Quran and Medicine

Quran and Medicine

Effect of Ramadan fasting on gastrointestinal tract: A review

Document Type : Original Article

Authors
Zeinab Nikniaz 1
Mahdieh Abbasalizad Farhangi 2
Leila Nikniaz 3
1 Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz, Iran
2 Nutrition faculty, Tabriz University of medical sciences, Tabriz, Iran
3 Health services management research center, Tabriz University of medical sciences, Tabriz, Iran
Abstract
Objective: In the present systematic review, we aimed at reviewing the peer review articles investigating the effect of Ramadan fasting on gastrointestinal disease.
Methods: We searched databases of Pubmed, Embase, google scholar, Cochrane library, SID, and Magiran from 1960 to June 2019. Only original research published in peer-reviewed scientific journals, which evaluated the effect of Ramadan fasting on gastrointestinal symptoms and diseases were included.
Results: Using our systematic search, 37 articles met our predefined inclusion criteria.
Studies showed that the upper gastrointestinal (UGI) bleeding and peptic and duodenal ulcers perfusion in Ramadan were higher compared with the month before and a month after Ramadan. Moreover, studies showed that anthropometric indices, inflammatory cytokines, liver enzymes level, and hepatic steatosis were improved in the fasting group compared with the non-fasting group in patients with non-alcoholic fatty liver disease. In cirrhotic patients, some studies showed that although Ramadan fasting had no effect on liver function or even improve liver enzymes in patients with disease severity of child class A & B, it was associated with higher risk UGI bleeding in cirrhotic patients. One study investigated the effect of Ramadan Fasting in inflammatory bowel disease patients and showed that in patients with ulcerative colitis (UC), the mean score of disease activity decreased after Ramadan and this decrement was significant in male UC patients.
In addition, studies indicated that Ramadan fasting does not have an effect on liver function or frequency and severity of gastrointestinal symptoms except for constipation in healthy subjects.  
Conclusion: According to the results, Ramadan fasting does not associate with any adverse effect in the healthy population. However, in some gastrointestinal diseases such as peptic ulcers, it may be associated with complications.
Keywords
Ramadan fasting
digestive diseases
gastrointestinal symptoms
peptic ulcer
1.    Azizi F. Islamic fasting and health. Ann Nutr Metab. 2010;56(4):273-82.
2.    Al Suwaidi J, Bener A, Suliman A, Hajar R, Salam A, Numan M, et al. A population based study of Ramadan fasting and acute coronary syndromes. Heart. 2004;90(6):695-6.
3.    Adawi M, Watad A, Brown S, Aazza K, Aazza H, Zouhir M, et al. Ramadan fasting exerts immunomodulatory effects: insights from a systematic review. Frontiers in immunology. 2017;8:1144.
4.    Bragazzi NL, Briki W, Khabbache H, Rammouz I, Mnadla S, Demaj T, et al. Ramadan fasting and infectious diseases: a systematic review. The Journal of Infection in Developing Countries. 2015;9(11):1186-94.
5.    Lee SWH, Lee JY, San San Tan C, Wong CP. Strategies to make Ramadan fasting safer in type 2 diabetics: a systematic review and network meta-analysis of randomized controlled trials and observational studies. Medicine (Baltimore). 2016;95(2).
6.    Mazidi M, Rezaie P, Chaudhri O, Karimi E, Nematy M. The effect of Ramadan fasting on cardiometabolic risk factors and anthropometrics parameters: a systematic review. Pakistan journal of medical sciences. 2015;31(5):1250.
7.    Sadeghpour S, Keshteli AH, Daneshpajouhnejad P, Jahangiri P, Adibi P. Ramadan fasting and digestive disorders: SEPAHAN systematic review No. 7. Journal of Research in Medical Science. 2012;17(4).
8.    Kocakusak A. Does Ramadan fasting contribute to the increase of peptic ulcer perforations. European Review for Medical and Pharmacological Sciences. 2017;21(1):150-4.
9.    Nomani M, Khan A, Shahda M, Nomani A, Sattar S. Predicting serum gastrin levels among men during Ramadan fasting. Eastern Mediterranean Health Journal, 2005, 11 (‎1-2)‎, 119-125.
10.    El Mekkaoui Amine SK, Ihssane M, Adil I, Dafr-Allah B. Effect of Ramadan fasting on acute upper gastrointestinal bleeding. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2013;18(3):230.
11.    Emami M, Rahimi H. Effects of Ramadan fasting on acute upper gastrointestinal bleeding due to peptic ulcer. Journal of Research in Medical Science. 2006;11(3):170-5.
