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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Psyllium fiber reduces abdominal pain in children with irritable bowel syndrome in a randomized, double-blind trial

Author
item Shulman, Robert - Children'S Nutrition Research Center (CNRC)
item Hollister, Emily - University Of Washington
item Cain, Kevin - University Of Washington
item Czyzewski, Danita - Baylor College Of Medicine
item Self, Mariella - Texas Children'S Hospital
item Weidler, Erica - Children'S Nutrition Research Center (CNRC)
item Devaraj, Sridevi - Children'S Nutrition Research Center (CNRC)
item Luna, Ruth Ann - Texas Children'S Hospital
item Versalovic, James - Texas Children'S Hospital
item Heitkemper, Margaret - University Of Washington

Submitted to: Clinical Gastroenterology and Hepatology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/1/2017
Publication Date: 5/1/2017
Citation: Shulman, R.J., Hollister, E.B., Cain, K., Czyzewski, D.I., Self, M.M., Weidler, E.M., Devaraj, S., Luna, R., Versalovic, J., Heitkemper, M. 2017. Psyllium fiber reduces abdominal pain in children with irritable bowel syndrome in a randomized, double-blind trial. Clinical Gastroenterology and Hepatology. 15(5):712-719.

Interpretive Summary: Belly pain is common in children and adults with nearly 20% of people having frequent pain. It is known that people in the US do not eat enough fiber. To find out if the lack of fiber in the diet contributes to belly pain, researchers at the Children's Nutrition Research Center in Houston, Texas carried out a study in which they added fiber to the diet of children. Adding fiber to the diet reduced the number of belly pain episodes experienced by children. This study provides a potential solution to relieve pain and further studies are needed.

Technical Abstract: We sought to determine the efficacy of psyllium fiber treatment on abdominal pain and stool patterns in children with irritable bowel syndrome (IBS). We evaluated effects on breath hydrogen and methane production, gut permeability, and microbiome composition. We also investigated whether psychological characteristics of children or parents affected the response to treatment. We performed a randomized, double-blind trial of 103 children (mean age, 13 +/- 3 y) with IBS seen at primary or tertiary care settings. After 2 weeks on their habitual diet, children began an 8-day diet excluding carbohydrates thought to cause symptoms of IBS. Children with >=75% improvement in abdominal pain were excluded (n = 17). Children were assigned randomly to groups given psyllium (n = 37) or placebo (maltodextrin, n = 47) for 6 weeks. Two-week pain and stool diaries were compared at baseline and during the final 2 weeks of treatment. We assessed breath hydrogen and methane production, intestinal permeability, and the composition of the microbiome before and after administration of psyllium or placebo. Psychological characteristics of children were measured at baseline. Children in the psyllium group had a greater reduction in the mean number of pain episodes than children in the placebo group (mean reduction of 8.2 +/- 1.2 after receiving psyllium vs mean reduction of 4.1 +/- 1.3 after receiving placebo; P = .03); the level of pain intensity did not differ between the groups. Psychological characteristics were not associated with response. At the end of the study period, the percentage of stools that were normal (Bristol scale scores, 3-5), breath hydrogen or methane production, intestinal permeability, and microbiome composition were similar between groups. Psyllium fiber reduced the number of abdominal pain episodes in children with IBS, independent of psychological factors. Psyllium did not alter breath hydrogen or methane production, gut permeability, or microbiome composition.