Search Results (165)

Background and aim: Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract resulting from a complex interplay among genetic susceptibility, immune dysregulation, environmental factors, and alterations in the gut microbiota. Among these, diet has emerged as a key modifiable factor influencing intestinal inflammation, barrier integrity, and disease progression. This review aims to critically evaluate the role of dietary patterns and food additives in the pathogenesis and management of Crohn’s disease, with particular emphasis on their effects on intestinal inflammation, epithelial barrier function, and host–microbiota interactions. Methods: A comprehensive literature search was conducted using the PubMed, Scopus, and Web of Science databases up to March 2026. Clinical trials, observational studies, and mechanistic research were included based on their relevance to dietary factors, food additives, and intestinal inflammation in CD. Evidence was synthesized narratively to integrate clinical and experimental findings. Results: Dietary interventions such as the Crohn’s disease exclusion diet (CDED), specific carbohydrate diet (SCD), low-FODMAP diet, and Mediterranean diet (MD) demonstrate varying degrees of efficacy in improving clinical symptoms and, in some cases, inflammatory markers. In contrast, high consumption of ultra-processed foods is consistently associated with increased disease risk and activity. Emerging evidence highlights the role of food additives—particularly emulsifiers and artificial sweeteners—in disrupting gut barrier integrity, promoting dysbiosis, and enhancing inflammatory responses. Recent human studies further suggest that exposure to these compounds may correlate with disease activity, supporting their potential role in CD pathophysiology. Conclusions: Diet plays a significant adjunctive role in the management of Crohn’s disease. Reducing exposure to ultra-processed foods and potentially harmful food additives, while promoting balanced dietary patterns, may improve clinical outcomes. Further research is needed to clarify long-term effects and to develop personalized, evidence-based nutritional strategies for patients with CD. Full article

The low-FODMAP diet (LFD) reduces gastrointestinal symptoms, restricting poorly absorbed short-chain carbohydrates to reduce colonic fermentation. It has been proposed as a dietary strategy for irritable bowel syndrome (IBS) and ulcerative colitis (UC) patients. However, this diet could affect patients’ nutritional status and alter their gut microbiota. We aimed to evaluate the effects of a 10-week LFD on nutritional status, quality of life, and gut microbiota in patients with IBS, UC, and a control group without gastrointestinal symptoms. A randomized, single-blind clinical trial was conducted, including adults with IBS and UC, as well as a control group. Participants were randomly assigned to receive either an LFD or a standard diet (STD). Nutritional status, stool consistency, bowel habits, and quality of life were assessed, and stool samples were collected. Stool microbiota was profiled by 16S rRNA gene sequencing (V3) and analyzed for alpha diversity, beta diversity and differential abundance. Body composition was assessed by bioelectrical impedance. The follow-up period lasted 10 weeks (W0 to W10). Analyses were conducted in the per-protocol population. In total, 86 patients were included (IBS n = 40, UC n = 34, Control n = 12) with an average age of 40 ± 11 years. After adjustment for baseline values, no statistically significant differences in anthropometric or body-composition outcomes were observed between the LFD and STD groups. Similarly, there was a notable reduction in diarrhea frequency (53.3% vs. 20%, p = 0.058). Additionally, patients with IBS and UC exhibited similar microbiota profiles at W0. Among UC patients following the LFD, there was increased presence of BX12, CAG-1427, Holdemania, Evtepia, and Granulicatella, while Angelakisella and CAG-177 were less abundant. LFD was associated with changes in stool consistency, bowel habits, quality of life, and gut microbiota in patients with UC and IBS. Full article

Objective: We aimed to investigate the effects of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet on symptom severity, quality of life, and fecal zonulin levels in patients with irritable bowel syndrome (IBS). Methods: Twenty-four patients with IBS were prospectively randomized to either a low-FODMAP diet (LFD) or a traditional diet (TD) for 4 weeks. IBS Symptom Severity Scale (IBS-SSS), IBS Quality of Life (IBS-QOL), and fecal zonulin levels were assessed at baseline and week 4 in both groups. In the LFD group, FODMAP-containing foods were gradually reintroduced after week 4, and all assessments were repeated at week 16. Changes in laboratory parameters, fecal zonulin levels, IBS-SSS, and IBS-QOL scores were evaluated. Results: Fecal zonulin levels did not differ significantly between groups at baseline or week 4, and no significant within-group changes were observed over time (all p > 0.05). IBS-SSS scores improved significantly at week 4 in both groups compared with the baseline (p < 0.05), with no significant difference in the magnitude of improvement between groups (p > 0.05). In the LFD group, IBS-SSS scores increased at week 16 compared with week 4 (p < 0.05). Similarly, IBS-QOL scores improved significantly at week 4 in both groups (p < 0.05), without significant between-group differences (p > 0.05). In the LFD group, IBS-QOL scores returned to baseline levels by week 16. Conclusions: Both the LFD and TD were associated with significant short-term improvements in IBS symptom severity and quality of life. However, the LFD did not demonstrate superiority over the TD. Furthermore, no statistically significant changes in fecal zonulin levels were observed in either group, although these findings should be interpreted cautiously. In the LFD group, some improvements observed at week 4 were attenuated following FODMAP reintroduction at week 16; however, these findings represent exploratory within-group observations and should not be interpreted as evidence of long-term treatment efficacy or sustained benefit following FODMAP reintroduction. Full article

