What question did this study set out to answer?

To evaluate the efficacy of a low FODMAP diet compared to a habitual diet in children with irritable bowel syndrome and explore associated metabolomic signatures.

May 15, 2026Alimentary Pharmacology & Therapeutics0 citations

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Clinical trial: Efficacy of a Low FODMAP Diet in Paediatric Irritable Bowel Syndrome—A Randomised Crossover Trial With Exploratory Metabolomic Analysis

FCFernanda CristoforiOspedale Pediatrico Giovanni XXIII GCGiuseppe CelanoUniversity of Bari Aldo Moro VDVanessa Nadia DargenioOspedale Pediatrico Giovanni XXIII

Key Points

To evaluate the efficacy of a low FODMAP diet compared to a habitual diet in children with irritable bowel syndrome and explore associated metabolomic signatures.
Single-centre, randomised assessor-blinded crossover trial.
Included children with Rome IV-defined IBS, followed by 14 days on each diet with a 2-week washout.
Primary outcome measured was treatment success defined as ≥ 50% reduction in abdominal pain.
Treatment success observed in 57.6% during low FODMAP diet versus 30.3% during habitual diet (p = 0.024).
Significant reductions in IBS severity scores and bloating were noted with the low FODMAP diet.
Lower faecal acetic acid levels were measured during the low FODMAP diet compared to habitual diet.

Abstract

BACKGROUND: Evidence supporting the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet in paediatric irritable bowel syndrome (IBS) remains limited. Mechanisms underlying inter-individual variability in dietary response in children are poorly understood. AIM: To compare the clinical efficacy of a low FODMAP diet (LFD) versus a dietitian-guided habitual diet (HD; standard FODMAP intake) in children with IBS and to identify faecal and urinary metabolomic signatures associated with treatment response. METHODS: Single-centre, randomised assessor-blinded crossover trial. Children with Rome IV-defined IBS underwent a 2-week run-in, followed by 14 days of LFD or dietitian-guided HD, a 2-week washout, and crossover to the alternate diet. The primary outcome was treatment success (≥ 50% reduction in abdominal pain; period-specific baseline VAS). Secondary outcomes included IBS Severity Scoring System (IBS-SSS), stool pattern, and metabolomic profiling. RESULTS: Sixty-six children (mean age 10.2 years) completed the trial. Treatment success was achieved in 57.6% during LFD versus 30.3% during HD (p = 0.024), with the greatest benefit observed in children with severe baseline pain (VAS > 5). LFD was associated with significant reductions in IBS-SSS scores and bloating. Targeted SCFA analyses showed lower faecal acetic acid during LFD than during HD, while exploratory faecal and urinary volatilome analyses identified candidate features associated with response categories. CONCLUSION: In this randomised crossover trial, a LFD improved abdominal pain and symptom severity in children with IBS, with the greatest benefit in those with severe baseline pain. Exploratory faecal and urinary metabolomic analyses identified candidate features associated with non-response, warranting further validation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06618677.

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Clinical trial: Efficacy of a Low FODMAP Diet in Paediatric Irritable Bowel Syndrome—A Randomised Crossover Trial With Exploratory Metabolomic Analysis

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Abstract

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