Carbohydrate Elimination or Adaptation Diet for Symptoms of Intestinal Discomfort in IBD: Rationales for “Gibsons’ Conundrum”

Table 4

(a) Human studies published on the use of prebiotics or nondigestible carbohydrates for inflammatory disorders. IBD: inflammatory bowel disease, UC: ulcerative colitis, CD: Crohn’s disease, and P: postoperative ileoanal anastomotic pouch inflammation, represents a spectrum of IBD recurrences. (b) Studies using combination of prebiotics and probiotics (synbiotics) for IBD.

(a)

Disorder	𝑁 = patients	Study type	Active agent	Outcome	Reference
UC^1	29	RCT	Ispaghula husk	Improved	[226]*
UC^1	102	RCT, OL	Plantago Ovata	Nonsuperior	[227]
UC^2	10	OL	GBF	Improved	[228]
UC^2	18	OL	GBF	Improved	[91]
UC^2	21	OL	GBF	Improved	[229]
UC^2	40	RCT	GBF	Cytokine decreased	[230]
UC^1	59	RCT, OL	GBF	Lower recurrence	[231]
UC^2	19	OL	OFS + IN + Bif	Improved clinical endoscopy	[232]
UC and CD^1	20 (10 controls)	OL	Lactulose	Adaptation in UC, but not in CD	[233]
UC and CD^1	31	OL	Lactulose	No effect, but improved quality of life in UC	[234]
CD^2	10	OL	FOS, IN	Improved score	[235]
CD^2	10	OL	FOS, IN	Improved	[236]
CD^2	103	DBRCT	FOS	No clinical benefit, despite impacting on DC function	[237]
P^2	20	DBRCT	IN	Improved inflammation	[238]*
P^2	21	OL	Lactose	Decreased bacterial sulfomucins	[239]

(b)

Disorder	𝑁 = patients	Study type	Active agent	Outcome	Reference
UC^2	16	OL	OFS + IN + Bif	Improved clinical endoscopy	[240]
UC^1	120	RCT	Bif/Psy/Bif + Psy	Improved quality of life with Bif + Psy	[241]
CD^3	30	OL	Mixed fiber + IN + 4 Lacto	Failed to prevent relapse	[242]
CD^2	10	OL	Psy + Bif + Lacto	Clinical improvement	[243]
CD^2	35	DBRCT	OFS + IN + Bif	Clinical improvement	[244]
P^2	10	OL	OFS, Lacto	Improved and remit	[245]

RCT: randomized controlled trial; DBRCT: double-blind randomized controlled trial; OL: open labeled; GBF: germinated barley foodstuffs; FOS: fructo-oligosaccharides (<5 degrees of polymerization); OFS: oligofructose (5–10 degrees of polymerization); IN: inulin (<200 degrees of polymerization); Psy: psyllium; Bif: Bifidobacteria species; Lacto: Lactobacillus species.
*Crossover design,
¹Disease in remission,
²Active disease,
³Maintenance after surgery.