Mrs Stephanie Brown1, Professor Andrew Day2, Professor Richard Gearry2, Professor Kevin Whelan3
1University of Otago, Christchurch, New Zealand, 2University of Otago, Christchurch, New Zealand, 3King’s College, Nutritioal sciences division, London, United Kingdom
Background: Functional gastrointestinal disorders (FGID) such as Irritable bowel syndrome (IBS) are increasingly more common in children (1) and affect 20% of children worldwide (2). The aetiology combines genetic, environmental and psychological factors, with no clear organic cause (3). Symptoms are recurrent, including abdominal pain, diarrhoea, constipation, alternating stool patterns, excessive gas production and abdominal distension (4). FGIDs are associated with a reduced quality of life, school absences and psychological challenges (5). Treatment options are variable due to the heterogeneity of FGIDs.
In adults with diagnosed IBS, a low FODMAP diet is an effective dietary strategy to alleviate symptoms (6). 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. Currently, there is a paucity of data examining dietary interventions that restrict carbohydrates in children with IBS. The aim of this study was to assess the efficacy of the low FODMAP diet in children with a FGID.
Methods: A retrospective cohort study of children with a FGID managed with FODMAP-free diet was undertaken. Subjective measures and a survey were used to assess diet efficacy.
Results: Of the 29 children included in this study, 16 subjects (55%) experienced complete resolution of symptoms by the end of the four-week diet. Twenty-eight percent of subjects had partial resolution and 13% experienced no symptom relief. Complete resolution of gastrointestinal symptoms were observed for 75% of those with distention, 62.5% of those with diarrhoea and 58% of those with abdominal pain. Fructans were the most common symptom-causing fermentable sugar.
Conclusion: The low FODMAP diet is an efficacious dietary treatment strategy for children with FGIDs. This study adds to the small body of evidence supporting FODMAP dietary interventions in children with FGID. Further prospective studies are required.
Stephanie Brown is a paediatric gastroenterology dietitian at Christchurch Hospital. She is part of a MDT responsible for the nutritional management of children who require dietetic input. Stephanie is completing her PhD with a focus on Nutrition and paediatric IBD. She is married with two young children and loves the outdoors.