Published: May 6, 2014
By Ed Susman , Contributing Writer, MedPage Today

CHICAGO — A diet low in foods with certain sugars known as FODMAPs appears to reduce symptoms in children diagnosed with irritable bowel syndrome (IBS), researchers said here.

Children had fewer daily abdominal pain episodes during the low-FODMAPs period — 2.2 episodes — compared with 2.6 episodes on high-FODMAPs (P<0.01), said Bruno Chumpitazi, MD, of the Texas Children’s Hospital/Baylor College of Medicine in Houston.

In addition, “when comparing the two dietary interventions, there was less bloating (P<0.05), nausea (P<0.05), breath hydrogen production (P<0.05), and a trend toward decreased abdominal discomfort (P=0.08) on the low-FODMAPs diet,” Chumpitazi said at the annual meeting of Digestive Disease Week.

The children were provided either a low-FODMAPs meal or a high-FODMAPs meal for 2 days, then were allowed to eat their normal diet over a 5-day period; they were then crossed over to receive either high- or low-FODMAPs meals prepared by the researchers for another 2 days, he explained.

“The children decreased episodes by about 20% while on the low-FODMAPs diet,” Chumpitazi said. He said that the reduction was clinically meaningful.

The proportion of children demonstrating at least a 50% decrease in abdominal pain frequency did not differ between the low-FODMAPs and high-FODMAPs periods. He said that 13 of 33 children in the low-FODMAPs period reduced pain frequency by 50%; 11 of the 33 children in the high-FODMAPs period reduced abdominal pain by 50%.

Similarly, there were no significant differences identified in pain characteristics or other measured gastrointestinal symptoms when comparing the two intervention periods over 48 hours.

FODMAPs are foods containing fermentable oligosaccharides, disaccharides, monosaccharides and polyols — a group that includes many dairy products, fruits, and other foods. However, Chumpitazi noted it doesn’t mean one can’t eat any fruit. Grapes, he said, are okay, but oranges are not.

“We have observed that adults with irritable bowel syndrome achieved some relief of their symptoms on FODMAPs diets,” he told MedPage Today. “We wanted to see if that could be extended to children.”

“Childhood irritable bowel syndrome affects up to 20% of school children, with different combinations of factors playing a role among patients,” Chumpitazi explained. “These factors include visceral hypersensitivity, diet, and the composition of the gut microbiome, amongst others.”

He and colleagues enrolled 52 children in the study; 33 were able to finish the study protocol. The children, ages 7 to 17, were diagnosed with Pediatric Rome III irritable bowel syndrome. They first recorded a 7-day diary of abdominal pain episodes — their frequency and severity and stool characteristics.

The high-FODMAPs meals provided up to 50 grams a day of FODMAPs; the low meals provided up to 9 grams a day of the foods. On the diets, children captured the same measures as during the baseline period. On the second day of each dietary intervention period, subjects collected hourly breath hydrogen samples for up to 15 hours.

“Importantly, children with low somatization and low baseline dietary fiber intake appeared to have a greater response to the low-FODMAPs diet,” he said. “This was a novel finding.” He said the decrease in breath hydrogen production when compared with the high-FODMAPs diet implies a change in the gut microbiome metabolic activity and/or consumption.

“These findings suggest the low-FODMAPs diet may be a valid therapeutic approach for children with irritable bowel syndrome,” Chumpitazi said.

He said additional research is required to determine how baseline psychosocial factors and baseline dietary factors may relate to the gut microbiome and the efficacy of the low-FODMAPs diet. Such studies are underway, he said.

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