12.    Malik G, Mubarik M, Jeelani G, Tajamul H, Kadla S, Lone B, et al. Endoscopic evaluation of peptic ulcer disease during Ramadan fasting. Diagnostic and therapeutic endoscopy. 1996;2(4):219-21.
13.    Özkan S, Durukan P, Akdur O, Vardar A, Torun E, Ikizceli I. Does Ramadan fasting increase acute upper gastrointestinal haemorrhage? Journal of International Medical Research. 2009;37(6):1988-93.
14.    Bener A, Derbala MF, Al-Kaabi S, Taryam LO, Al-Ameri MM, Al-Muraikhi NM, et al. Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital. Eastern Mediterranean Health Journal. 2006;12(1-2):105-11. Epub 2006/10/14.
15.    Davoodabadi A, Akbari H, Ghasembandi M. Does Ramadan Fasting Increase duodenal ulcer perforation? Journal of Fasting and Health. 2016;4(1):25-31.
16.    Jastaniah S, Al Naami MY, Malatani TM. Perforated duodenal ulcer in Asir central hospital. Saudi Journal of Gastroenterology. 1997;3(2):90.
17.    Mallk GM, Mubarik M, Hussain T. Acid peptic disease in relation to Ramadan fasting: a preliminary endoscopic evaluation. American Journal of Gastroenterology. 1995;90(11):2076-7. Epub 1995/11/01.
18.    Torab FC, Amer M, Abu-Zidan FM, Branicki FJ. Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-ain medical district, United Arab Emirates. Asian Journal of Surgary. 2009;32(2):95-101. Epub 2009/05/09.
19.    Gokakin AK, Kurt A, Akgol G, Karakus BC, Atabey M, Koyuncu A, et al. Effects of Ramadan fasting on peptic ulcer disease as diagnosed by upper gastrointestinal endoscopy. Arab Journal of Gastroenterology. 2012;13(4):180-3. Epub 2013/02/26.
20.    Gokakin AK, Kurt A, Atabey M, Koyuncu A, Topcu O, Aydin C, et al. The impact of Ramadan on peptic ulcer perforation. Ulus Travma Acil Cerrahi Derg. 2012;18(4):339-43. Epub 2012/11/10.
21.    Donderici O, Temizhan A, Kucukbas T, Eskioglu E. Effect of Ramadan on peptic ulcer complications. Scandinavian Journal of Gastroenterology. 1994;29(7):603-6. Epub 1994/07/01.
22    Elnagib E, Mahadi SEI, Ahmed ME. Perforated peptic ulcer in Khartoum. Khartoum Medical Journal. 2012;1(2).
23    Kucuk H, Censur Z, Kurt N, Ozkan Z, Kement M, Kaptanoglu L, et al. The effect of Ramadan fasting on duodenal ulcer perforation: a retrospective analysis. Indian Journal of Surgery. 2005;67(4).
24    Mehranbian A, Homayouni R, Hashemi M, Moradi A. Is healing of duodenal ulcer delayed by Ramadan fasting? Koomesh. 2007;8(2):67-72.
25    Fayyazi E, Dehkordi MHE, Fahim A, Tavakol N, Mahdavi SB, Marzbani E, et al. Effects of Ramadan Fasting on Dyspepsia Symptoms. Govaresh. 2017;22(3):188-94.
26    Rahimi H, Tavakol N. Effects of Ramadan Fasting on the Symptoms of Gastroesophageal Reflux Disease. journal of nutrition, fasting and health, 2018, 6(4), 213-219.
27    Mardhiyah R, Makmun D, Syam AF, Setiati S. The Effects of Ramadhan Fasting on Clinical Symptoms in Patients with Gastroesophageal Reflux Disease. Acta Medica Indonesia. 2016;48(3):169-74. 
28    SaberiIsfeedvajani M, Abolghasemi R, MousaviHeris A, SedaghatSiyahkal M. Disease Patterns in Ramadan in Comparison with other Months of the Year. Journal of Religion and Health. 2015;3(1):83-9.
29    Elnadry MH, Negm IAE, Abdel-aziz IM, Elshafee AM, El-azhary SS, Abdelhafez MA, et al. Effect of ramadan fasting on muslim patients with chronic liver diseases. Journal of Hepatology. 2011;54:S67-S8.
30    Mohamed SY, Emara MH, Hussien HI, Elsadek HM. Changes in portal blood flow and liver functions in cirrhotics during Ramadan fasting in the summer; a pilot study. Gastroenterology and Hepatology from Bed to Bench. 2016;9(3):180-8. Epub 2016/07/28.
