Effect of prebiotics on gastrointestinal symptoms and quality of life in children with intestinal failure: A pilot study

Children with intestinal failure (IF) have a substantial disease burden, with significant gastrointestinal (GI) symptoms, abnormal stool patterns and reduced health-related quality of life (HRQOL). This study examined the effects of prebiotic supplementation on GI symptoms and HRQOL. An open-label, randomised controlled trial involving two phases. In Phase 1, children aged 1-18 years with IF received supplementation with a blend of prebiotics for 4 weeks. In Phase 2, participants were randomised to either continue supplementation or cease supplementation for 6 months to evaluate long-term effects. Primary end points included parent-reported GI symptoms and HRQOL, measured by PedsQL™ scales. Secondary end points were stool consistency and frequency, nutritional support and antibiotic use. Out of 47 children completing Phase 1, 43 completed Phase 2 (24 in the intervention group, 19 in the control group). After 4 weeks, 60% reported reduced GI symptoms. By the end of Phase 2, the intervention group showed no significant changes in HRQOL score, but significant GI symptom improvements compared to controls (mean paediatric quality of life inventory GI score difference of 6.9, p = 0.01). Stool frequency decreased (median -1.0 vs. 0 stools/day, p = 0.003), and stool consistency normalised more frequently in the intervention group (42% vs. 6%, p = 0.02). No significant changes were noted in nutritional support or antibiotic use. While HRQOL remained unchanged, short- and long-term prebiotic supplementation significantly improved GI symptoms, stool frequency and stool consistency in children with IF, indicating its potential as a therapeutic option in paediatric IF. ClinicalTrials.gov ID: NCT04981262 https://clinicaltrials.gov/study/NCT04981262?cond=intestinal%20failure&term=prebiotics&rank=2.