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Title: Fructans exacerbate symptoms in a subset of children with irritable bowel syndrome

item CHUMPITAZI, BRUNO - Baylor College Of Medicine
item MCMEANS, ANN - Children'S Nutrition Research Center (CNRC)
item VAUGHAN, ADETOLA - Baylor College Of Medicine
item ALI, AMNA - Baylor College Of Medicine
item ORLANDO, SHANNON - Baylor College Of Medicine
item ELSAADI, ALI - Baylor College Of Medicine
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Clinical Gastroenterology and Hepatology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/4/2017
Publication Date: 5/25/2018
Citation: Chumpitazi, B.P., McMeans, A.R., Vaughan, A., Ali, A., Orlando, S., Elsaadi, A., Shulman, R.J. 2018. Fructans exacerbate symptoms in a subset of children with irritable bowel syndrome. Clinical Gastroenterology and Hepatology. 16:219-225.

Interpretive Summary: Many children (and adults) complain of belly pain related to certain foods. What foods are most problematic and why this is so remains unclear. In this study we tested whether a type of carbohydrate commonly found in foods (fructans) can provoke belly pain in children. Children were given fructans and a placebo in random order. They did not know which carbohydrate they were ingesting. Half of the children had belly pain after ingesting the fructans but the pain was not related to the amount of gas they had. The stools of the children will be analyzed to understand how differences in the types of bacteria in the colon may account for the development of belly pain. By having the children avoid these carbohydrates they can decrease their chances of getting belly pain.

Technical Abstract: Dietary fructans exacerbate symptoms in some, but not all, adults with irritable bowel syndrome (IBS). We sought to determine whether fructans worsen symptoms in children with IBS and whether clinical and psychosocial factors, and/or gas production, can identify those who are fructan sensitive. We performed a double-blind placebo-controlled (maltodextrin) cross-over trial of 23 children with IBS, based on pediatric Rome III criteria, from September 2014 through December 2016. At baseline, participants completed 1-week pain and stool diaries and a 3-day food record and psychosocial factors (depression, anxiety, and somatization) were measured. Subjects were randomly assigned to groups that were provided meals for 72 hours containing either fructans or maltodextrin (0.5 g/kg; maximum, 19 g). Following a washout period of 10 days or more, the subjects received the meal they were not given during the first study period (crossed over). Gastrointestinal symptoms and breath hydrogen and methane production were captured during each meal period. Fructan sensitivity was defined as an increase of 30% or more in abdominal pain frequency following fructan ingestion. Subjects had more mean episodes of abdominal pain/day during the fructan-containing diet (3.4 +/- 2.6) vs the maltodextrin-containing diet (2.4 +/- 1.7) (P < .01), along with more severe bloating (P < .05) and flatulence (P = .01). Hydrogen (but not methane) production was greater while subjects were on the fructan-containing diet (617 +/- 305 ppm*h) than the maltodextrin-containing diet (136 +/- 78 ppm/h) (P < .001). Eighteen subjects (78.2%) had more frequent abdominal pain while on the fructan-containing diet and 12 (52.2%) qualified as fructan sensitive. We found no difference between fructan-sensitive and fructan-insensitive subjects in baseline abdominal pain or bowel movement characteristics, dietary intake, psychosocial parameters, IBS subtype, or gas production. In a randomized controlled trial of children with IBS, we found fructans to exacerbate several symptoms. However, fructan sensitivity cannot be identified based on baseline gastrointestinal symptoms, dietary intake, psychosocial factors, or gas production.