Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

Abstract

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. In recent years, interest in the role of diet in the treatment of FGIDs has increased. Currently, interest focuses on the low-FODMAP diet (LFD), the fructose- or lactose-restricted diet (FRD or LRD), the gluten-free diet (GFD), and the Mediterranean diet (MD). In this review, we focus on the role of these dietary patterns in the FGIDs most commonly diagnosed in clinical practice, namely irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and functional constipation (FC). Fifteen clinical trials were systematically reviewed (both RCTs and single-arm clinical trials). We demonstrated the lack of high-quality intervention trials. Based on current evidence, low-FODMAP diet, LRD, FRD, and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS or RAP may experience some benefit from the use of a low-FODMAP diet or FRD/LRD. Limited data suggest that MD may be promising in the management of FGIDs, especially in IBS patients, but more data are required to investigate the mechanisms of its protective effects.

Italian guidelines for the management of irritable bowel syndrome in children and adolescents

“…In conclusion, based on a recent systematic review of intervention studies [ 132 ], low-FODMAP diet, fructose- or lactose-restricted diet (FRD or LRD) and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS may experience some benefit from following a low-FODMAP diet or FRD/LRD [ 133 ].…”

Terapias utilizadas no tratamento da constipação intestinal primaria

“…A indicação de dietas para o manejo de distúrbios da constipação intestinal inicia com a regularização do consumo de fibras alimentares alinhadas a ingestão hídrica adequada. Esse manejo pode se estender por outras perspectivas de tratamento que podem ser direcionadas para a dieta pobre em FODMAP (Oligossacarídeos, dissacarídeos, monossacarídeos e polióis fermentáveis), dietas com restrição de frutose e lactose, dietas sem glúten, dieta mediterrânea entre outras (Katsagoni et al, 2023). Existe evidência de que a prática de exercícios físicos associada ao manejo dietético traz efeitos positivos na melhoria da motilidade intestinal e qualidade de vida.…”

“…Outras estratégias dietéticas podem ser utilizadas em pacientes com distúrbios gastrointestinais funcionais como a dieta com restrição de frutose e lactose (Fructose-or lactose-Restricted Diet -FRD ou LRD), a dieta sem glúten (Gluten-Free Diet -GFD) e a dieta do mediterraneo (Mediterranean Diet -MD) e, mesmo não sendo utilizadas com frequência na prática clínica, tem sido uma alternativa no tratamento da constipação funcional que ainda precisam ser mais bem estudadas (Katsagoni et al, 2023).…”

Editorial: Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment

“…There is also a lack of high quality nutritional intervention trials in children for diets such as the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, the fructose-or lactose-restricted diet (FRD/LRD), and the gluten-free diet. For this reason, and due to the risk of nutritional inadequacy or disorder eating behaviors, these have been stated as having no or limited place in daily clinical practice for FGID in children [22,23]. Showing greater promise are non-pharmacological interventions such as hypnotherapy, cognitive behavioral therapy (CBT), probiotics, and fiber supplements [24].…”

“…Specifically within the FGID of functional abdominal pain (FAP), pharmacological intervention studies have been hampered by small sample sizes and minimal effects [25]. Some patients, specifically those with irritable bowel syndrome (IBS) and FAP, may experience some benefit from low FODMAP or FRD/LRD [22]. However, CBT has shown more promise in reducing symptoms and improving HRQoL, among other outcomes [26,27].…”