Background/Objectives: Gastrointestinal (GI) symptoms, including abdominal pain, bloating, altered stool pattern, dyschezia, and nausea, are frequent in women with endometriosis and may persist despite conventional gynecological treatment. The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet is an established dietary intervention for irritable bowel syndrome. Its endometriosis-specific evidence base remains limited. This systematic review evaluated clinical evidence on the low-FODMAP diet or structured FODMAP restriction for GI symptoms in women with endometriosis. Methods: This systematic review was prospectively registered in PROSPERO (CRD420261388786) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, EBSCOhost, and BASE were searched from inception to 30 April 2026. Eligible reports were clinical studies investigating low-FODMAP diet or structured FODMAP restriction in women with confirmed, clinically diagnosed, imaging-based, or medically reported endometriosis and extractable GI or related clinical outcomes. Risk of bias was assessed with design-specific tools. Due to substantial heterogeneity across studies in design, comparators, and outcome measures, a narrative synthesis was performed. Results: Five clinical reports met the inclusion criteria: one randomized controlled crossover feeding trial, two prospective non-randomized studies, one retrospective audit of prospectively collected clinic data, and one case report. The randomized trial showed greater GI response during a 28-day low-FODMAP feeding period than during a nutritionally matched control diet. Prospective studies reported improvements in selected GI symptoms, constipation, pain, and quality-of-life domains, but interpretation was limited by non-randomized allocation, attrition, and mixed or pooled diet comparisons. The retrospective audit and case report supported clinical plausibility but were hypothesis-generating. Conclusions: The five available studies, though limited in number and design, indicate that a low-FODMAP diet can reduce GI symptoms in women with endometriosis, particularly those with abdominal pain, bloating, constipation, or IBS-like symptoms. Currently, the low-FODMAP diet should be viewed as a potentially useful, dietitian-guided GI symptom intervention for selected patients. Future trials should define responder profiles, assess long-term tolerability and nutritional safety, and determine the added value of reintroduction and personalization beyond short-term restriction. Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article

Background/Objectives: Short-term low-fermentable oligo-, di-, and monosaccharide and polyol (FODMAP) diets can reduce exercise-associated gastrointestinal symptoms (Ex-GIS); however, their effects on the gut microbiome, short-chain fatty acids (SCFAs), and gastrointestinal biomarkers remain unclear. This study explored the effects of 48 h dietary FODMAP manipulation within a high-carbohydrate diet on faecal bacterial and SCFA profiles, and their relationships with exercise-induced gastrointestinal syndrome (EIGS) biomarkers, Ex-GIS, and performance. Methods: Twelve endurance athletes experiencing Ex-GIS were randomly allocated to a 48 h high-carbohydrate (mean ± SD: 12.1 ± 1.8 g∙d⁻¹)–high-FODMAP (HC-HFOD) (54.8 ± 10.5 g∙d⁻¹) and a 48 h high-carbohydrate–low-FODMAP (HC-LFOD) (3.0 ± 0.2 g∙d⁻¹) diet before 2 h of running at 60% $\dot{V}$O_2max, followed by a 1 h distance test (22.9 ± 1.2 °C, 46 ± 8% RH). Baseline faecal samples were collected before exercise trials to determine faecal bacterial and SCFA profiles. Blood samples were collected pre- and post-exercise to determine plasma I-FABP, sCD14, and CRP concentrations. Ex-GIS were recorded every 15 min throughout exercise. Results: Faecal bacterial α-diversity and relative abundance (RA%) at the phylum level were unchanged following both diets, while several family- and genus-level taxa RA% values were changed (p < 0.05), with greater shifts after HC-HFOD. HC-HFOD significantly increased faecal total-SCFA (p = 0.004), acetic (p = 0.002), and butyric (p = 0.028) acid concentrations. Strong positive and negative correlations between bacterial RA% and EIGS biomarkers and Ex-GIS were observed. Strong negative correlations with bacterial RA% and performance were observed. Conclusions: The 48 h HC-HFOD resulted in greater increases in bacterial RA% and SCFA concentrations compared with baseline. Bacterial RA% correlated bidirectionally with EIGS biomarkers and Ex-GIS, alongside strong negative associations with performance. Full article

