Gastrointestinal Manifestations and Low- FODMAP Protocol in a Cohort of Fabry Disease Adult Patients

• Published in: Nutrients Vol. 15; no. 3; p. 658
• Main Authors: Gugelmo, Giorgia, Vitturi, Nicola, Francini-Pesenti, Francesco, Fasan, Ilaria, Lenzini, Livia, Valentini, Romina, Carraro, Gianni, Avogaro, Angelo, Spinella, Paolo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28-01-2023; MDPI
• Subjects: Abdomen; Adult; Body mass index; Carbohydrates; Constipation; Diarrhea; Diet; Disaccharides; Dysbacteriosis; Enzymes; Fabry disease; Fabry Disease - complications; Fabry Disease - drug therapy; Fabry's disease; Fermentation; FODMAP Diet; Food; Food intake; Galactosidase; gastrointestinal manifestations; Gastrointestinal symptoms; Health services; Humans; Intestine; Irritable Bowel Syndrome; Lactose; low-FODMAP diet; Metabolism; Middle Aged; Monosaccharides; Mutation; Nutrient deficiency; Nutrition; Oligosaccharides; Pain; Patients; Polyols; Quality of Life; Rare diseases; Retrospective Studies; Saccharides; gastrointestinal manifestations; Fabry disease; low-FODMAP diet
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu15030658

Fabry disease (FD) is an X-linked lysosomal disorder caused by α-galactosidase A enzyme deficiency. Gastrointestinal (GI) manifestations are reported in FD with a prevalence of about 50%, usually treated by Enzymatic Replacement Therapy (ERT) or oral treatment. Since FODMAPs (
) can be involved in GI manifestations and dysbiosis in FD patients, a low-
diet could represent an alternative adjunctive treatment in FD subjects, as well as being useful for reducing symptoms in Irritable Bowel Syndrome (IBS). We retrospectively assessed data from 36 adult FD patients followed at the Inherited Metabolic Rare Diseases Adult Centre of the University Hospital of Padova (mean age 47.6 ± 16.2 years). Patients were screened for GI symptoms by IBS severity score and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires. In symptomatic patients, the low-
diet was proposed in order to improve GI manifestations; it consists of a phase of elimination of fermentable saccharides, succeeded by a gradual reintegration of the same. Severe or moderate GI symptoms were found in 61.1% of patients, with no correlation to the therapy in use, and significantly more severe in the classical form of FD. The protocol was completed by seven patients affected by severe GI manifestations, significantly higher than the others. The low-
diet significantly improved indigestion, diarrhoea, and constipation. This dietetic protocol seemed to have a positive impact on intestinal symptoms, by identifying and reducing the intake of the foods most related to the onset of disorders and improving the clinical manifestations. A low-
diet may be an effective alternative approach to improve intestinal manifestations and quality of life, and nutrition can play an important role in the multidisciplinary care of patients with FD.