SUMMARY Background A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 hours. Aim To determine the efficacy of a low FODMAP diet in childhood IBS and whether gut microbial composition and/or metabolic capacity are associated with its efficacy. Methods In a double-blind, crossover trial, children with Rome III IBS completed a one-week baseline period. They then were randomized to a low FODMAP diet or typical American childhood diet (TACD), followed by a 5-day washout period before crossing over to the other diet. GI symptoms were assessed with abdominal pain frequency being the primary outcome. Baseline gut microbial composition (16S rRNA sequencing) and metabolic capacity (PICRUSt) were determined. Metagenomic biomarker discovery (LEfSe) compared Responders (≥50% decrease in abdominal pain frequency on low FODMAP diet only) versus Non-Responders (no improvement during either intervention). Results Thirty-three children completed the study. Less abdominal pain occurred during the low FODMAP diet versus TACD (1.1 ± 0.2 (SEM) episodes/day versus 1.7 ± 0.4, P<0.05). Compared to baseline (1.4 ± 0.2), children had fewer daily abdominal pain episodes during the low FODMAP diet (P<0.01) but more episodes during the TACD (P<0.01). Responders were enriched at baseline in taxa with known greater saccharolytic metabolic capacity (e.g., Bacteroides, Ruminococcaceae, Faecalibacterium prausnitzii) and 3 KEGG orthologs, of which two relate to carbohydrate metabolism. Conclusions In childhood IBS, a low FODMAP diet decreases abdominal pain frequency. Gut microbiome biomarkers may be associated with low FODMAP diet efficacy.

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In a randomized controlled trial of children with IBS, we found fructans to exacerbate several symptoms. However, fructan sensitivity cannot be identified based on baseline gastrointestinal symptoms, dietary intake, psychosocial factors, or gas production. Clinicaltrials.gov no: NCT02842281.

Objectives This study sought to: 1) evaluate the ability of children to reliably use a modified Bristol Stool Form Scale for Children (mBSFS-C), 2) evaluate criterion-related validity of the mBSFS-C, and 3) identify the lower age limit for mBSFS-C use. Study design The mBSFS-C comprises five stool form types described and depicted in drawings. Children 3–18 years rated stool form for ten stool photographs. Due to low reliability when stool form descriptors were not read aloud (n=119), a subsequent sample (n=191) rated photographs with descriptors read. Results Intraclass correlation coefficients for descriptor-unread versus -read samples were 0.62 and 0.79. Children were increasingly reliable with age. Percentage of correct ratings varied by stool form type but generally increased with age. With descriptors unread, children 8 years and older demonstrated acceptable inter-observer reliability with over 78% of ratings correct. With descriptors read, children 6 years and older demonstrated acceptable reliability and over 80% of ratings correct. Conclusions The mBSFS-C is reliable and valid for use by children, age 6 being the lower limit for scale use with descriptors read and age 8 without descriptors read. We anticipate that the mBSFS-C can be effectively used in pediatric clinical and research settings.

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Obesity and Hispanic ethnicity are strongly correlated with symptomatic pediatric gallbladder disease. In comparison with our historical series, hemolytic disease is no longer the predominant risk factor for symptomatic gallstone disease in children.

Background Peppermint oil has been used for centuries as a treatment for gastrointestinal ailments. It has been shown to have several effects on gastroesophageal physiology relevant to clinical care and management. Aim To review the literature on peppermint oil regarding its metabolism, effects on gastrointestinal physiology, clinical use and efficacy, and safety. Methods We performed a PubMed literature search using the following terms individually or in combination: peppermint, peppermint oil, pharmacokinetics, menthol, esophagus, stomach, small intestine, gallbladder, colon, transit, dyspepsia, and irritable bowel syndrome. Full manuscripts evaluating peppermint oil that were published through July 15, 2017 were reviewed. When evaluating therapeutic indications, only randomized clinical trials were included. References from selected manuscripts were used if relevant. Results It appears that peppermint oil may have several mechanisms of action including: smooth muscle relaxation (via calcium channel blockade or direct enteric nervous system effects); visceral sensitivity modulation (via transient receptor potential cation channels); anti-microbial effects; anti-inflammatory activity; modulation of psychosocial distress. Peppermint oil has been found to affect esophageal, gastric, small bowel, gallbladder, and colonic physiology. It has been used to facilitate completion of colonoscopy and endoscopic retrograde cholangiopancreatography. Placebo controlled studies support its use in irritable bowel syndrome, functional dyspepsia, childhood functional abdominal pain, and postoperative nausea. Few adverse effects have been reported in peppermint oil trials. Conclusion Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.

Background A standardized 4-hour adult-based gastric emptying scintigraphy (GES) protocol is increasingly being used in children to evaluate for gastroparesis. We sought to determine the effect of age, anthropometrics, and study duration on GES results using this protocol in children. Methods Retrospective review of children who underwent a 4-hour solid-meal GES study at a tertiary care center. GES results and anthropometric data (e.g., weight, stature, body surface area) were systematically captured. Key Results Of 216 children, 188 (87%) were able to complete the study meal. Children unable to complete the meal were younger and smaller. In multivariate analysis, only increasing body surface area (BSA) was identified as being positively associated with ability to complete the meal (odds ratio: 19.7; P<0.001). Of those completing the meal, 48 (26%) had delayed emptying (4-hour retention value >10%). These children were significantly younger and smaller than those with normal emptying. In multivariate analysis of those completing the meal, only increasing BSA (odds ratio: 0.26; P=0.006) was identified as being negatively associated with delayed emptying. There was a progressive increase in the positive predictive value for identification of delayed gastric emptying as the duration of the study increased (0.25, 0.60, and 0.71 at 1, 2, and 3 hr, respectively) using the 4-hr value as a comparator. Conclusions and Inferences Young children have more difficulty completing the GES meal. Childhood gastric retention is affected by age and anthropometric factors, primarily BSA. The standardized 4-hr GES protocol may need to take these factors into account in children.