Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome

Chumpitazi, Bruno P.; McMeans, Ann R.; Vaughan, Adetola O; Ali, Amna; Orlando, S; Elsaadi, Ali; Shulman, Robert J.

doi:10.1016/j.cgh.2017.09.043

Cited by 47 publications

(117 citation statements)

References 39 publications

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“…Two studies were cross‐sectional, 1 study was a prospective cohort, and 2 studies were randomized crossover trials. Of note, 4 of the studies were completed by the same primary author and research team . However, each study was unique and therefore included.…”

Section: Methodsmentioning

confidence: 99%

“…These subtypes include constipation‐predominant (IBS‐C), diarrhea‐predominant (IBS‐D), mixed (IBS‐M), and unspecified IBS (IBS‐U) . The most common subtypes of IBS in the pediatric population are IBS‐C (43%–75%) and IBS‐U (0%–43%) …”

Section: Introductionmentioning

confidence: 99%

“…Fermentable carbohydrates are molecules that pass through the upper GI tract to the colon without complete digestion. Within the colon, these molecules serve as substrates for bacterial metabolism, also known as fermentation . Byproducts of the fermentation process include water and gas causing intraluminal distention of the colon .…”

Section: Introductionmentioning

confidence: 99%

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Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

2019

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Irritable bowel syndrome (IBS) is classified as a functional gastrointestinal (GI) disorder characterized by abdominal pain, bloating, and changes in bowel function. Although the pathophysiology of IBS is incompletely understood, fermentable carbohydrates are implicated as a potential cause of symptoms. An elimination diet, such as a low‐FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, represents a potential intervention for reducing GI symptoms in patients with IBS. The role of fermentable carbohydrates in symptom onset is well studied in adult patients with IBS; however, less research exists in the pediatric population. This review sought to explore evidence for the role of dietary fermentable carbohydrate elimination to reduce GI symptoms (abdominal pain, stool changes, abdominal bloating) in children and adolescents (4–19 years of age) diagnosed with IBS based on Rome III or IV criteria. Five studies of neutral to positive quality rating were identified and analyzed using the Academy of Nutrition and Dietetics Evidence Analysis Process. These studies demonstrate that dietary elimination of fermentable carbohydrates, such as through a low‐FODMAP diet, reduces the severity of 1 or more GI symptoms in about one‐quarter to one‐half of pediatric patients with IBS. Patients without improvement are considered “nonresponders” and may require an alternative intervention. More research is needed to establish the best way to identify patients who would respond to elimination diets vs other IBS treatment strategies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

2019

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“…Studies using magnetic resonance imaging show that polysaccharides such as inulin commonly derived from plant products such as chicory root increase colonic gas in both healthy individuals and patients with irritable bowel syndrome and are associated with symptoms in patients with irritable bowel syndrome . A double‐blind, placebo‐controlled trial of the administration of a fructan (maltodextrin) to children with irritable bowel syndrome showed a significant worsening of bloating, flatulence, and abdominal pain symptoms with fructan exposure …”

Section: Introductionmentioning

confidence: 99%

“…Short‐chain fatty acids in luminal contents have been shown create visceral hypersensitivity in animal studies . Low FODMAP diets are associated with a decrease in liposaccharides (a complex of fat and polysaccharides) in the luminal content of the colon . Intracolonic administration of fecal supernatant from patients with irritable bowel syndrome induces visceral hypersensitivity in rats .…”

Section: Introductionmentioning

confidence: 99%

Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease

Vakil

2018

Nut in Clin Prac

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FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Dietary modification of FODMAPs has been shown to have significant effects on the physiology of the gastrointestinal tract and improves symptoms of abdominal pain, distention, and bloating in patients with irritable bowel syndrome. Structured withdrawal and reintroduction of FODMAPs supervised by a dietitian is the optimal practice for dietary FODMAP modification in irritable bowel syndrome. FODMAPs are present in enteral feeding formulas and may have a role in diarrhea and bloating in tube-fed patients. Emerging areas of research include the effects of dietary modification of FODMAPs on the microbiome, micronutrient absorption, and caloric intake. FODMAP dietary modification is an emerging area in other gastrointestinal disorders and is of relevance to all practicing dietitians.

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Low FODMAP diet in children and adolescents with functional bowel disorder: A clinical case note review

et al. 2019

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Background and Aims Functional bowel disorders (FBD), such as irritable bowel syndrome (IBS), are increasingly more common in children and affect up to 20% of children. The etiology is multifactorial with no clear organic cause. Symptoms are recurrent and are associated with a reduced quality of life, school absences, and psychological challenges. Treatment options are variable. FODMAPs are short‐chained carbohydrates, poorly absorbed by the gastrointestinal tract due to their increased osmotic activity and excess gas production from the bacterial fermentation process. There is a paucity of data examining dietary interventions that restrict carbohydrates in children with IBS. The aim of this study was to examine the use of the low FODMAP diet (LFD) in children with an FBD. Methods A retrospective clinical case note review of children with an FBD managed with an LFD was undertaken. Anthropometry and clinical data were collected by a pediatric gastroenterology dietitian. An IBS satisfaction survey was used to assess diet outcomes. Statistical analyses were completed using Excel. Results Of the 29 children included in this study, complete resolution of gastrointestinal symptoms was observed for 11 of 12 (92%) of those with bloating, 13 of 15 (87%) of those with diarrhea, and 17 of 22 (77%) of those with abdominal pain. Twenty‐three (79%) participants reported an improvement of symptoms. Fructans were the most common symptom‐causing carbohydrate. Conclusion The LFD is a useful dietary treatment strategy for children with FBD. This study adds to the small body of evidence supporting FODMAP dietary interventions in children with FBD. Further prospective studies are required.

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Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome

Cited by 47 publications

References 39 publications

Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease

Low FODMAP diet in children and adolescents with functional bowel disorder: A clinical case note review

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