Cynthia M. Tsai

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

A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 h.

Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome

We sought to determine whether a low fermentable substrate diet (LFSD) decreases abdominal pain frequency in children with irritable bowel syndrome (IBS) and to identify potential microbial factors related to diet efficacy. Pain symptoms, stooling characteristics, breath hydrogen and methane, whole intestinal transit time, stool microbiome, and metabolite composition were collected and/or documented in eight children with IBS at baseline and during one week of an LFSD intervention. Pain frequency (P < 0.05), pain severity (P < 0.05), and pain-related interference with activities (P < 0.05) decreased in the subjects while on the LFSD. Responders vs. non-responders: four children (50%) were identified as responders (>50% decrease in abdominal pain frequency while on the LFSD). There were no differences between responders and non-responders with respect to hydrogen production, methane production, stooling characteristics, or gut transit time. Responders were characterized by increased pre-LFSD abundance of bacterial taxa belonging to the genera Sporobacter (P < 0.05) and Subdoligranulum (P < 0.02) and decreased abundance of taxa belonging to Bacteroides (P < 0.05) relative to non-responders. In parallel, stool metabolites differed between responders and non-responders and were associated with differences in microbiome composition. These pilot study results suggest that an LFSD may be effective in decreasing GI symptoms in children with IBS. Microbial factors such as gut microbiome composition and stool metabolites while on the diet may relate to LFSD efficacy.

Child and parent perceived food-induced gastrointestinal symptoms and quality of life in children with functional gastrointestinal disorders.

It is unknown whether children with functional gastrointestinal (GI) disorders identify specific foods that exacerbate their GI symptoms. The objectives of this study were to determine the perceived role of food on GI symptoms and to determine the impact of food-induced symptoms on quality of life (QOL) in children with functional GI disorders. Between August and November 2010, 25 children ages 11 to 17 years old with functional GI disorders and a parent completed a food symptom association questionnaire and validated questionnaires assessing FGID symptoms and QOL. In addition, children completed a 24-hour food recall, participated in focus groups to identify problematic foods and any coping strategies, and discussed how their QOL was affected. Statistical analyses were conducted using χ2, t test, Mann-Whitney U test, Wilcoxon signed rank, and Spearmans ρ. Children identified a median of 11 (range=2 to 25) foods as exacerbating a GI symptom, with the most commonly identified foods being spicy foods, cows milk, and pizza. Several coping strategies were identified, including consuming smaller portions, modifying foods, and avoiding a median of 8 (range=1 to 20) foods. Children reported that food-induced symptoms interfered with school performance, sports, and social activities. Although the parents assessment of their childs QOL negatively correlated with the number of perceived symptom-inducing foods in their child, this relationship was not found in the children. Findings suggest that specific foods are perceived to exacerbate GI symptoms in children with functional GI disorders. In addition, despite use of several coping strategies, food-induced symptoms can adversely impact childrens QOL in several important areas.

Interprovider variation of celiac disease testing in childhood chronic abdominal pain

BackgroundTo determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated.MethodsRetrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children’s hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included.Results160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P < 0.01) were more likely to be tested. Eighty-two (51.3%) children underwent either serologic testing and/or esophagogastroduodenoscopy. Four (4.9%, 95% CI: 1.6-11.3%) of the 82 tested were diagnosed with celiac disease.ConclusionsThough interprovider variation for celiac disease testing in children with chronic abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children’s race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population.

Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention

AIM To assess pediatric patients for choledocholithiasis. We applied current adult guidelines to identify predictive factors in children. METHODS A single-center retrospective analysis was performed at a tertiary childrens hospital. We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography (ERCP) for suspected choledocholithiasis. Patients were stratified into those with common bile duct stones (CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines (Very Strong and Strong criteria) for suspected CBDS. RESULTS CBDS were identified in 84% at the time of ERCP. Abdominal ultrasound identified CBDS in 36% of patients. Conjugated bilirubin ≥ 0.5 mg/dL was an independent risk factor for CBDS (P = 0.003). The Very Strong (59.5%) and Strong (48.6%) ASGE criteria identified the majority of patients (P = 0.0001). A modified score using conjugated bilirubin had a higher sensitivity (81.2% vs 59.5%) and more likely to identify a stone than the standard criteria, odds ratio of 25.7 compared to 8.8. Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25, respectively. CONCLUSION Current adult guidelines identified the majority of pediatric patients with CBDS, but specific pediatric guidelines may improve detection, thus decreasing risks and unnecessary procedures.