Alterations in the intestinal microbiota have been implicated in both irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). However, their biological significance and therapeutic implications differ substantially between the two conditions. Although dysbiosis is a common feature, the mechanisms by which alterations in the microbiota contribute to disease pathophysiology and clinical expression are distinct. Some pathways are more prominent in IBS (e.g., the gut–brain axis), whereas others are more prominent in IBD (e.g., reduced microbial diversity). Equally important are pathways that appear to play a role exclusively in IBD [e.g., Adherent-invasive Escherichia coli (AIEC) and Paneth cells], as well as others that seem to be specific to IBS (e.g., mast cell activation). In IBD, microbiota changes are primarily linked to immune dysregulation, mucosal barrier impairment, and inflammation-driven pathways, whereas in IBS, they are mainly associated with functional disturbances mediated by neuroimmune signaling and microbial metabolites. Furthermore, several microbiome-associated biomarkers differ between these two diseases, and some are already assessed by international guidelines. Although the microbiota plays a key role in IBS and IBD pathophysiology, microbiome-based treatments remain limited, especially in IBD. There are clinically available treatments in IBS (e.g., rifaximin, low-FODMAP diet), but in IBD, only the probiotic VSL#3 is guideline-approved in ulcerative colitis pouchitis prophylaxis. Nevertheless, the dynamic nature of the microbiota continues to support the investigation of already studied (e.g., probiotics, fecal microbiota transplantation) and potential novel therapeutic approaches at the research level. The aim of this review is to compare the gut-microbiota-related pathophysiological pathways and biomarkers between IBS and IBD, to summarize the microbiome-related medications that have already been studied in both diseases, and to suggest new potential therapeutic options based on the gut microbiota. Full article

Introduction: Alterations of the microbiota–gut–brain axis, including increased intestinal permeability (IP), changes in microbial activity, and immune activation, are central to the pathophysiology of irritable bowel syndrome with diarrhea (IBS-D). The low-fermentable oligo-di-monosaccharides and polyols (FODMAP) diet (LFD) is an established therapy for IBS, yet its systemic effects, particularly in patients with elevated depressive symptoms, remain incompletely characterized. Methods: This single-arm pre–post study investigated associations between depressive symptom severity and markers of small IP (s-IP), endotoxin exposure, inflammation, and erythrocyte membrane polyunsaturated fatty acid (PUFA) composition in 43 IBS-D patients undergoing a 12-week personalized LFD. Patients were classified using the Symptom Checklist-90-Revised depression subscale into those with (d+, n = 23) and without (d−, n = 20) clinically elevated depressive symptoms. Results: At baseline, d+ patients exhibited higher s-IP, circulating lipopolysaccharide levels, inflammatory markers, and a more pro-inflammatory PUFA profile. Following LFD, significant improvements in symptoms and several biological parameters were observed in the overall cohort. Greater absolute changes in d+ patients were consistent with their higher baseline values rather than indicating differential responsiveness. Baseline depressive symptoms were not significantly associated with the magnitude of post-intervention changes in IP or inflammatory markers. Conclusions: These findings suggest that elevated depressive symptoms identify an IBS-D subgroup characterized by greater baseline biological burden. Results should be interpreted as associative given the single-arm design, absence of a control group, and the concurrent reduction in body weight, which may have influenced the observed changes. Randomized controlled studies are needed to clarify the role of dietary interventions in modulating gut–brain axis-related pathways in IBS-D. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is primarily treated via dietary modifications. Several diets have been shown to improve symptoms with similar efficacy. Other aspects of IBS, such as insufficient nutrient intake and being overweight, should also be considered when planning treatment options. The present scoping review aimed to identify various diets investigated in IBS-related clinical trials and to map the measured outcomes. Methods: We performed a systematic search of three databases: PubMed, Embase, and CINAHL Ultimate. Our search was limited to papers published between January 2000 and February 2026, and included human studies published as peer-reviewed original articles in English that described dietary interventions in adult patients (≥18 years) with IBS. Results: The titles and abstracts of 1261 studies were screened; 1147 studies were excluded; and 114 full-text articles were assessed for eligibility. Excluding articles outside the scope of our research resulted in a total of 71 included articles from 57 unique clinical trials. The most common interventions were low fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) (n = 43), traditional dietary advice (n = 13), and gluten-free diets (n = 11). The most common primary outcomes were the effect on IBS symptoms (n = 48), efficacy in terms of improving quality of life (n = 10), psychological well-being (n = 7), nutrient intake (n = 7), and adherence/applicability/feasibility to the diet (n = 7). Conclusions: In conclusion, the most studied dietary intervention in IBS was low FODMAP, and an effect on GI symptoms was the most common outcome. Considering other conditions associated with IBS, the effects on anthropometric, endocrine, metabolic, and nutritional parameters should also be evaluated. Full article

