World Gastroenterology Organisation Global Guidelines

Makaleler > Tam Makale · 2021

Yazarlar: Govind Makharia, Peter R. Gibson, Julio C. Bai, Tarkan Karakan, Yeong Yeh Lee, Lyndal Collins, Jane Muir, Nevin Oruc, Eamonn Quigley, David S. Sanders, Caroline Tuck, Cihan Yurdaydin, Anton Le Mair

Journal of Clinical Gastroenterology, Uluslararası, Wos, 2021, cilt 56, ss 1-15

DOI: 10.1097/mcg.0000000000001588

Özet

This guideline was produced in connection with the World Digestive Health Day (WDHD) held in 2016 on the theme of “Diet and the Gut.” The Guideline Development Review Team consisted of experts on the WDHD theme as well as invited experts, including diet and nutrition specialists, pharmacists, and primary care physicians. Given the central role of the digestive tract and its related organs in the processes of digestion and absorption, it should come as no surprise that the food we eat has critical and complex interactions with the gastrointestinal tract and its contents, including the microbiota. The nature of these interactions is influenced not only by the composition of the diet and the integrity of the gastrointestinal tract but also by psychosocial and cultural factors. The general public—and in particular those who suffer from gastrointestinal ailments—rightly perceive their diet as being a major determinant of such symptoms and seek guidance on optimal dietary regimens. Many medical practitioners, including gastroenterologists, are unfortunately often ill-prepared to deal with such issues. This is a reflection of the lack of education on the topic of diet and nutrition in many curricula. Dietary changes have the potential to alleviate symptoms, but they may also result in regimens that are nutritionally deficient in 1 or more respects. It is vital, therefore, that whenever possible, the medical practitioner should engage the services of a skilled nutritionist/dietitian to evaluate a given individual’s nutritional status, instruct the patient on new diet plans, and monitor progress. It is also incumbent on gastroenterologists to become educated on modern dietary practices as they relate to gastrointestinal health and disease. We hope that this guideline will become a valuable resource in this regard. Diet, in general, is a very broad subject; we have therefore decided to be selective and have focused on certain diets and conditions for which the diet has a real causative or therapeutic role in adults: celiac disease, dietary fibers, FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), carbohydrate intolerance, and the role of diet in irritable bowel syndrome (IBS). The topic of celiac disease has already been dealt with in the World Gastroenterology Organisation (WGO) guideline on celiac disease published in 2016, which should be referred to for further details.1,2 With WGO “cascades,” the intention is to recognize differences in disease epidemiology, sociocultural factors, and health care provision that exist in different parts of the world and the ways in which they preclude, in most instances, the promulgation of a “one size fits all” or a single gold-standard approach. Table 10 in this guideline lists organizations that produce relevant guidelines. This Global WGO Guideline includes a set of cascades intended to provide context-sensitive and resource-sensitive options for the dietary approach to gastrointestinal conditions. Through the WGO cascades, the WGO Guidelines program aims to provide clinical practice recommendations that are useful in many different environments across the world. This WGO Guideline on diet and the gut is intended for use by health providers, including family care and primary care physicians, gastroenterologists, pharmacists, and nutritionists/dietitians. The WGO Guidelines are produced through a systematic development process for achieving an expert consensus on the basis of the medical and scientific literature, existing practice guidelines, and regional best-practice standards. All available sources were used to develop this guideline. Monthly high-level evidence literature searches in EMBASE/Medline are delivered to the review team members as alerts and are scanned by team members to identify new insights and evidence for the next guideline update. CASCADES OF DIET OPTIONS AND ALTERNATIVES Tables 1–3 present cascades of resource-sensitive diet options and alternatives for countries and regions with different levels of resources, access, culture, and epidemiology. TABLE 1 - Cascade of Guidelines On Dietary Fiber Individual strategies Dietary education and/or behavior-change counseling for individuals with a low-fiber diet or health condition modulated by fiber intake Increased consumption of high-fiber foods, including fruit, vegetables, legumes, and whole grains Use of fiber supplementation where recommended intake cannot be met through diet alone, or there is evidence of therapeutic benefit for a specific health condition Strategies for governments, international partners, civil society, nongovernmental organizations, and the private sector Shape healthy environments Make healthier, high-fiber food options affordable and easily accessible to all Promote high-fiber food options and increase public awareness of the health benefits associated with consumption Strategies for the food industry Increase the fiber content of processed foods through changes in food-processing practices and/or fortification of highly processed foods Increasingly introduce and promote production of innovative, fiber-rich products TABLE 2 - Cascade of Recommendations on FODMAP Extensive resources (gold standard) Clinical evaluation to confirm the of including of celiac disease Dietary by an expert to evaluate dietary of FODMAP consumption Dietary with dietary of FODMAP intake for education on foods to be and to be as well as to the dietary dietary food to evaluate the of the FODMAP diet on has been to to FODMAP by on the basis of the to the has been of with dietary of dietary and strategies resources Clinical evaluation to confirm the of including of celiac disease Dietary by a to evaluate dietary intake Dietary with dietary of FODMAP intake for education on foods to be and to be as well as to the dietary dietary food to evaluate the of the FODMAP diet on has been to to FODMAP by on the basis of the to the has been of with dietary of dietary and strategies resources Clinical evaluation to confirm the of including of celiac disease Dietary by a to evaluate dietary intake Dietary with dietary of FODMAP intake for to evaluate the of the FODMAP diet on has been to to FODMAP FODMAP oligosaccharides, disaccharides, monosaccharides, and irritable bowel TABLE - Cascade of Recommendations on Extensive resources (gold standard) with or and of the and or food with to identify and education by a to intake of of dietary intake of foods in with and products and/or use of should be as a of the FODMAP diet The of in has been in The of this in is not a and diet by by a supplementation resources as as available as as should be given to a and by by a for resources with to identify Dietary education by a health to intake of of dietary intake of foods in with and products and/or use of available should be as a of the FODMAP diet the of clinical should be given to the clinical and to in with only should be given to a and diet with from a and only in with are used on the of produced by the of the the development of is in oligosaccharides, disaccharides, monosaccharides, and DIET Dietary are and that digestion in the of and a health Fiber to the in foods, and may and or many a of individuals not dietary fiber to recommended dietary fiber sources whole and vegetables, and intake of dietary fiber has been associated with a of including disease and and it may the of Dietary fiber may be in the nutrition on food and it is as a of TABLE - Dietary The parts of or that are to digestion and in the with or in the Dietary fiber includes oligosaccharides, and associated Dietary promote including and/or and/or that are foods as should health to a fiber has been that fiber and health by experts the and the gut Clinical intended to the disease or or to or in to gastrointestinal or more of fiber in on food of to the of food Fiber Fiber content in a of a food or of and for diets intake of Dietary Fiber a of and fibers, and have health benefits in the of a high-fiber the of fiber was to its more that of and are more and as associated with dietary fiber may also to disease of Dietary a of the and benefits of fibers, to Table in the WGO of this guideline The is a of associated with the consumption of a high-fiber diet with whole foods in in and/or in and/or Increased and/or Increased production of to by the microbiota. 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