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Nutritional Management of Gastrointestinal Dysfunction in Children

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 47413

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Special Issue Editor

Dr. Licia Pensabene

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Guest Editor

Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
Interests: pediatric gastroenterology; functional gastrointestinal disorders; gastrointestinal motility disorders; inflammatory bowel disease; chronic constipation; celiac disease

Special Issue Information

Dear Colleagues,

Dietary therapy is an essential aspect of the management of several gastrointestinal dysfunctions, despite different underlying pathophysiologic mechanisms, such as inflammation (inflammatory bowel disease), genetic or acquired conditions (short bowel syndrome (SBS)), or motility disorders (pediatric intestinal pseudo-obstruction (PIPO)).

Gastrointestinal dysfunctions affect many children, with a significant impact on pediatric health care. Abnormal gastrointestinal motility/function is found in children with common, less disabling conditions, such as gastroesophageal reflux and irritable bowel syndrome, and in rarer but life-impairing diseases, such as in a subgroup of children with intestinal failure (IF), including SBS and PIPO. Dietary management aims to improve nutritional status and also to minimize debilitating and potentially lethal consequences associated with failing gastrointestinal function, and it could require a complex nutritional approach. For example, nutritional management strategies in IF include optimizing meal volume, calories/fat, and fiber content, as well as meal composition (solid vs. liquid), to promote stomach emptying and small bowel transit. In the most severe presentation of dysmotility, such as PIPO, different strategies, such as oral feeding, enteral feeding (bolus or continuous), or parenteral nutrition, should be tailored to each patient, depending on the extent of motility disturbance and feeding tolerance.

Moreover, as another example of beneficial effect, in children with active luminal Crohn's disease, dietary therapy with exclusive enteral nutrition is recommended as first-line treatment for induction of remission.

The purpose of this Special Issue is to provide new insight into the dietary management of pediatric gastrointestinal dysfunctions to help improve the care of the affected patients.

Therefore, we invite investigators to contribute original research articles as well as review articles on this field, including all conditions affecting gastrointestinal function.

Dr. Licia Pensabene
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Dietary therapy
Nutritional management
Oral feeding
Enteral feeding
Parenteral nutrition
Gastrointestinal dysfunction
Gastrointestinal disorders

Published Papers (13 papers)

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Research

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16 pages, 278 KiB

Open AccessArticle

Prevalence of Rome IV Pediatric Diagnostic Questionnaire-Assessed Disorder of Gut–Brain Interaction, Psychopathological Comorbidities and Consumption of Ultra-Processed Food in Pediatric Anorexia Nervosa

by Sara Rurgo, Maria Rosaria Marchili, Giulia Spina, Marco Roversi, Flavia Cirillo, Umberto Raucci, Giovanni Sarnelli, Massimiliano Raponi and Alberto Villani

Nutrients 2024, 16(6), 817; https://0-doi-org.brum.beds.ac.uk/10.3390/nu16060817 - 13 Mar 2024

Viewed by 615

Abstract

Anorexia nervosa (AN) is a severe eating disorder primarily affecting children and adolescents. Disorders of the gut–brain interaction (DGBIs) have gained recognition as significant symptoms in individuals with AN. However, limited studies have explored GI symptoms in pediatric populations with AN using age-specific diagnostic tools. This study aims to investigate the prevalence of DGBIs, their associated psychopathological aspects and their potential correlations with ultra-processed food (UPF) consumption among pediatric AN patients. The study included AN patients who were under the care of a specialized multidisciplinary team. We assessed DGBI-related symptoms using the Rome IV Pediatric Diagnostic Questionnaire on Functional Gastrointestinal Disorders (R4PDQ) and conducted psychological evaluations. Dietary intake and UPF consumption were evaluated. Among 56 AN patients, we observed a lower prevalence of DGBIs (functional constipation: 61%; functional dyspepsia: 54%; irritable bowel syndrome: 25%) compared to the existing literature. The psychological assessments revealed high rates of depression (72%) and anxiety (70%). UPF consumption was inversely related to depression levels (p = 0.01) but positively correlated with functional constipation (p = 0.046). This study highlights the importance of using age-specific diagnostic tools and emphasizes the crucial role of a specialized multidisciplinary team in the treatment of AN. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

