°­ÇÑ À½½ÄÀ» ¸Ô°í ÀÖ³Ä°í ¹°¾îºÃ´Ù.

"¾Æħ¿¡ »ç°ú´Â ±Ý»ç°ú¶ó°í Çؼ­ ¾Æħ½Ä»ç ´ë½Å ¿ìÀ¯¿¡ »ç°ú¿Í À§Àå¿¡ ÁÁ´Ù´Â ºê·ÎÄø®¿Í ¾ç¹èÃßµµ °°ÀÌ ³Ö¾î °¥¾Æ ¸¶½Ê´Ï´Ù. ¹é¹Ì´Â °Ç°­¿¡ ¾ÈÁÁÀ» ±îºÁ ¹äµµ ÄáÀ» ¼¯Àº Àâ°î¹äÀ» ¸Ô°íÀÖ¾î¿ä."

À§¿¡¼­ ¾ð±ÞÇß´ø ³»¿ë¿¡ Çѹø ±â¹ÝÇؼ­ ÀÌ È¯ÀÚÀÇ ½ÄÀ̳»¿ëÀ» º¸¸é ¾î¶²°¡? ȯÀÚ´Â ½º½º·Î Áõ»óÀ» À¯¹ßÇÏ´Â À½½Äµé¸¸ °ñ¶ó¼­ ¸Ô°í ÀÖ¾ú´ø °ÍÀÌ´Ù.

ÀÌ È¯ÀÚ¿¡°Ô´Â ´Ù¸¥ ¾àÀ» ´õ ÁÖ´Â °Íº¸´Ù ¿ì¼± ³»ÀϺÎÅÍ Áö±Ý±îÁö ¾Æħ¿¡ ¸Ô°í ÀÖ´ø °ÍÀ» Áß´ÜÇÏ°í ½Ò¹äÀ¸·Î ½Ä»ç¸¦ Çغ¼ °ÍÀ» ±ÇÇß´Ù. ±× ´ÙÀ½ ȯÀÚ°¡ ¹æ¹®ÇßÀ» ¶§´Â Áõ»óÀº °ÅÀÇ ¾ø¾îÁ³´Ù¸é¼­ ÁÁ¾ÆÇϸ鼭µµ ¿©ÀüÈ÷ '¸ö¿¡ ÁÁÀº ¾Æħ ±Ý»ç°ú'¸¦ ¸ø ¸Ô´Â °Í¿¡ ´ëÇØ ¾Æ½¬¿öÇÏ´ø ±â¾ïÀÌ ³­´Ù.


1) FODMAPÀÌ ¹«½¼ ¸»ÀԴϱî?

¿îµ¿ÇÐȸ¿¡¼­ ³ª¿Â ´Þ·ÂÇü ¼³¸í¼­

»ï¼º¼­¿ïº´¿ø ȨÆäÀÌÁö

2) Low FODMAP diet (IBS ȯÀÚ¿¡°Ô ÀûÇÕÇÑ À½½Ä)

3) FODMAPÀÌ ¸¹¾Æ ÇÇÇØ¾ß ÇÒ À½½Ä

4) ȯÀÚ ¼³¸í¼­

2015³â »ï¼º¼­¿ïº´¿ø ȯÀÚ ¼³¸í¼­

2021³â »ï¼º¼­¿ïº´¿ø ȯÀÚ¿Í º¸È£ÀÚ¸¦ À§ÇÑ ¾È³»¼­

5) 2018-8-18. ¹ÚÁ¤È£ ±³¼ö´Ô °­ÀÇÀÇ °á·Ð


2. Overlap of IBS and IBD

ÇÑ ½ÉÆ÷Áö¾ö¿¡¼­ Overlap of IBS symptoms and IBD¶ó´Â Á¦¸ñÀÇ °­ÀÇ(¼ºÀÎ°æ ±³¼ö´Ô)¸¦ µé¾ú½À´Ï´Ù. Áúº´ÀÇ ¼¼°èµµ ±×¸® ¼ø¼öÇÏÁö ¾ÊÀº °Í °°½À´Ï´Ù. ¸¶±¸ ¼¯¿©ÀÖ½À´Ï´Ù. °­ÀÇ ¿äÁ¡ÀÔ´Ï´Ù.

1) IBS ÄÚȣƮ¿¡¼­ IBDÀÇ ¹ßº´·üÀÌ ³ô½À´Ï´Ù (¸µÅ©).


