Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial

Abstract

BACKGROUND & AIMS 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. ClinicalTrials.gov no: NCT00526903.

Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome

“…This study utilized previously collected clinical study data from children with IBS. The participants’ data were collected from a total of four observational and interventional pediatric clinical trials conducted at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX . One parent signed informed consent and the child provided assent prior to initiation of each study.…”

The Gut Microbiome in Adult and Pediatric Functional Gastrointestinal Disorders

“…One study found that VSL#3 improved GI symptoms 134 , while the other reported that a combination of three bifidobacteria resolved abdominal pain and improved quality of life to a greater extent than placebo 135 . On the other hand, psyllium fiber reduced pain episodes in an RCT enrolling children with IBS without altering the composition of the gut microbiota based on 16S ribosomal RNA analysis 136 .…”

Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

“…These subtypes include constipation‐predominant (IBS‐C), diarrhea‐predominant (IBS‐D), mixed (IBS‐M), and unspecified IBS (IBS‐U) . The most common subtypes of IBS in the pediatric population are IBS‐C (43%–75%) and IBS‐U (0%–43%) …”