Dietary Carbohydrates and Childhood Functional Abdominal Pain
Bruno P. Chumpitazi, Robert J. Shulman 2016
Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. Carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one’s diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. Until now there is a general lack of strong evidence supporting a restriction of individual carbohydrates (e.g., lactose) for childhood functional gastrointestinal disorders. Rather, as in adults with IBS, FODMAP restriction is emerging as a better clinical strategy. Two prospective studies have evaluated a low-FODMAP diet in children with IBS. In the open-label study from Chumpitazi et al. 2014, 8 children with IBS were instructed by a dietitian to follow a low-FODMAP diet for 1 week. The group as a whole had a decrease in abdominal pain frequency, with 4 children having a ≥ 50% decrease in abdominal pain frequency as compared to baseline.
In the randomized double-blind crossover trial conducted by Chumpitazi et al. 2015, children with IBS (n = 33) received a low-FODMAP or typical American childhood diet for 48 h. The group as a whole had fewer abdominal pain episodes during the low-FODMAP diet. Those who had significant improvement (>50% decrease in abdominal pain frequency) on the low-FODMAP diet, compared to those who did not, had a gut microbiome composition that was enriched in bacteria with high saccharolytic potential.In addition to a low-FODMAP diet, soluble fiber supplementation appears to be an effective therapy in childhood AP-FGID. Still further researches are needed to understand the long-term effects of dietary carbohydraterelated interventions on the gut microbiome composition and function.