{
  "abstract": "Background Recent studies have shown increased duodenal mucosal permeability as a possible key player in the pathophysiology of functional dyspepsia (FD). Adverse reaction to nutrients is an important candidate underlying mechanism. Intragastric infusion of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) induced symptoms reminiscent of FD with a rapid onset.Objective We evaluated the effect of a low FODMAP diet (LFD) and individual FODMAP-triggers on symptom severity and duodenal mucosal permeability in FD.Design Patients with FD followed a 6-week LFD and filled out the validated Leuven Postprandial Distress Syndrome (LPDS) daily diary, Short Form-Nepean Dyspepsia Index (SF-NDI) Questionnaire, patient assessment of upper gastrointestinal symptoms (PAGI-SYM) and Patient Health Questionnaire (PHQ). Patients underwent an endoscopy with duodenal biopsies to define mucosal integrity by quantifying transepithelial electrical resistance (TEER) and dextran flux. LFD was followed by a blinded reintroduction during which patients were challenged by 7 powders (fructans, fructose, galacto-oligosaccharides (GOS), lactose, mannitol, sorbitol, glucose).Results 36 FD patients entered the study. LPDS improved significantly at the end of the LFD in 73%. In addition, SF-NDI, PAGI-SYM and PHQ improved significantly. Dextran flux and TEER were not significantly different, but delta TEER correlated positively with delta LPDS. A large variety of FODMAP powders was able to induce recurrence with mannitol as the most prevalent triggering FODMAP (23%). Surprisingly, 27% showed higher LPDS scores during intake of glucose.Conclusions A LFD significantly improved PDS symptoms, but this was not associated with altered mucosal integrity. Powder reintroduction identified a large variety in individual FODMAPs and glucose as triggers.",
  "authors": [
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium"
      ],
      "name": "Karen Van den Houte"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium"
      ],
      "name": "Bert Broeders"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium"
      ],
      "name": "Joran Tóth"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium"
      ],
      "name": "Karen Routhiaux"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium"
      ],
      "name": "Zoë Mariën"
    },
    {
      "affiliations": [
        "Department of Endocrinology, UZ Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Jasmien Van den Bergh"
    },
    {
      "affiliations": [
        "Department of Endocrinology, UZ Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Julie Vanderstappen"
    },
    {
      "affiliations": [
        "Department of Endocrinology, UZ Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Nelle Pauwels"
    },
    {
      "affiliations": [
        "Department of Endocrinology, UZ Leuven, Leuven, Belgium",
        "Clinical and Experimental Endocrinology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Ann Meulemans"
    },
    {
      "affiliations": [
        "Department of Endocrinology, UZ Leuven, Leuven, Belgium",
        "Clinical and Experimental Endocrinology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Christophe Matthys"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Tim Vanuytsel"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Florencia Carbone"
    },
    {
      "affiliations": [
        "Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium",
        "Department of Gastroenterology, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Jan Tack"
    }
  ],
  "title": "Outcome of a FODMAP restriction diet with subsequent blinded reintroduction in functional dyspepsia/postprandial distress syndrome",
  "uid": "92cf989d-60cf-508c-b92d-59e9ef744daf"
}