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Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review.
Nutr Clin Pract. 2020 Apr; 35(2):231-245.NC

Abstract

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.

Authors+Show Affiliations

Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30937981

Citation

Fisher, Kelly, et al. "Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: a Narrative Review." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 35, no. 2, 2020, pp. 231-245.
Fisher K, Hutcheon D, Ziegler J. Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review. Nutr Clin Pract. 2020;35(2):231-245.
Fisher, K., Hutcheon, D., & Ziegler, J. (2020). Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 35(2), 231-245. https://doi.org/10.1002/ncp.10269
Fisher K, Hutcheon D, Ziegler J. Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: a Narrative Review. Nutr Clin Pract. 2020;35(2):231-245. PubMed PMID: 30937981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review. AU - Fisher,Kelly, AU - Hutcheon,Deborah, AU - Ziegler,Jane, Y1 - 2019/04/01/ PY - 2019/4/3/pubmed PY - 2020/11/3/medline PY - 2019/4/3/entrez KW - FODMAP KW - disaccharides KW - gastrointesinal disorders KW - irritable bowel syndrome KW - monosaccharides KW - oligosaccharides KW - pediatrics KW - polyols SP - 231 EP - 245 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 35 IS - 2 N2 - 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. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/30937981/Elimination_of_Fermentable_Carbohydrates_to_Reduce_Gastrointestinal_Symptoms_in_Pediatric_Patients_With_Irritable_Bowel_Syndrome:_A_Narrative_Review_ L2 - https://doi.org/10.1002/ncp.10269 DB - PRIME DP - Unbound Medicine ER -