31    Mohamed SY, Emara MH, Gabballah BA, Mostafa EF, Maaly MA. Effects of Ramadan Fasting on Muslim Patients with Liver Cirrhosis: A Comparative Study. Govaresh. 2018;23(1):47-52.
32    Elfert AA, AbouSaif SA, Kader N, AbdelAal E, Elfert AY, Moez A, et al. A multicenter pilot study of the effects of Ramadan fasting on patients with liver cirrhosis. Tanta Medical Science Journal. 2011;6(3):25-33.
33    Aliasghari F, Izadi A, Gargari BP, Ebrahimi S. The Effects of Ramadan Fasting on Body Composition, Blood Pressure, Glucose Metabolism, and Markers of Inflammation in NAFLD Patients: An Observational Trial. Journal of American College of Nutrition. 2017;36(8):640-5. Epub 2017/09/19.
34    Ebrahimi S, Gargari BP, Aliasghari F, Asjodi F, Izadi A. Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease. International journal of Vitamin and Nutrition Research. 2019:1-8. Epub 2019/04/02.
35    Ebrahimi S, Gargari BP, Izadi A, Imani B, Asjodi F. The effects of Ramadan fasting on serum concentrations of vaspin and omentin-1 in patients with nonalcoholic fatty liver disease. European Journal of Integrative Medicine. 2018;19:110-4.
36    Rahimi H, Habibi ME, Gharavinia A, Baghaei A, Tavakol N. Effect of Ramadan fasting on alanine transferase (ALT) in nonalcoholic fatty liver disease (NAFLD). Journal of Nutrition, Fasting and Health. 2017;5(3):107-12.
37    Arabi SM, Hejri Zarifi S, Nematy M, Safarian M. The effect of Ramadan fasting on non-alcoholic fatty liver disease (NAFLD) Patients. Journal of Fasting and Health. 2015;3(2):74-80.
38    Naseri H. The metabolic effect of ramadan diet on the fatty liver and metabolic syndrome in overweight and obese women. urmia medical journal. 2016;27(4):277-87.
39    Tavakkoli H, Haghdani S, Emami MH, Adilipour H, Tavakkoli M, Tavakkoli M. Ramadan fasting and inflammatory bowel disease. Indian Journal of Gastroenterology. 2008;27(6):239-41. Epub 2009/05/02.
40    Sulu B, Gunerhan Y, Ozturk B, Arslan H. Is long-term hunger (Ramadan model) a risk factor for acute appendicitis? Saudi Medical Journal. 2010;31(1):59-63. Epub 2010/01/12.
41    Davoodabadi A, Akbari H, Rasoulinejad A. The impact of fasting during the holy month of Ramadan on incidence of acute appendicitis. Iranian Journal of Medical Sciences. 2005;30(1):21-3.
42    Hosseini SV, Torabijahromi M, Mosallaei M, Sabet B, Pourahmad S. The effect of season and Ramadan fasting on the onset of acute cholecystitis. Saudi medical journal. 2006;27(4):503-6.
43    Keshteli AH, Sadeghpour S, Feizi A, Boyce P, Adibi P. Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting. Journal of Religion and Health. 2017;56(5):1620-7. Epub 2015/11/26.
44    Kareem I, Bavikar J, Asegaonkar S, Aghade S, Pagdhune A, Thorat A. Effect of Ramadan fasting on hepatic function in healthy adults. Paripex Indian Journl of Research. 2016;5(3):373-4.
45    Darvish MS. Relative frequency of minor digestive symptoms in healthy fasting Muslems and their relation to dietary pattern. 2002.
46    Ferolla SM, Silva LC, Ferrari MdLA, da Cunha AS, dos Santos Martins F, Couto CA, et al. Dietary approach in the treatment of nonalcoholic fatty liver disease. World journal of hepatology. 2015;7(24):2522.
47    Aoki T, Müller W, Brennan M, Cahill Jr G. Metabolic effects of glucose in brief and prolonged fasted man. The American journal of clinical nutrition. 1975;28(5):507-11.
48    Albillos A, Bañares R, González M, Catalina M-V, Pastor O, Gonzalez R, et al. The extent of the collateral circulation influences the postprandial increase in portal pressure in patients with cirrhosis. Gut. 2007;56(2):259-64.
49    Sarna SK. Cyclic motor activity; migrating motor complex: 1985. Gastroenterology. 1985;89(4):894-913.