Background
There is quality evidence for a diet low in FODMAPs for the management of functional gastrointestinal (GI) symptoms. Whether FODMAPs alter the upper GI response, including gastric accommodation (GA), remains to be assessed.
Objective
To assess the role of FODMAPs in the intragastric pressure (IGP; which reflects GA), meal-induced satiation and symptom generation.
Design
A high resolution manometry and infusion catheter were positioned in the proximal stomach of healthy volunteers. After a stabilisation period and during a late phase II of the migrating motor complex, one of four solutions (see table) were intragastrically infused at 60mL/min, minimum three days apart, in a single-blind randomised cross-over order. The infusion ended when subjects scored maximum satiation (0-5 scale). Intensity of symptoms were rated every 15 minutes (100mm VAS). Results were compared using repeated measures ANOVA.
Table. Infusion solutions (in 500ml water)
1. Fructans 19g
2. Fructose 50g
3. FODMAP mix 15g fructose
10g fructans
5g GOS
5g sorbitol
5g mannitol
4. Glucose 50g
Outcomes
15 healthy volunteers (19-32y, 7 men) were randomised. Total ingested volumes at maximal satiation did not differ significantly between solutions. In all subjects and with each infusion, the IGP decreased initially to gradually recover thereafter. The mean IGP drop (mmHg) during infusion was significantly less for fructans (-4.71±0.59), when compared to fructose -5.86±0.75, FODMAP mix -5.38±0.64 and glucose -5.69±0.70 (p<0.001). In comparison to glucose, differences in symptoms were reported for bloating following fructose; for wind following fructans, fructose and FODMAP mix; and for cramps following fructose and FODMAP mix (p<0.05).
Conclusion
This study indicates that fructans induce a significantly lower IGP response in the healthy state, when compared to other FODMAPs and glucose. Further mechanistic studies are required to unravel the sensory, neural and/or hormonal pathways involved in the effect of fructans on gastric physiology.
Source of funding
Not applicable.