Reduced efficacy of low FODMAPs diet in patients with IBS-D carrying sucrase-isomaltase ( SI ) hypomorphic variants
Open accessAbstract
Recently in Gut and elsewhere,1–3 rare and common hypomorphic sucrase-isomaltase ( SI ) gene variants have been linked to an increased risk of IBS. Similar to congenital SI deficiency (a form of carbohydrate malabsorption caused by homozygous SI loss-of-function mutations),4 reduced SI enzymatic activity may trigger IBS symptoms via colonic accumulation of undigested disaccharides from starch and sucrose, resulting in fermentation with gas production and osmotic diarrhoea. This information holds potential for patients’ stratification, and the identification of IBS subgroups better suited to benefit from specific dietary restrictions. For instance, diets low in short chain carbohydrates like the FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols that are poorly absorbed in the small intestine) have been shown to be effective in reducing GI symptoms in some patients with IBS,5 6 though this has not been studied in relation to SI genotype and/or function. While sucrose and, in part, starch are not specifically restricted in a standard low FODMAP diet, such a therapeutic approach may be less effective in individuals whose reduced SI activity contributes …
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Gut-brain communication is bidirectional.
“In addition to the psychological component of IBS, 22 gut-brain communication is bidirectional.”
From Irritable bowel syndrome (2020) · cites this paper as [22]
The paper’s main text (page not provided) discusses sucrase-isomaltase variants, carbohydrate malabsorption, and dietary response in IBS-D. Searches for bidirectional gut-brain communication and the brain–gut axis found no passage addressing the claim. (LLM, conf=0.76)
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- Authors
- Zheng, T., Eswaran, S., Photenhauer, A. L., Merchant, J. L., Chey, W. D., & D’Amato, M.
- Affiliations
- Karolinska Institutet (SE)
- University of Michigan (US)
- University of Arizona (US)
- Ikerbasque (ES)
- Corresponding author
- D’Amato, Mauro
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2019-01-18
- Volume
- 69
- Issue
- 2
- Pages
- 397-398
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC6984052
- OpenAlex
- W2909817703
- Cited by
- 66
- References
- 7
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 11 · 2023: 7 · 2022: 10 · 2021: 10 · 2020: 10 · 2019: 6
- FWCI
- 8.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gut (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- QOL Medical
- China Scholarship Council
- Vetenskapsrådet
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Digestive system and related health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome with diarrhea, sucrase-isomaltase deficiency, hypomorphic variants, low FODMAP diet, carbohydrate malabsorption, osmotic diarrhea
- MeSH terms
- Adult, Female, Genotype, Humans, Male, Middle Aged, Prognosis, Sucrase-Isomaltase Complex, Genetic Variation, Treatment Outcome, Irritable Bowel Syndrome, Diet, Carbohydrate-Restricted
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