Number of incident IBD cases over time in active duty US military personnel. For subjects with IBS who were subsequently diagnosed with IBD, the median time to the first IBD diagnosis was 2.1 years (IQR: 1.4, 3.8). There was no significant difference (p=0.5) in the time to reaching an IBD outcome for subjects with UC (median: 2.1 years; IQR: 1.4, 4.4) or CD (median: 1.8 years; IQR: 1.4, 3.3). While the time to meeting the IBD outcome definition was more prolonged for subjects without an antecedent IBS diagnosis (median: 2.6; IQR: 1.9, 4.5), this difference was not statistically significant (p=0.2). Of the subjects with antecedent IBS who ultimately met the IBD definition, 28 (37.3%) continued to be coded for IBS for a median 278 (IQR: 66, 698) days after IBD diagnosis.

2) Postinfectious IBS¿Í IBD-IBS À¶ÇÕ¸ðµ¨ÀÌ Á¦¾ÈµÇ±âµµ ÇÏ¿´½À´Ï´Ù (¸µÅ©). ÃÊ·ÏÀ» ¿Å±é´Ï´Ù.

Gastroenterologists often encounter situations when the clinical and pathophysiological features that typically distinguish functional from organic disorders overlap. This "blurring of boundaries" can occur with post-infectious irritable bowel syndrome (PI-IBS), a subset of IBS and a newly described entity IBD-IBS. The key associating features include pain and usually diarrheal symptoms that are disproportionate to the observed pathology, microscopic inflammation, and often a co-association with psychological distress. A previous initiating gastrointestinal infection is required for PI-IBS and assumed for IBD-IBS. Using this perspective we discuss the clinical and pathophysiological features of PI-IBS and IBD-IBS and the growing evidence for the overlapping features of these two disorders in terms of alteration of gut flora, immune dysregulation, and role of stress. A unifying model of PI-IBS and IBD-IBS is proposed that may have important clinical and research implications. It obligates us to reframe our understanding of illness and disease from the dualistic biomedical model into a more integrated biopsychosocial (BPS) perspective.

3) IBS¿Í IBD´Â Ä¡·á ¾àÁ¦¸¦ °øÀ¯ÇÒ ¼ö ÀÖ½À´Ï´Ù. 5-ASA°¡ µµ¿òÀÌ µÇ´Â IBS°¡ ÀÖ´Ù°í ÇÕ´Ï´Ù.

- Common IBS antidepressant therapy may help reduce abdominal pain, diarrhea in IBD patients.
- Some IBS patients may find relief from anti-inflammatory drug used in IBD.

IBD ¾àÀ» ½á¾ß ÁÁ¾ÆÁö´Â IBS°¡ ÀÖ½À´Ï´Ù. Ä¡·á¿¡ ¹ÝÀÀÇÏÁö ¾Ê´Â IBS¿¡¼­ ´ëÀå³»½Ã°æÀ» ÅëÇÑ Á¶Á÷°Ë»ç·Î microscopic colitis°¡ ¼û¾îÀÖ´Â °ÍÀº ¾Æ´ÑÁö ã¾Æº¼ ÇÊ¿ä°¡ ÀÖ´Ù°í »ý°¢ÇÏ¿´½À´Ï´Ù.


3. °­ÀÇ¿Í Åä·Ð

(1) APDW 2016. Recent advances in irritable bowel syndrome (Peter Gibson)

¿¬ÀÚ°¡ ÀþÀº ¼ÒÈ­±â ÀÇ»çÀÏ ¶§¿¡´Â ÇÒ ¼ö ÀÖ´Â °ÍÀÌ °ÅÀÇ ¾ø¾î¼­ very depressing Çß´Ù°í ÇÕ´Ï´Ù. ±×·¯³ª ÃÖ±Ù¿¡´Â ¸¹Àº Á¢±Ù¹ýÀÌ °¡´ÉÇÕ´Ï´Ù.

Dietary approaches: gluten free diet¿Í low FODMAP diet°¡ ÇÙ½ÉÀÔ´Ï´Ù. Low FODMAP diet can be highly effective, but requires skills more than just giving the patient a diet sheet.

Low FODMAP diet´Â ¿Ö ¼º°øÀûÀ̾ú´Â°¡? (1) luminal distensionÀÌ ÁÙ¾îµì´Ï´Ù. (2) À½½Ä¿¡ ´ëÇÑ ÀÚ·á°¡ ÃàÀûµÇ°í ÀÖ½À´Ï´Ù. (3) ÁÁÀº ±³À° ¹æ¹ýÀÌ È®¸³µÇ¾î ÀÖ½À´Ï´Ù. (4) ¿¬±¸°¡ ¸¹½À´Ï´Ù. (5) AppÀ» ÅëÇÏ¿© Á¤º¸°¡ À¯ÅëµÇ°í ÀÖ½À´Ï´Ù.

