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Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients

  • Received : 2022.04.05
  • Accepted : 2022.09.18
  • Published : 2022.11.15

Abstract

Purpose: Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. Methods: This clinical trial included 50 patients aged 3-18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. Results: After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. Conclusion: A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Keywords

References

  1. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C. A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr 2009;154:322-6. https://doi.org/10.1016/j.jpeds.2008.09.047
  2. Tarsitano F, Castelluzzo MA, Concolino D, Pensabene L. Functional abdominal pain. Curr Pediatr Rep 2018;6:67-78. https://doi.org/10.1007/s40124-018-0158-7
  3. Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS One 2015;10:e0126982. https://doi.org/10.1371/journal.pone.0126982
  4. Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet 2020;396:1675-88. https://doi.org/10.1016/S0140-6736(20)31548-8
  5. Tuck CJ, Muir JG, Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome. Expert Rev Gastroenterol Hepatol 2014;8:819-34. https://doi.org/10.1586/17474124.2014.917956
  6. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 2010;25:1366-73. https://doi.org/10.1111/j.1440-1746.2010.06370.x
  7. O'Keeffe M, Lomer MC. Who should deliver the low FODMAP diet and what educational methods are optimal: a review. J Gastroenterol Hepatol 2017;32 Suppl 1:23-6. https://doi.org/10.1111/jgh.13690
  8. Mitchell H, Porter J, Gibson PR, Barrett J, Garg M. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019;49:124-39. https://doi.org/10.1111/apt.15079
  9. Ford AC, Moayyedi P, Chey WD, Harris LA, Lacy BE, Saito YA, et al. American College of Gastroenterology monograph on management of irritable bowel syndrome. Am J Gastroenterol 2018;113(Suppl 2):1-18.
  10. McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O'Sullivan NA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016;29:549-75. https://doi.org/10.1111/jhn.12385
  11. Newlove-Delgado TV, Martin AE, Abbott RA, Bethel A, Thompson-Coon J, Whear R, et al. Dietary interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev 2017;3:CD010972.
  12. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: children and adolescents. Gastroenterology 2016;150:1456-68.e2. https://doi.org/10.1053/j.gastro.2016.02.015
  13. Chambers CT, Giesbrecht K, Craig KD, Bennett SM, Huntsman E. A comparison of faces scales for the measurement of pediatric pain: children's and parents' ratings. Pain 1999;83:25-35. https://doi.org/10.1016/S0304-3959(99)00086-X
  14. Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, et al. KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res 2005;5:353-64. https://doi.org/10.1586/14737167.5.3.353
  15. The KIDSCREEN Group Europe. The KIDSCREEN questionnaires-quality of life questionnaires for children and adolescents. Handbook. Lengerich: Pabst Science Publishers, 2006.
  16. Monash University. The Monash University low FODMAP diet [Internet]. Melbourne: Monash University; 2019 [cited 2019 Jul 1]. Available from: www.monashfodmap.com/about-fodmap-and-ibs/high-and-lowfodmap-foods
  17. Hahn J, Choi J, Chang MJ. Effect of low FODMAPs diet on irritable bowel syndromes: a systematic review and meta-analysis of clinical trials. Nutrients 2021;13:2460. https://doi.org/10.3390/nu13072460
  18. Gibson PR. The evidence base for efficacy of the low FODMAP diet in irritable bowel syndrome: is it ready for prime time as a first-line therapy? J Gastroenterol Hepatol 2017;32 Suppl 1:32-5. https://doi.org/10.1111/jgh.13693
  19. Gibson PR. Use of the low-FODMAP diet in inflammatory bowel disease. J Gastroenterol Hepatol 2017;32 Suppl 1:40-2. https://doi.org/10.1111/jgh.13695
  20. Nanayakkara WS, Skidmore PM, O'Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol 2016;9:131-42.
  21. Chumpitazi BP, Hollister EB, Oezguen N, Tsai CM, McMeans AR, Luna RA, et al. Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome. Gut Microbes 2014;5:165-75. https://doi.org/10.4161/gmic.27923
  22. Chumpitazi BP, Cope JL, Hollister EB, Tsai CM, McMeans AR, Luna RA, et al. Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Aliment Pharmacol Ther 2015;42:418-27. https://doi.org/10.1111/apt.13286
  23. Baranguan Castro ML, Ros Arnal I, Garcia Romero R, Rodriguez Martinez G, Ubalde Sainz E. [Implementation of a low FODMAP diet for functional abdominal pain]. An Pediatr (Engl Ed) 2019;90:180-6. Spanish.
  24. Brown SC, Whelan K, Gearry RB, Day AS. Low FODMAP diet in children and adolescents with functional bowel disorder: a clinical case note review. JGH Open 2019;4:153-9.
  25. Dogan G, Yavuz S, Aslantas H, Ozyurt BC, Kasirga E. Is low FODMAP diet effective in children with irritable bowel syndrome? North Clin Istanb 2020;7:433-7.
  26. Boradyn KM, Przybylowicz KE, Jarocka-Cyrta E. Low FODMAP diet is not effective in children with functional abdominal pain: a randomized controlled trial. Ann Nutr Metab 2020;76:334-44. https://doi.org/10.1159/000510795
  27. van Lanen AS, de Bree A, Greyling A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. Eur J Nutr 2021;60:3505-22. Erratum in: Eur J Nutr 2021;60:3523.
  28. Fedewa A, Rao SS. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep 2014;16:370. https://doi.org/10.1007/s11894-013-0370-0
  29. Thapar N, Benninga MA, Crowell MD, Di Lorenzo C, Mack I, Nurko S, et al. Paediatric functional abdominal pain disorders. Nat Rev Dis Primers 2020;6:89. https://doi.org/10.1038/s41572-020-00222-5