946 Low Fermentable Substrate Diet (LFSD) in Children With Irritable Bowel Syndrome (IBS): Pilot Efficacy and Microbiological Predictors of Response

Background: A LFSD has demonstrated efficacy in reducing gastrointestinal (GI) symptoms in adults with IBS, though not all respond. The efficacy of a LFSD in children with IBS is unknown. We sought to determine whether a LFSD decreases abdominal pain frequency in children with IBS and factors determining efficacy of the diet. Methods: Children with Pediatric Rome III-defined IBS completed a 1-wk baseline period on their habitual diet followed by a 1-wk LFSD intervention. Participants were informed they would be taught one of two potential diets, although all participants were taught the same LFSD by a dietitian. Measurements during baseline and LFSD intervention included: A Pain/Stool Diary (capturing the number of pain episodes, stool frequency, and stool form using the modified Bristol Stool Form Scale for children), breath hydrogen/methane production, whole intestinal transit time, and stool microbiome composition analysis. Responders were defined as having ≥ 50% decrease in abdominal pain frequency. Results: Eight children (4 girls), mean age 9.0 ± 3.6 yrs were enrolled and completed the LFSD. Baseline vs LFSD Diet: As a group, overall pain frequency, pain severity, and pain related interference with activities decreased, with a trend toward fewer bowel movements but no differences in stool form (Table). There were no changes in breath hydrogen or methane production, or intestinal transit time. Trends toward increased abundances of Clostridiales and decreased abundance of Bacteroidetes were observed during the LFSD. Responders vs Non-responders: Four children (50%) were identified as responders. There were no differences between responders and non-responders with respect to baseline pain frequency, stool frequency, stool form, hydrogen, or methane production. During the LFSD, responders produced less hydrogen than non-responders (P,0.05), without differences between the groups in stooling characteristics or methane production. Responders (n=3) and non-responders (n=3) with constipation-predominant IBS could be separated by principal components analysis based on the relative species abundance of their baseline gut microbiota. Responders were characterized by increased abundance of taxa belonging to the genera Sporobacter (P ,0.05) and Subdoligranulum (P,0.02) and decreased abundance of taxa belonging to Bacteroides (P,0.05) relative to nonresponders. In addition, other differences in microbiome composition between responders vs. non-responders were identified during the LFSD. Conclusions: A LFSD was effective in decreasing abdominal pain frequency in children with IBS. Those children who had ≥ 50% reduction in pain frequency had less hydrogen production and a different stool microbiome composition vs. those who did not respond to the LFSD suggesting that gut microbiome makeup may predict LFSD efficacy in childhood IBS. Pain and stool characteristics (baseline vs. LFSD*)

Sa2022 Focus Group Assessment of Reported Food Intolerances (Rfis) and Quality of Life (QOL) in Children With Abdominal Pain-Related Functional Gastrointestinal Disorders (APFGIDs)

G A A b st ra ct s (33 PR, 232 PU) children completed 8/8 surveys of the study, 67 completed most surveys (67/8). Overall weekly prevalence of GI symptoms: AP (35.3%), nausea (25.5%), constipation (11.3%), diarrhea (8%), vomiting (7.3%). 56% of children with AP reported interference with activities: gym (18.9%), school (14%), difficulty sleeping (12.2%), social activities (10.6%). 2.5% of all children missed school for all causes during study period: 1.1% for AP. 5.7% of all children sought medical attention during study period (1% AP). Extra-GI complaints were common: pains in arms/legs (38.7%), headaches (30.8%) and chest pain (25.2%). Conclusions GI symptoms are common in school-aged children in Colombia and interfere with both daily activities and school attendance. The prevalence of AP and other GI symptoms found in this study were similar to published prevalence of American children using similar methods. Similarly to the American study, children rarely seek medical attention for AP.

Diet-Induced Gastrointestinal (GI) Symptoms in Children With Childhood Abdominal Pain-Related Functional Gastrointestinal Disorders (APFGIDs): Identification of Foods and Impact on Quality of Life (QOL)

G A A b st ra ct s and methods. Fifty IBS children (20 males, 40%, 30 females, 60%; mean age 9.9 ± 3.7 years) were consecutively enrolled. All subjects underwent lactulose hydrogen/methane breath test (LBT) to assess SIBO before and one month after the treatment with rifaximin 600 mg daily for one week. All IBS patients filled out a Visual Analogic Scale (VAS) to assess and score gastrointestinal symptoms (abdominal pain, constipation, diarrhoea, bloating, flatulence) at baseline and one month after treatment. Results. The prevalence of abnormal LBT in patients with IBS was 66% (33/50). LBT normalization rate after therapy was 64% (21/33). Compliance was excellent, and no relevant side-effects were observed during treatment. VAS score was significantly higher in IBS children with abnormal LBT than SIBO negatives, and strongly improved after successful treatment. Conclusions. Rifaximin was effective and safe in SIBO treatment and IBS symptoms improvement in childhood. Double blind placebo-controlled interventional studies are warranted to verify the real impact of SIBO on gastrointestinal symptoms in children with IBS.