الفهرس 
IRRITABLE BOWEL SYNDROME OVERVIEWOnly 14 pages are availabe for public view
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Abstract
SUMMARY
I
rritable bowel syndrome (IBS) is one of the commonest functional gastrointestinal disorders (FGID) in children which presents by recurrent abdominal pain.
Diagnosis of IBS in children relies on diagnostic criteria described by ROME IV criteria for FGIDs.
IBS has been defined by the Rome IV criteria. These criteria must be fulfilled for at least 2 months before a diagnosis of IBS can be made:
Abdominal pain at least 4 days per month associated with one or more of the following:
a. Related to defecation,
b. A change in stool frequency,
c. A change in form (appearance) of stool.
During the consultation, it is essential to ask about and exclude ”red flag” symptoms as these may indicate a serious underlying organic pathology. Red flag symptoms are: Abdominal pain or diarrhea that awakes the child from sleep.
1) Delay in onset or progression of puberty.
2) Faltering growth.
3) Family history of inflammatory bowel disease (IBD), celiac disease.
4) History of significant weight loss.
5) Bleeding per rectum.
6) Persistence of severe vomiting or diarrhea.
7) Persistent joint pains.
8) Recurrent unexplained fever.
9) Unexplained pallor
Irritable Bowel Syndrome has negative impact on children quality of life and affects all QOL dimensions.
Low FODMAP diet is an important dietary intervention that improves the symptoms of IBS and has positive impact on patient’s quality of life.
This study was carried out to evaluate the impact of low FODMAP diet on Health related Quality of life in children with Irritable bowel syndrome according to ROME IV criteria in a group of patients in pediatric Hospital at Ain Shams University
A Randomized two-arm interventional study was conducted at Pediatric gastroenterology outpatient clinic at Pediatric Hospitals, Ain Shams University Hospitals. Participants were randomly allocated in to two groups: low FODMAP diet group and Standard instructions (NICE Guidelines) group (42 patients per group).
The patients evaluated through history and examination, Visual analogue scale (VAS), Pediatrics quality of life inventory (PedsQL) GIT module score and Pediatric quality of life inventory (PedsQL) generic core score to evaluate: pain severity, gastrointestinal symptoms and quality of life of the participants respectively. Dietary intervention was done throughout 6 weeks with strict follow up by food diary, 24 diet recall, VAS and PedsQL questionnaires.
IBS was found to markedly affect all aspects of Quality of life (physical, social, emotional and school functioning), School functioning was the most affected dimension.
There were also associated symptoms with IBS like: Abdominal distension, nausea, vomiting and reflux.
Out of 84 patients 80patients continues the study, 39 in the low FODMAPs group and 40 in the standard group. VAS score decreased from 9.15 ± 0.71 to 0.90 ±0.79 in the low FODMAPs group, and from 8.90 ± 0.92 to 4.54 ±1.07 in the standard group, PedsQL gastrointestinal symptoms module scale increased from 71.04 ± 6.07 to 91.37 ±4.99 in the low FODMAPs group and from 72.34 ± 6.18 to 84.16 ±6.26 in the standard group, PedsQL life inventory generic core score increased from 90.27 ± 7.03 to 98.13 ±1.98 in low FODMAPs group and from 90.87 ± 6.44 to 96.18 ±3.37 in the standard diet group.
PedsQL Generic core scale was significantly improved among low FODMAP diet.
So according the present study it is recommended that:
- Dietary modification should be the main part in treatment children with IBS.
- Family Physicians should follow the guidelines for diagnosis IBS in children and the dietary modifications and instructions for treatment as family doctors are the gate of health care system.
- Further studies are needed to evaluate the nutritional effect of Low FODMAPs diet if applied for long term.
- More studies are needed to assess the effect of re-introduction of FODMAPs food staff.