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BACKGROUND Functional abdominal pain disorders (FAPDs) are a common health problem in the pediatric population. Research suggests that several environmental modifiable factors, such as physical activity, growth status and dietary habits, may determine the symptoms of the disease. The aim of this pilot study was to assess whether the frequency and severity of gastrointestinal symptoms are associated with dietary intake, physical activity level and BMI in children with functional abdominal pain (FAP). METHODS The study enrolled 25 children (5-11 years old) with diagnosed FAP. Dietary intake data were collected using a 7-day food diary. Patients were asked about physical activity at school and during their free time. Participants collected information about gastrointestinal symptoms over a 2-week period. The frequencies of abdominal pain and stools were recorded as number of events per day; the severity of abdominal pain was assessed using the Wong-Baker FACES Pain Rating Scale, and stool consistency based on the Bristol Stool Form Scale. Differences between groups were verified with the Kruskal-Wallis test. RESULTS In the group of children with insufficient intake of fiber, abdominal pain intensity was significantly higher (median: 1.75 points/day, IQR: 1.18-2.32) than among participants with adequate intake (median: 0.29 points/day, IQR: 0.08-0.57; p = 0.006). Stool frequency was significantly lower in children who reported moderate physical activity in their free time (median: 0.86 times/day, IQR: 0.64-1.14) than in children with high free time physical activity (median: 1.36 times/day, IQR: 1.29-1.50; p = 0.031). There was no significant association between other lifestyle factors and gastrointestinal symptoms. CONCLUSIONS Our results suggest that simple recommendations relative to modifiable lifestyle factors, such as diet or physical activity, may reduce abdominal pain intensity and improve stool frequency in children with FAP.

Introduction: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been shown to reduce symptoms among adult patients and children with irritable bowel syndrome. There are no studies investigating the effectiveness of the low FODMAP diet in pediatric patients with functional abdominal pain (FAP). Objective: The study aimed to evaluate the effectiveness of the low FODMAP diet in reducing gastrointestinal symptoms in children with FAP in comparison to the control diet based on the National Institute for Health and Care Excellence (NICE) guidelines. Methods: Twenty-seven children with diagnosed FAP were randomized to 2 groups. Each group received an intervention: the low FODMAP diet or the diet based on NICE. All food was prepared and delivered by a catering company. Data regarding gastrointestinal symptoms were recorded by participants during the 2-week baseline assessment and 4-week dietary intervention. The frequencies of abdominal pain and stools were reported as a number of events per day. The severity of abdominal pain was assessed using the Wong-Baker FACES Pain Rating Scale. The assessment of stool consistency was based on the Bristol Stool Form Scale. Results: The tendency toward the improvement in abdominal symptoms was noted in the low FODMAP group but without statistical significance. No significant differences in stool consistency were observed in this group. The NICE group experienced significant reduction in abdominal pain intensity and frequency (p < 0.01) and improvement in stool consistency (93% reporting normal stool, p < 0.05). Conclusions: The results of this pilot study suggest that the low FODMAP diet is not effective in the reduction of symptoms in children with FAP.

The aim of this study was primarily to evaluate differences between parental opinion about the diet and overall changes in children&rsquo, s symptoms of functional abdominal pain (FAP) during the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet and National Institute for Health and Care Excellence (NICE) diet. Secondly, this paper examined the agreement between parental perception of children&rsquo, s symptoms and children&rsquo, s self-assessment of symptoms during the diet in both treatment groups. Twenty-seven children with diagnosed functional abdominal pain (FAP) were randomized to one of two group, receiving the low FODMAP diet or the diet based on NICE guidelines. Children reported gastrointestinal symptoms at baseline and during the diet. At the end of the intervention, parents assessed their children&rsquo, s diet and symptoms changes, using Likert scales. The agreement between parental and children assessments of gastrointestinal symptoms was defined as the percentage of compatible answers. In the low FODMAP group a significantly lower percentage of parents (38%) declared that it was easy to follow the diet, compared to the NICE group (57%), (p = 0.017). A high percentage of parents in both groups reported improvement in all symptoms of children during dietary intervention. A high level of agreement was also observed between parental and children&rsquo, s self-assessment of abdominal pain intensity and frequency. Our research suggests that in parental opinion the low FODMAP diet is as effective as the diet based on NICE guidelines in children with FAP. However, the low FODMAP diet may seem more difficult to follow, and this may have had an impact on the effectiveness and acceptability of the FODMAP diet by children.

A child's diet has an important impact on their quality of life, and with functional gastrointestinal disorders becoming an increasing issue, a child's diet has become recognised as an area to be investigated in how to treat such disorders. Katarzyna Miroslawa Boradyn and Katarzyna Eufemia Przybylowicz from the University of Warmia and Mazury explore the potential of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet as an effective treatment for these disorders.Functional gastrointestinal disorders (FGID) are one of the most prevalent disorders diagnosed by paediatricians.[1] Within this wide range, functional abdominal pain (FAP) is a disorder particularly common among school-age children and it can substantially affect their quality of life.[2] A child's diet has a significant influence on the occurrence of symptoms.[1] So far, previously tested therapies have not provided an effective treatment that would alleviate the symptoms and improve the microbiota.[2] Researchers from Monash University in Australia developed a diet based on the elimination, or at least a reduction, of foods high in FODMAP. These compounds are characterised by high resistance to digestion, low level of absorption in the gastrointestinal tract and long fermentation in the gut.[1],[3] Depending on the type of sugar, FODMAPs are found in various foods. Fructo-oligosaccharides are contained among others in wheat, rye, onions, garlic and artichokes and galacto-oligosaccharides are a component of legumes. Lactose is mainly found in milk and other dairy products. The richest food sources of fructose are honey, apples, pears, watermelon and mango; and of sorbitol are: stone fruits, apples, pears and sugar-free mints/gum. Mannitol is found in sugar-free mints/gum and is also one of the components in mushrooms and cauliflower.[4]Existing evidence suggests that the use of a low FODMAP diet is associated with the reduction of the symptoms of irritable bowel syndrome (IBS), Crohn's disease and coexisting functional symptoms.[3],[4] Moreover, an experimental study in children confirmed that a low FODMAP diet reduced abdominal pain in children with IBS by 50%.[1] Interestingly, to our knowledge, no previous studies have investigated the impact of low FODMAP diet in children with FAP.Currently, two approaches have been suggested in planning a low FODMAP diet: bottom-up and top-down. The bottom-up method allows you to specify the patient's limit of FODMAP and is a gradual elimination of single products (or groups of products) from the diet until the symptoms have been alleviated. This progressive method can be applied in (1) patients who have not been diagnosed with IBS, but experience symptoms affecting their life quality; (2) patients who have already started elimination of other components from their diet; or (3) patients who struggle to follow a diet low in FODMAP. …