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Title: Randomised clinical trial: Gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome

item CHUMPITAZI, B - Texas Children'S Hospital
item COPE, J - Baylor College Of Medicine
item HOLLISTER, E - Baylor College Of Medicine
item TSAI, C - Baylor College Of Medicine
item MCMEANS, A - Children'S Nutrition Research Center (CNRC)
item LUNA, R - Texas Children'S Hospital
item VERSALOVIC, J - Texas Children'S Hospital
item SHULMAN, R - Children'S Nutrition Research Center (CNRC)

Submitted to: Alimentary Pharmacology & Therapeutics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/30/2015
Publication Date: 6/24/2015
Citation: Chumpitazi, B.P., Cope, J.L., Hollister, E.B., Tsai, C.M., Mcmeans, A.R., Luna, R.A., Versalovic, J., Shulman, R.J. 2015. Randomised clinical trial: Gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 42:418-427.

Interpretive Summary: Up to 15% of school age children have recurrent bouts of abdominal (belly) pain that is unexplained. It has been thought that some of these children have pain related to foods. In this study, we tested whether certain types of foods that are not well digested cause abdominal pain. Our results show that some children with unexplained abdominal pain get better when less of these poorly digestible foods are fed. In addition, we found that the type of bacteria in the gut appears to predict who will get better when put on the diet with less digestible foods.

Technical Abstract: A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 h. To determine the efficacy of a low FODMAP diet in childhood IBS and whether gut microbial composition and/or metabolic capacity are associated with its efficacy. In a double-blind, crossover trial, children with Rome III IBS completed a 1-week baseline period. They then were randomised to a low FODMAP diet or typical American childhood diet (TACD), followed by a 5-day washout period before crossing over to the other diet. GI symptoms were assessed with abdominal pain frequency being the primary outcome. Baseline gut microbial composition (16S rRNA sequencing) and metabolic capacity (PICRUSt) were determined. Metagenomic biomarker discovery (LEfSe) compared Responders (=50% decrease in abdominal pain frequency on low FODMAP diet only) vs. Nonresponders (no improvement during either intervention). Thirty-three children completed the study. Less abdominal pain occurred during the low FODMAP diet vs. TACD [1.1 +/ 0.2 (SEM) episodes/day vs. 1.7 +/ 0.4, P < 0.05]. Compared to baseline (1.4 +/ 0.2), children had fewer daily abdominal pain episodes during the low FODMAP diet (P < 0.01) but more episodes during the TACD (P < 0.01). Responders were enriched at baseline in taxa with known greater saccharolytic metabolic capacity (e.g. Bacteroides, Ruminococcaceae, Faecalibacterium prausnitzii) and three Kyoto Encyclopedia of Genes and Genomes orthologues, of which two relate to carbohydrate metabolism. In childhood IBS, a low FODMAP diet decreases abdominal pain frequency. Gut microbiome biomarkers may be associated with low FODMAP diet efficacy.