Diet is a major modifiable determinant of gastrointestinal (GI) health, influencing disease risk and progression through coordinated effects on the gut microbiome, immune regulation, epithelial barrier integrity, oxidative balance, and epigenetic mechanisms. This narrative review synthesizes epidemiological, mechanistic, and clinical evidence from the past decade to examine bidirectional relationships between dietary patterns and seven common GI disorders: celiac disease, irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, Helicobacter pylori-associated gastritis, peptic ulcer disease, and lactose intolerance. Western dietary patterns, characterized by high intake of ultra-processed foods and saturated fats and low fiber consumption, are consistently associated with microbial dysbiosis, impaired barrier function, and enhanced inflammatory signaling. In contrast, Mediterranean and plant-forward dietary patterns show protective associations across multiple GI conditions. Mechanistically, diet influences GI pathophysiology largely through microbiome-derived metabolites, particularly short-chain fatty acids, which regulate epithelial homeostasis, immune tolerance, and inflammatory pathways. Condition-specific dietary strategies remain clinically important. Gluten exclusion is essential in celiac disease, low- fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) approaches provide evidence-based symptom control in IBS, and exclusive enteral nutrition or targeted exclusion diets support remission induction in Crohn’s disease. Selected probiotics and emerging postbiotics may provide adjunctive benefits in specific contexts. Despite growing evidence, dietary research remains limited by methodological heterogeneity and interindividual variability. Precision nutrition approaches integrating microbiome profiling and artificial intelligence represent a promising translational direction. Overall, dietary patterns—rather than isolated nutrients—form the foundation of GI dietary therapy. Full article

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits that significantly impair patients’ quality of life. Dietary triggers of IBS symptoms are common, and consequently, diet-based treatments are often prescribed. We conducted a review of current evidence on dietary interventions for IBS, focusing specifically on the evaluation of the scientific rationale and effectiveness of the most commonly adopted diets. Clinical trials and guideline recommendations were analyzed to assess each diet’s efficacy in symptom relief and patient adherence. Traditional dietary advice, although not a structured diet, but rather a set of lifestyle and dietary recommendations, is commonly recommended as first-line therapy and provides a solid base for symptom improvement in almost half of patients with IBS. Conversely, the low-FODMAP diet is a strict dietary pattern characterized first by the exclusion and then by the gradual and personalized reintroduction of several foods. Several clinical trials have demonstrated the efficacy of a low-FODMAP diet in reducing global IBS symptoms, and due to the established evidence, it is now incorporated into many clinical guidelines as a second- or even first-line approach for patients with IBS. Limited data supports the starch- and sucrose-reduced diet as an option for symptom relief, with evidence stemming from the relatively recent finding of hypomorphic variants of the sucrose-isomaltase gene in a subset of patients with IBS. Nonetheless, its application in clinical practice is still very limited. Data on gluten-free diet is more controversial as although it may benefit a subset of patients with IBS, strong evidence is still lacking for identifying the best candidates for a restrictive diet with a high burden in terms of economical, psychological and social costs. Beyond exclusion diets, a few studies on the Mediterranean diet suggest it may be a potential option with benefits that go beyond IBS symptom relief. Overall, dietary modification can significantly alleviate IBS symptoms. Tailoring recommendations to individual patient triggers may further enhance outcomes. Full article