Low FODMAP diet¸¦ ÇÏ¸é ´ëº¯ÀÇ ±Õ Á¾·ù°¡ ´Þ¶óÁý´Ï´Ù. ¿¬ÀÚ´Â ÀÌ·± Áú¹®À» ´øÁ³½À´Ï´Ù. ÀÌ·± º¯È­°¡ dysbiosisÀϱî¿ä, prebiosysÀϱî¿ä?

Dietary and psychological interventionÀÌ first-line therapy°¡ µÇ¾î¾ß ÇÑ´Ù´Â take-home message·Î °­ÀÇ°¡ ³¡³µ½À´Ï´Ù. ¾à¿¡ ´ëÇÑ À̾߱⺸´Ù´Â À½½Ä°ú stress °ü¸®¿¡ ´ëÇÑ À̾߱Ⱑ ¸¹¾Æ¼­ ¸¸Á·½º·¯¿î ½Ã°£À̾ú½À´Ï´Ù. IBS´Â ¾àÀ¸·Î Ä¡·áÇÒ º´ÀÌ ¾Æ´Ñ °Í °°½À´Ï´Ù.

Food allergy¿¡ ´ëÇÑ Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. ¾ÆÁ÷ ¸íÈ®È÷ È®¸³µÇÁö ¾ÊÀº °Í °°½À´Ï´Ù. À½½Ä¿¡ ´ëÇÑ IgG Ç×ü¸¦ ÃøÁ¤ÇÏ°í À̸¦ ¹ÙÅÁÀ¸·Î À½½ÄÀ» Á¶ÀýÇÏ´Â Á¢±ÙÀº È¿°ú°¡ ¾ø°í, allergy ÇÐÀÚµéÀº ±×·± Á¢±ÙÀº ÇÏÁö ¸»¶ó°í ±ÇÇÑ´Ù°í ÇÕ´Ï´Ù.

* Âü°í: EndoTODAY Celiac disease and gluten sensitivity


(2) 2017³â °­ÀÇ. ¿ù¿äÁý´ãȸ. Management of IBS (±èÀº¶õ ±³¼ö´Ô)

IBSÀÇ Áõ»óÀÌ ¹èº¯°ú °ü·ÃµÇ¾îÀÖ´Ù´Â °ÍÀÌÁö ´ëº¯À» º»´Ù°í Ç×»ó Áõ»óÀÌ ÁÁ¾ÆÁö´Â °ÍÀº ¾Æ´Õ´Ï´Ù.

°ú°Å¿¡ ºñÇÏ¿© º¹ºÎÆظ¸°¨, °¡½º µîÀ» È£¼ÒÇϴ ȯÀÚ°¡ ´Ã¾ú½À´Ï´Ù. Àΰø°¨¹Ì·á¸¦ »ç¿ëÇÑ À½½ÄÀÌ ¸¹±â ¶§¹®ÀÌ ¾Æ´Ò±î »ý°¢µË´Ï´Ù.


(3) Åä·Ð

Áú¹®: IBS¿Í IBD¿ÍÀÇ °ü·Ã¼ºÀº ¾î´À Á¤µµÀԴϱî? IBS ȯÀÚÀÇ °æ°ú°üÂû¿¡¼­ IBDÀÇ ¹ß»ý·üÀÌ ³ô´Ù´Â ¿ªÇÐ ÀÚ·áµµ º» ÀûÀÌ ÀÖ½À´Ï´Ù. IBD ¾àÀ» ½á¾ß ÁÁ¾ÆÁö´Â IBS ȯÀÚ°¡ ÀÖ°í À̵éÀº Á¶Á÷°Ë»ç¿¡¼­ microscopic colitis·Î Áø´ÜµÈ´Ù°í Çϴµ¥¿ä... IBD ȯÀÚ¿¡¼­ Á¶Á÷°Ë»ç¿¡¼­ microscopic colitis°¡ È®ÀεÇÁö ¾Ê¾Æµµ 5-ASA¸¦ ½á º¼ ¼ö ÀÖ½À´Ï±î?