14 pages, 712 KiB

Open AccessArticle

Noninvasive Ventilation and Rapid Enteral Feeding Advances in Preterm Infants—2-Year Follow-Up of the STENA-Cohort

by Judith Behnke, Vanessa Estreich, Frank Oehmke, Bernd Axel Neubauer, Anita Windhorst and Harald Ehrhardt

Nutrients 2023, 15(5), 1292; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15051292 - 06 Mar 2023

Viewed by 1874

Abstract

The importance of nutritional supply for somatic growth and neurodevelopmental outcome in very-low-birthweight infants is an established medical strategy for reducing long-term morbidities. Our cohort study on rapid enteral feeding advances using a standardized protocol (STENA) previously demonstrated a 4-day reduction of parenteral nutrition. STENA did not impede the success of noninvasive ventilations strategies but significantly less infants required mechanical ventilation. Most importantly, STENA resulted in improved somatic growth at 36 weeks of gestation. Here, we evaluated our cohort for psychomotor outcomes and somatic growth at 2 years of age. n = 218 infants of the original cohort were followed-up (74.4%). Z-scores for weight and length did not differ but the benefits of STENA for head circumference persisted until the age of 2 years (p = 0.034). Concerning the psychomotor outcome, we neither found any statistically significant differences in the mental developmental index (MDI) (p = 0.738), norin the psychomotor developmental index (PDI) (p = 0.122). In conclusion, our data adds important insights on the topic of rapid enteral feeding advances and confirms the safety of STENA with respect to somatic growth and psychomotor outcome measures. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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12 pages, 979 KiB

Open AccessArticle

Home Parenteral Nutrition for Children: What Are the Factors Indicating Dependence and Mortality?

by Ying-Cing Chen, Chia-Man Chou, Sheng-Yang Huang and Hou-Chuan Chen

Nutrients 2023, 15(3), 706; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15030706 - 30 Jan 2023

Cited by 2 | Viewed by 1961

Abstract

Parenteral nutrition (PN) in children with short bowel syndrome is crucial and lifesaving. Taking care of such patients requires interprofessional practice and multiple team resource management. Home PN (HPN) usage allows patients and families to live regular lives outside hospitals. We share our experiences for the last two decades and identify the risk factors for complications and mortality. A retrospective study of HPN patients was conducted between January 2000 and February 2022. Medical records of age, body weight, diagnosis, length of residual intestines, HPN period, central line attempts, complications, weaning, and survival were collected and analyzed. The patients were classified as HPN free, HPN dependent, and mortality groups. A total of 25 patients received HPN at our outpatient clinic, and one was excluded for the adult age of disease onset. There were 13 patients (54.1%) who were successfully weaned from HPN until the record-enroled date. The overall mortality rate was 20.8% (five patients). All mortality cases had prolonged cholestasis, Child Class B or C, and a positive Pediatric End-Stage Liver Disease (PELD) score. For HPN dependence, extended resection and multiple central line placement were two significant independent factors. Cholestasis, Child Class B or C, and positive PELD score were the most important risk factors for mortality. The central line-related complication rate was not different in all patient groups. The overall central line infection rate was 1.58 per 1000 catheter days. Caution should be addressed to prevent cholestasis and intestinal failure-associated liver disease during the HPN period, to prevent mortality. By understanding the risks of HPN dependence and mortality, preventive procedures could be addressed earlier. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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12 pages, 927 KiB

Open AccessArticle

Early Naso-Gastric Feeding and Outcomes of Anorexia Nervosa Patients

by Maria Rosaria Marchili, Antonella Diamanti, Valeria Zanna, Giulia Spina, Cristina Mascolo, Marco Roversi, Benedetta Guarnieri, Gianluca Mirra, Giulia Testa, Umberto Raucci, Antonino Reale and Alberto Villani

Nutrients 2023, 15(3), 490; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15030490 - 17 Jan 2023

Cited by 2 | Viewed by 1834

Abstract

Nutritional rehabilitation with weight restoration is an important step in patients hospitalised for anorexia nervosa (AN). Naso-gastric feeding (NGF) should be considered when oral nutrition (OF) and oral nutritional supplementation (ONS) are insufficient. We evaluated the role of NGF on short- and long-term outcomes, considering weight gain, the length of hospitalisation (LOS) and the time to relapse. We report on the characteristics of patients under 18 years of age with AN admitted to the Department of Emergency and Acceptance of the Bambino Gesù Children’s Hospital, IRCCS, Rome, between March 2019 and August 2022. Three hundred and fifteen patients were enrolled. We compared patients treated with NGF (group A) and patients without NGF (group B). Group A was characterised by a significantly lower BMI on admission and discharge, more frequent use of inpatient psychotropic therapy (IPDT) and longer hospital stay. The time to relapse was significantly longer in group A compared to group B. An early NGF setting correlates with a longer time to relapse and may be associated with a shorter LOS. A high caloric intake with a balanced nutritional formula provided by NGF allows an earlier recovery. The main advantages of this approach could be the rapid discharge of patients and a more effective psychological and social recovery. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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11 pages, 890 KiB

