Low FODMAP diet: a potential treatment of functional abdominal pain in children.

Abstract

A child's diet has an important impact on their quality of life, and with functional gastrointestinal disorders becoming an increasing issue, a child's diet has become recognised as an area to be investigated in how to treat such disorders. Katarzyna Miroslawa Boradyn and Katarzyna Eufemia Przybylowicz from the University of Warmia and Mazury explore the potential of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet as an effective treatment for these disorders.Functional gastrointestinal disorders (FGID) are one of the most prevalent disorders diagnosed by paediatricians.[1] Within this wide range, functional abdominal pain (FAP) is a disorder particularly common among school-age children and it can substantially affect their quality of life.[2] A child's diet has a significant influence on the occurrence of symptoms.[1] So far, previously tested therapies have not provided an effective treatment that would alleviate the symptoms and improve the microbiota.[2] Researchers from Monash University in Australia developed a diet based on the elimination, or at least a reduction, of foods high in FODMAP. These compounds are characterised by high resistance to digestion, low level of absorption in the gastrointestinal tract and long fermentation in the gut.[1],[3] Depending on the type of sugar, FODMAPs are found in various foods. Fructo-oligosaccharides are contained among others in wheat, rye, onions, garlic and artichokes and galacto-oligosaccharides are a component of legumes. Lactose is mainly found in milk and other dairy products. The richest food sources of fructose are honey, apples, pears, watermelon and mango; and of sorbitol are: stone fruits, apples, pears and sugar-free mints/gum. Mannitol is found in sugar-free mints/gum and is also one of the components in mushrooms and cauliflower.[4]Existing evidence suggests that the use of a low FODMAP diet is associated with the reduction of the symptoms of irritable bowel syndrome (IBS), Crohn's disease and coexisting functional symptoms.[3],[4] Moreover, an experimental study in children confirmed that a low FODMAP diet reduced abdominal pain in children with IBS by 50%.[1] Interestingly, to our knowledge, no previous studies have investigated the impact of low FODMAP diet in children with FAP.Currently, two approaches have been suggested in planning a low FODMAP diet: bottom-up and top-down. The bottom-up method allows you to specify the patient's limit of FODMAP and is a gradual elimination of single products (or groups of products) from the diet until the symptoms have been alleviated. This progressive method can be applied in (1) patients who have not been diagnosed with IBS, but experience symptoms affecting their life quality; (2) patients who have already started elimination of other components from their diet; or (3) patients who struggle to follow a diet low in FODMAP. …