´äº¯: (1) IBD¿ÍÀÇ °¨º°ÀÌ Áß¿äÇÕ´Ï´Ù. CalprotactinÀÌ Á¤»óÀ̸é IBDÀÇ °¡´É¼ºÀÌ ³·Àº °ÍÀ¸·Î º¸°í Ä¡·áÇÏ°í ÀÖ½À´Ï´Ù. ´Ù¸¸ grey zoneÀÌ Å©´Ù´Â ¹®Á¦°¡ ¾ø½À´Ï´Ù. ÃÖ±Ù¿¡´Â IBS ȯÀÚ ÃÊÁø¿¡¼­ calprotactinÀ» °ÅÀÇ routineÀ¸·Î ó¹æÇÏ°í ÀÖ½À´Ï´Ù. ´ëÀå³»½Ã°æÀ¸·Î ´Ù¸¥ Áß¿äÇÑ º´ÀÌ ¾ø´ÂÁö È®ÀÎÇϸé ÁÁ½À´Ï´Ù. (2) Microscopic colitis´Â ¿ì¸®³ª¶ó¿¡¼­ ºóµµ°¡ ³ôÁö ¾Ê½À´Ï´Ù. º¸ÅëÀÇ IBS ȯÀÚº¸´Ù ³ªÀÌ°¡ ¸¹°í, ¼³»ç°¡ ÁÖ Áõ»óÀÌ°í painÀÌ ¶Ñ·ÇÇÏÁö ¾ÊÀ¸¸é ´ëÀå³»½Ã°æÀ¸·Î Á¡¸·º´¼Ò°¡ ¾ø´ÂÁö È®ÀÎÇÏ°í Á¶Á÷°Ë»ç¸¦ ÇØ º¼ ¼ö ÀÖ½À´Ï´Ù. (3) 5-ASA´Â ¾ÆÁ÷ controversial ÇÕ´Ï´Ù. º´¸®ÇÐÀûÀ¸·Î microscopic colitis°¡ ÀÔÁõµÈ °æ¿ì¿¡ ÇÑÇÏ¿© »ç¿ëÇÏ´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù.


Áú¹®: Food allergy¿Í IBS¿ÍÀÇ °ü·Ã¼ºÀº?

´äº¯: Áõ»ó°ú ½ÄÇ°ÀÌ °ü·Ã¼ºÀÌ ÀÖÀ¸¸é ȸÇÇ¿ä¹ýÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. IgG antibodyÀÇ ¿ªÇÒÀº ºÒ¸íÈ®ÇÕ´Ï´Ù.


Áú¹®: Non-celiac gluten hypersensitivity

´äº¯: ¿ì¸®³ª¶ó¿¡¼­´Â celiac disease·Î ÀÔÁõµÈ ȯÀÚ°¡ ¾ø½À´Ï´Ù. ȯÀÚ ½º½º·Î gluten °ú¹Î¼ºÀÌ ÀÖ´Ù°í ¸»Çϴ ȯÀÚ´Â ¸¹½À´Ï´Ù. ȸÇÇ ¿ä¹ý Á¤µµ¸¦ ±ÇÇÒ ¼ö ÀÖ°Ú½À´Ï´Ù.


Áú¹®: FODMAP dietÀÇ È¿°ú´Â? ¾î¶»°Ô ¼³¸íÇÏ´Â °ÍÀÌÁö¿ä?

´äº¯: ȯÀÚ°¡ ¸¹ÀÌ ¸Ô´Â À½½Ä¿¡ FODMAP À½½ÄÀÌ ÀÖÀ¸¸é ÇÇÇϵµ·Ï ±ÇÇÕ´Ï´Ù. ƯÈ÷ bloating ȯÀÚ¿¡¼­´Â µµ¿òÀÌ µË´Ï´Ù. ¾ç¹èÃß, »ç°ú, Äá µîÀ» ÇÇÇغ¸´Â °Í¿¡¼­ ½ÃÀÛÇϸé ÁÁ½À´Ï´Ù. ¿Ü·¡¿¡¼­ FODMAP chart¸¦ ³ª´²Áֱ⵵ ÇÕ´Ï´Ù. Á¤È®È÷ ½ÃÇàÇÏ·Á¸é ¿Ü·¡¿¡¼­ °£´ÜÈ÷ Àû¿ëÇϱ⠾î·Æ°í, ȯÀÚ¿Í ¿µ¾ç»ç°¡ Àå½Ã°£ »ó¼¼È÷ »ó´ãÇϵµ·Ï ÇØ¾ß Çϴµ¥ ¿ì¸®³ª¶ó¿¡¼­´Â ½±Áö ¾Ê½À´Ï´Ù.