Open AccessArticle

Dietary Habits of a Group of Children with Crohn’s Disease Compared to Healthy Subjects: Assessment of Risk of Nutritional Deficiencies through a Bromatological Analysis

by Flavio Labriola, Caterina Marcato, Chiara Zarbo, Ludovica Betti, Arianna Catelli, Maria Chiara Valerii, Enzo Spisni and Patrizia Alvisi

Nutrients 2022, 14(3), 499; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14030499 - 24 Jan 2022

Cited by 5 | Viewed by 2341

Abstract

Diet is a matter of interest in the pathogenesis and management of Crohn’s Disease (CD). Little is known about CD children’s dietary habits. Our aim was assessing the quality and the amount of nutrient intake in a group of CD pediatric patients. Data were compared with those of healthy subjects (HS). In total, 20 patients (13 males) and 48 HS (24 males) aged 4–18 years were provided with a food diary to fill out for one week. Winfood software performed the bromatological analysis, providing data about intakes of proteins and amino acids, fatty acids, carbohydrates, cholesterol, fibers, minerals, vitamins, and polyphenols. Estimates of the antioxidant activity of foods and of the dietetic protein load were also calculated. The diet of CD patients was poorer in fibers, polyphenols, vitamin A, beta-carotene, and fatty acids, and richer in animal proteins, vitamin B12, and niacin. PRAL was higher in CD patients’ diets, while ORAC was higher in HS. No significant differences were observed in carbohydrate and other macro- and micronutrient consumptions. CD dietary habits seem to reflect the so-called Western diet, possibly involved in CD pathogenesis. Furthermore, analysis of dietary habits allows for prevention of nutritional deficiencies and timely correction through education and supplementation. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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16 pages, 1091 KiB

Open AccessArticle

Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials

by Zengbin Li, Guixian Zhu, Chao Li, Hao Lai, Xin Liu and Lei Zhang

Nutrients 2021, 13(12), 4319; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124319 - 29 Nov 2021

Cited by 19 | Viewed by 6320

Abstract

Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = −0.84 day; 95% confidence interval (CI), −1.39, −0.29], Bifidobacterium lactis (MD = −0.98 day; 95%CI, −1.82, −0.14), Saccharomyces boulardii (MD = −1.25 day; 95%CI, −1.59, −0.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = −1.19 day; 95%CI, −1.81, −0.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = −1.1 day; 95%CI, −1.84, −0.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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13 pages, 1733 KiB

Open AccessArticle

A Novel UC Exclusion Diet and Antibiotics for Treatment of Mild to Moderate Pediatric Ulcerative Colitis: A Prospective Open-Label Pilot Study

by Chen Sarbagili-Shabat, Lindsey Albenberg, Johan Van Limbergen, Naomi Pressman, Anthony Otley, Michal Yaakov, Eytan Wine, Dror Weiner and Arie Levine

Nutrients 2021, 13(11), 3736; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13113736 - 23 Oct 2021

Cited by 15 | Viewed by 4966

Abstract

Background: As the microbiome plays an important role in instigating inflammation in ulcerative colitis (UC), strategies targeting the microbiome may offer an alternative therapeutic approach. The goal of the pilot trial was to evaluate the potential efficacy and feasibility of a novel UC exclusion diet (UCED) for clinical remission, as well as the potential of sequential antibiotics for diet-refractory patients to achieve remission without steroids. Methods: This was a prospective, single-arm, multicenter, open-label pilot study in patients aged 8–19, with pediatric UC activity index (PUCAI) scores >10 on stable maintenance therapy. Patients failing to enter remission (PUCAI < 10) on the diet could receive a 14-day course of amoxycillin, metronidazole and doxycycline (AMD), and were re-assessed on day 21. The primary endpoint was intention-to-treat (ITT) remission at week 6, with UCED as the only intervention. Results: Twenty-four UCED treatment courses were given to 23 eligible children (mean age: 15.3 ± 2.9 years). The median PUCAI decreased from 35 (30–40) at baseline to 12.5 (5–30) at week 6 (p = 0.001). Clinical remission with UCED alone was achieved in 9/24 (37.5%). The median fecal calprotectin declined from 818 (630.0–1880.0) μg/g at baseline to 592.0 (140.7–1555.0) μg/g at week 6 (p > 0.05). Eight patients received treatment with antibiotics after failing on the diet; 4/8 (50.0%) subsequently entered remission 3 weeks later. Conclusion: The UCED appears to be effective and feasible for the induction of remission in children with mild to moderate UC. The sequential use of UCED followed by antibiotic therapy needs to be evaluated as a microbiome-targeted, steroid-sparing strategy. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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15 pages, 3457 KiB

