Fructans and FODMAPs in Children with Irritable Bowel Syndrome

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A recent randomized control trial (BP Chumpitazi et al. Clin Gastroenterol Hepatol 2018; 16: 219-25) evaluated 23 children in a double-blind placebo (maltodextrin) cross-over design (2014-2016) to determine whether fructans (0.5 g/kg/day with max 19 g divided over 3 meals) worsen symptoms in children with irritable bowel syndrome (IBS). Fructans are a commonly ingested FODMAP carbohydrate (oligosaccharides).  All subjects were 7-18 years (median 12.4 years) and met Rome III IBS criteria.

Key findings:

  • Subjects had more episodes of abdominal pain/day while receiving fructan-containing diet (3.4 ± 2.6) compared with placebo-group (2.4 ± 1.7) (P<.01).
  • The fructan group had more severe bloating (P<.05) and flatulence (P=.01).  This was associated with higher hydrogen production (617 ppm/h compared with 136 pph/h) (P<.001)
  • 18/23 (78%) had more frequent abdominal pain with fructan-containing diet and 12 (52%) had fructan sensitivity which the authors defined as having an increase of ≥30% in abdominal pain frequency following fructan ingestion.

My take: While the number of participants in this study is limited, the implications are clear: in children with irritable bowel, fructans frequently exacerbate symptoms. At this time, though, it is not possible to predict which patients with IBS will benefit.

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