FODMAP diet ȯÀÚ ¼³¸í¿ë ÀÚ·á (±èÀº¶õ ±³¼ö´Ô Á¦°ø)

¼­¿ï´ëÇб³ º´¿ø °­³² ¼¾ÅÍ


Áú¹®: ÃÖ±Ù 10³â À̳»¿¡ ³ª¿Â ¿©·¯ IBS ¾àµéÀÌ ¿µ ¹Ì´þÁö ¾Ê½À´Ï´Ù. (1) ½ÃÆÇÇÏ´Ù°¡ öȸÇÏ¿´´Ù°¡ Á¦ÇÑµÈ Á¶°ÇÀ¸·Î ´Ù½Ã ½ÃÆǵǾú´Ù°Å³ª, (2) ºÎÀÛ¿ëÀÌ ¸¹´Ù´Â ¼Ò¹® µî.

´äº¯: º¯ºñÇü¿¡¼­ »ç¿ëµÇ´Â procalopride, ¼³»çÇü¿¡¼­ »ç¿ëµÇ´Â ramosetron (À̸®º¸) ´Â ºñ±³Àû ¾ÈÀüÇÏ°í È¿°úÀûÀÔ´Ï´Ù.


Áú¹®: ¼³»çÇü IBS³ª bloatingÀÌ Àִ ȯÀÚ¿¡¼­ rifaximin 550mg po tid, 14days¸¦ ¾ð±ÞÇϼ̴µ¥¿ä...

´äº¯: °£È¤ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù.


Áú¹®: ¾ðÁ¦ ½ÅÁ¤Á¤½Å°ú ÀÚ¹®ÀÌ ÇÊ¿äÇÒ±î¿ä?

´äº¯: ´Ù¸¥ Áõ¼¼¿¡ ´ëÇÑ ¾àµéÀº ÁÁ¾ÆÁö°í Àִµ¥ painÀÌ ¹®Á¦ÀÔ´Ï´Ù. ³»°ú¿¡¼­µµ amitryptiline 5mg ÇÏ·ç Çѹø Á¤µµ´Â º°´Ù¸¥ ¿ì·Á ¾øÀ̽õµÇÒ ¼ö ÀÖ½À´Ï´Ù. ³ôÀº ¿ë·®À¸·Î ¿Ã·Á¾ß Çϰųª ±âŸ ÀÓ»óÀûÀ¸·Î ÇÊ¿äÇϸé psychologic evaluationÀ» °í·ÁÇÒ ¼ö ÀÖ½À´Ï´Ù.


[FAQs]

[2018-10-8. ±èÅÂÁØ ±³¼ö´Ô comment]

ÃÖ±Ù °íÇ÷¾Ð¾à olmesartan¿¡ ÀÇÇÑ enteropathyÀÇ ÀÓ»ó º¸°í°¡ ÀÖ½À´Ï´Ù (°ü·Ã ´º½º: 2016/4 ¸Þµð°ÔÀÌÆ®). ´ÙÇེ·´°Ô class effect´Â ¾øÀ¸¹Ç·Î ÀÌ·¯ÇÑ »óȲÀÌ ÀÇ½ÉµÇ¸é ¾àÁ¦¸¦ ¹Ù²ãÁÖ¸é Å« ¹®Á¦°¡ ¾øÀ» °Í °°½À´Ï´Ù.

Olmesartan-Induced Enteropathy (Methodist Debakey Cardiovasc J. 2016)

Olmesartan-induced enteropathy mimics celiac disease clinically and pathologically. As in celiac disease, the pathologic findings are villous atrophy and increased intraepithelial lymphocytes.

Clinical presentation of olmesartan-induced enteropathy includes diarrhea, weight loss, and nausea. In contrast to celiac disease, tissue transglutaminase is not elevated and there is no response to a gluten-free diet. Including this entity in the differential diagnosis of sprue-like enteropathy is critical for its early diagnosis since replacing olmesartan with an alternative antihypertensive drug can simplify the diagnostic workup and provide both clinical and histologic improvement.


[References]

1) °ú¹Î¼º ÀåÁõÈıº Ä¡·á¿¡ °üÇÑ ÀÓ»óÁø·áÁöħ ±ÇÁß±¸ µî. ´ëÇѼÒÈ­±âÇÐȸÁö 2011

2) How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice JNM 2022:28:343



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.