Background: A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies. Aim: To systematically evaluate the effect of dietary fibers for treating abdominal pain-related FGIDs in children. Methods: In December 2011, MEDLINE, EMBASE and the Cochrane Library were searched for randomized controlled trials (RCTs) evaluating fiber supplementation in children with FGIDs. Results: Only 3 RCTs were identified, which enrolled a total of 167 children and adolescents (5–17 years old) with recurrent abdominal pain. Only 1 study used the Rome III criteria. Patients were supplemented with different dietary fiber types for 4–6 weeks. The use of dietary fibers did not influence the proportion of responders to treatment, and improvement did not occur in reported clinically relevant outcomes such as no pain or a significant decrease in pain intensity (risk ratio 1.17, 95% confidence interval 0.75–1.81). Conclusion: There is no evidence that supplementation with fiber as a dietary manipulation may be useful for treating children with FGIDs. However, one should not overlook the fact that the main limitation for recommendation of the routine fiber use in clinical practice derives from the weak quality and paucity of available studies.

Keywords:
Chronic abdominal pain, Fiber, Microbiota, Prebiotics, Randomized controlled trials
1.
Chiou E, Nurko S: Management of functional abdominal pain and irritable bowel syndrome in children and adolescents. Expert Rev Gastroenterol Hepatol 2010;4:293–304.
2.
Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J: Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2006;130:1519–1526.
3.
Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS: Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527–1537.
4.
Malone MA: Irritable bowel syndrome. Prim Care 2011;38:433–447.
5.
Sainsbury A, Ford AC: Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents. Therap Adv Gastroenterol 2011;4:115–127.
6.
Halpert A, Dalton CB, Palsson O, Morris C, Hu Y, Bangdiwala S, Hankins J, Norton N, Drossman D: What patients know about irritable bowel syndrome (IBS) and what they would like to know. National Survey on Patient Educational Needs in IBS and development and validation of the Patient Educational Needs Questionnaire (PEQ). Am J Gastroenterol 2007;102:1972–1982.
7.
Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P: Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008;337:a2313.
8.
Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum AL: Meta-analysis: the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2004;20:1253–1269.
9.
Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C: Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev 2009;1:CD003019.
10.
Chouinard LE: The role of psyllium fibre supplementation in treating irritable bowel syndrome. Can J Diet Pract Res 2011;72: e107–e114.
11.
Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N: Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol 2002;97:S7–S26.
12.
Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ: Randomized patients in IBS research had different disease characteristics compared to eligible and recruited patients. J Clin Epidemiol 2008;61:1176–1181.
13.
Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW: Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2011;8:CD003460.
14.
Jailwala J, Imperiale TF, Kroenke K: Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med 2000;133:136–147.
15.
American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM: An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104:S1–S35.
16.
Christensen MF: Do bulk preparations help in cases of recurrent abdominal pain in children? A controlled study (in Danish). Ugeskr Laeger 1982;144:714–715.
17.
Feldman W, McGrath P, Hodgson C, Ritter H, Shipman RT: The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial. Am J Dis Child 1985;139:1216–1218.
18.
Higgins JPT, Deeks JJ: Special topics in statistics; in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.1.Cochrane Collaboration. Chichester, Wiley, 2008.
19.
Weydert JA, Ball TM, Davis MF: Systematic review of treatments for recurrent abdominal pain. Pediatrics 2003;111:e1–e11.
20.
Humphreys PA, Gevirtz RN: Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr 2000;31:47–51.
21.
Kokke FT, Scholtens PA, Alles MS, Decates TS, Fiselier TJ, Tolboom JJ, Kimpen JL, Benninga MA: A dietary fiber mixture versus lactulose in the treatment of childhood constipation: a double-blind randomized controlled trial. J Pediatr Gastroenterol Nutr 2008;47:592–597.
22.
Üstündağ G, Kuloğlu Z, Kirbaş N, Kansu A: Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation? Turk J Gastroenterol 2010;21:360–364.
23.
Khoshoo V, Sun SS, Storm H: Tolerance of an enteral formula with insoluble and prebiotic fiber in children with compromised gastrointestinal function. J Am Diet Assoc 2010;110:1728–1733.
24.
Christensen MF: Recurrent abdominal pain and dietary fiber. Am J Dis Child 1986;140:738–739.
25.
Horvath A, Dziechciarz P, Szajewska H: Effectiveness of glucomannan in the treatment of abdominal pain-related functional gastrointestinal disorders in children: a randomized, double-blind, placebo-controlled trial. J Acad Nutr Diet Submitted.
26.
Saad RJ: Peripherally acting therapies for the treatment of irritable bowel syndrome. Gastroenterol Clin North Am 2011;40:163–182.
27.
de Vrese M, Schrezenmeir J: Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol 2008;111:1–66.
28.
Gibson GR, Roberfroid MB: Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 1995;125:1401–1412.
29.
Chmielewska A, Horvath A, Dziechciarz P, Szajewska H: Glucomannan is not effective for the treatment of functional constipation in children: a double-blind, placebo-controlled, randomized trial. Clin Nutr 2011;30:462–468.
30.
Roberfroid MB: Prebiotics: the concept revisited. J Nutr 2007;137:830S.
31.
Spiller R: Review article: probiotics and prebiotics in irritable bowel syndrome. Aliment Pharmacol Ther 2008;28:385–396.
32.
Carbohydrate and dietary fiber; in Kleinman RE (ed): Pediatric Nutrition Handbook, ed 4. Elk Grove Village, American Academy of Pediatrics, 1998, pp 203–211.
33.
Williams CL, Bollella M, Wynder EL: A new recommendation for dietary fiber in childhood. Pediatrics 1995;96:985–988.
34.
Irvine EJ, Whitehead WE, Chey WD: Design of treatment trials for functional gastrointestinal disorders. Gastroenterology 2006;130:1538–1551.
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2012
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