Efficacy of Oral Psyllium in Pediatric Irritable Bowel Syndrome

Abstract

Objective: Pediatric irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with variable response to various therapeutic agents. Psyllium has been proven to be effective in adults; however, there is no study in children. The objective of this study is to evaluate the efficacy of psyllium husk as compared to placebo in pediatric IBS patients. Methods: In this double-blind randomized controlled trial, 43 children were assigned to psyllium arm (Group A) and 38 into placebo arm (Group B). Severity is assessed at baseline and after 4 weeks of treatment using IBS severity scoring scale (IBS-SSS) and classified into mild, moderate, and severe categories. Categorical data was compared with chi-square test and paired categorical variable was compared with McNemer test. Results: Mean ages (±SD; in years) of Groups A and B were 9.87 (2.7) and 9.82 (3.17), respectively, with median duration of illness of 12 months. At baseline, type, severity, and parameters (IBS-SSS) of IBS were equally distributed in 2 groups. There was a significant reduction in median interquartile range (IQR) of total IBS-SSS in psyllium versus placebo [75 (42.5–140) vs 225 (185–270); P < 0.001] at 4 weeks. Similarly 43.9% in Group A versus 9.7% in Group B attained remission [IBS-SSS < 75 (P < 0.0001)]. The mean difference in IBS-SSS between Group A and Group B was −122.85 with risk ratio of 0.64 (95% CI; 0.42–0.83; P= 0.001) and absolute risk reduction of 32% (NNT = 3). Conclusions: Psyllium husk is effective for the therapy of pediatric IBS when compared with placebo in short term.

Prebiotics in the management of pediatric gastrointestinal disorders: Position paper of the ESPGHAN special interest group on gut microbiota and modifications

“…A 2022 systematic review and meta‐analysis identified six studies evaluating the role of prebiotics in the management of FAPD in children 39 . Three trials examined children diagnosed with irritable bowel syndrome (IBS) according to the Rome II, III, and IV criteria 31,32,40 . In the randomized, double‐blind, controlled, and prospective study from Turkiye, included 71 children between the ages of 4 and 16 years who were diagnosed with IBS according to the Rome III criteria.…”

“…39 Three trials examined children diagnosed with irritable bowel syndrome (IBS) according to the Rome II, III, and IV criteria. 31,32,40 In the randomized, double-blind, controlled, and prospective study from Turkiye, included 71 children between the ages of 4 and 16 years who were diagnosed with IBS according to the Rome III criteria. Administration of synbiotics and probiotics resulted in significant improvements for belching-abdominal fullness, bloating after meals, and constipation when compared to prebiotics.…”

What is new with irritable bowel syndrome

“…A double-blind RCT in 2022 by Menon et al was conducted to assess the efficacy of oral psyllium in IBS compared with placebo. There was a statistically significant reduction in the severity of symptoms in the psyllium group versus the placebo group at the end of 4 weeks and treatment was determined to be equally effective in different IBS subtypes, constipation, diarrhea, and mixed [20 ▪ ].…”

Response to Letter to the Editor: Severity Assessment Scores for Irritable Bowel Syndrome in Children: Are We There Yet?

“…We thank van Tilburg et al (1) for their interest regarding our randomized controlled trial in children with irritable bowel syndrome (IBS) (2). The authors have raised a concern on applying IBS Severity Scoring System (IBS‐SSS) in children (3).…”