Background: Endometriosis is a chronic inflammatory gynecological disease affecting approximately 10% of women of reproductive age and is associated with pelvic pain, infertility, and reduced quality of life. Increasing evidence suggests that diet may influence endometriosis development and symptom severity through modulation of inflammation, oxidative stress, and hormone metabolism. This scoping review aimed to map current evidence on the role of nutrition in endometriosis. Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed and Scopus were searched for original human studies published in English between 2014 and 2024. Eligible studies examined dietary patterns, food groups, micronutrients, bioactive compounds, body mass index, or fat consumption in relation to endometriosis risk, progression, or symptoms. Results: Diets rich in fruits and vegetables, including Mediterranean and low-FODMAP dietary patterns, were associated with reduced pain symptoms and improved quality of life. Antioxidant and anti-inflammatory nutrients, particularly vitamins C and D, zinc, and curcumin, were linked to modulation of oxidative stress, inflammation, angiogenesis, and cellular proliferation. Evidence regarding dairy intake, gluten, carbohydrates, dietary fat, and BMI was inconsistent or limited. Considerable heterogeneity across study designs and outcome measures was observed. Conclusions: Dietary factors may contribute to the modulation of endometriosis-related symptoms and underlying pathogenic mechanisms. Nutrients with antioxidant and anti-inflammatory properties appear promising as complementary, non-invasive strategies; however, methodological heterogeneity highlights the need for high-quality randomized controlled trials. Full article

Small-intestinal bacterial overgrowth (SIBO) is defined by an excessive microbial presence in the small intestine and is associated with a range of gastrointestinal symptoms. Its management remains complex due to diagnostic limitations and high recurrence rates following treatment. A narrative review was conducted using MEDLINE (PubMed) and Cochrane databases to identify relevant studies published between 1984 and 2024. Search terms included small intestinal bacterial overgrowth SIBO, FODMAP, probiotics, prebiotics, synbiotics, and low-carbohydrate diets. Reference lists were also screened for additional studies. Antibiotics, particularly rifaximin, are commonly used for SIBO treatment but recurrence is frequent. Dietary strategies, such as low-FODMAP and low-carbohydrate diets, may help reduce symptoms, especially in patients with complications like D-lactic acidosis. Evidence for biotic agents (probiotics, prebiotics, synbiotics) is mixed, with limited high-quality studies and inconsistent outcomes. Some probiotic strains show symptom improvement, but effects on breath-test results are variable. A tailored, multidisciplinary approach combining dietary and medical therapies may offer optimal symptom control in SIBO. However, heterogeneity in study designs and limited evidence highlight the need for further research to inform standardised, evidence-based clinical practice. Full article

Background/Objectives: Intense physical activity can cause gastrointestinal symptoms, negatively impacting athletic performance. A low-FODMAP diet has the potential to reduce these symptoms and is increasingly being considered by physically active individuals. The aim of this review is to present the current knowledge on the importance of FODMAPs in sports nutrition. Methods: A narrative review was conducted in PubMed, Web of Science, ScienceDirect, and Google Scholar, covering publications published up to October 2025. Original studies, reviews, and meta-analyses addressing the relationship between FODMAP intake and gastrointestinal symptoms during physical activity were included. Selected articles were assessed for specific criteria, and the results were grouped thematically to present the current state of knowledge. Results: FODMAP consumption increases the risk of intestinal symptoms. Short-term FODMAP restriction, especially before and during exercise, reduced the severity of symptoms in most of the analyzed studies. Data on the long-term effects of a low FODMAP diet on the health, nutrition, and gut microbiota of athletes remain limited. Conclusions: A strategy of short-term FODMAP restriction in athletes’ diets shows potential for reducing gastrointestinal symptoms. An optimal approach requires individualization. Further research is needed to monitor potential side effects and long-term outcomes. Full article

Background/Objectives: Recent reports on the co-occurrence of allergies and endometriosis have provided grounds for expanding research in this area, suggesting that diagnostics should be extended to women with endometriosis. However, numerous studies on nutrients and antioxidants do not specify the type of diet that supports the treatment process. In our review, we focus on the types of food elimination and dietary approaches that have been used. Methods: This systematic review was conducted according to the PRISMA guidelines. We searched the EMBASE, PUBMED and SCOPUS databases, as well as the bibliographies of research papers and reviews, including the latest reports from June 2025. The search keywords were “endometriosis” and “type of diet”, “nutrition”, “food products”, “nutrients”, “elimination diet”, and “allergies”. Results: Excluding coexisting allergies and introducing an anti-inflammatory diet low in animal products, limiting butter and margarine, and eliminating fried foods and refined simple sugars may be the best solution to help treat endometriosis. Conclusions: Personalised nutritional counselling for patients with endometriosis is particularly helpful and necessary, as there is no single elimination diet that can be recommended for all patients with endometriosis. The first step should be an anti-inflammatory diet, such as the Mediterranean diet or the MIND diet (Mediterranean-DASH diet intervention for neurological delay), followed by more in-depth allergy screening. The phenotypic diversity of this group of patients may require the use of a low-FODMAP (fermentable oligo-, di-, monosaccharides and polyols), low-nickel, gluten-free or other elimination diet. Full article