Efficacy of low FODMAP diet in pediatric patients with disorders of gut–brain interaction

Abstract

Objectives: Disorders of gut-brain interaction (DGBIs), including irritable bowel syndrome (IBS), are common among children. Although a diet that is low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been proven to help adults with IBS, there is conflicting evidence of its efficacy in pediatric patients. Methods: This was a retrospective chart review of pediatric patients with DGBIs diagnosed by a pediatric gastroenterologist between December 2018 and April 2022 and referred to a dietician for low FODMAP diet (LFD). The diagnosis was based on Rome IV criteria, and the chart review was based on International Classification of Diseases 10 diagnosis codes for DGBIs. Subjective historical assessment was used to define symptom improvement. The causative FODMAP Monash group(s) were identified during the reintroduction phase based on a symptom diary. Results: A total of 58 patients were initially identified (38 females), 47 of whom completed the LFD and followed up. This included 24 patients with IBS-diarrhea predominant (IBS-D), 10 patients with IBS-mixed type (IBS-M), 6 patients with IBS-constipation predominant (IBS-C), and 7 patients with functional abdominal pain (FAP) or functional dyspepsia (FD). Symptom improvement occurred in 22 (91.6%) of IBS-D, 7 (70%) of IBS-M, 3 (50%) of IBS-C, and 3 (42.8%) of FAP/FD. Fructans, garlic, onions, and lactose were the most common offenders. Conclusion: LFD improves symptoms in most patients with DGBIs, particularly those with IBS-D.