Open AccessArticle

Gluten-Free Diet: Nutritional Strategies to Improve Eating Habits in Children with Celiac Disease: A Prospective, Single-arm Intervention Study

by Marta Suárez-González, Carlos Bousoño-García, Santiago Jiménez-Treviño and Juan José Díaz-Martín

Nutrients 2021, 13(4), 1108; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13041108 - 28 Mar 2021

Cited by 7 | Viewed by 5618

Abstract

Background: Elimination of gluten-containing cereals and consumption of ultra-processed gluten-free foods might cause an unbalanced diet, deficient in fiber and rich in sugar and fat, circumstances that may predispose celiac children to chronic constipation. Aim: to evaluate if counseling with a registered dietitian (RD) was capable of improving eating and bowel habits in a celiac pediatric population. Methods: Dietetic, lipid profile and stool modifications were analyzed, comparing baseline assessments with those twelve months after receiving heathy eating and nutrition education sessions. At both time points, 3-day food records, a bowel habit record and a lipid panel were conducted. Calculated relative intake of macro- and micro-nutrients were compared with current recommendations by the European Food Safety Authority (EFSA). Student’s paired t-test, McNemar test, Mandasky test and Pearson correlation tests were used. Results: Seventy-two subjects (58.3% girls) with a mean (standard deviation (SD)) age of 10.2 (3.4) years were included. Baseline diets were imbalanced in macronutrient composition. Significant improvements were observed in their compliance with dietary reference values (DRVs), where 50% of the subjects met fat requirements after the education and 67% and 49% with those of carbohydrates and fiber, respectively (p < 0.001). Celiac children decreased red meat and ultra-processed foods consumption (p < 0.001) and increased fruits and vegetables intake (p < 0.001), leading to a reduction in saturated fat (p < 0.001) and sugar intake (p < 0.001). Furthermore, 92% of the patients achieved a normal bowel habit, including absence of hard stools in 80% of children constipated at baseline (p < 0.001). Conclusions: RD-led nutrition education is able to improve eating patterns in children with celiac disease (CD). Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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Review

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17 pages, 1470 KiB

Open AccessEditor’s ChoiceReview

Dietary Fibers in Healthy Children and in Pediatric Gastrointestinal Disorders: A Practical Guide

by Silvia Salvatore, Maria Serena Battigaglia, Elena Murone, Eugenia Dozio, Licia Pensabene and Massimo Agosti

Nutrients 2023, 15(9), 2208; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15092208 - 06 May 2023

Cited by 10 | Viewed by 3559

Abstract

Dietary fibers include non-digestible plant carbohydrates, lignin and resistant starch. Dietary fibers provide immune, cardiovascular, metabolic and intestinal beneficial effects in humans. Fibers naturally present in foods (fruits, vegetables, legumes, cereals) or used as supplements have different physical, chemical and functional profiles. This narrative review provides an update to the knowledge on the effects of dietary fibers in healthy subjects and in children with gastrointestinal disorders. Soluble fibers are digested by gut bacteria, producing short-chain fatty acids and energy for colonocytes, and may exert prebiotic effects that promote the growth of bifidobacteria and lactobacilli. Non-soluble fibers are bulking agents and may improve intestinal transit. The exact amount and characteristics of the fiber requirement in infants and children need to be further established. There are limited data evaluating fibers in children with gastrointestinal disorders. The low intake of fibers has been associated with constipation, but the intake of excessive fibers is not recommended as it may cause flatulence and abdominal discomfort. Certain fibers (particularly psyllium in irritable bowel syndrome) have shown beneficial effects in children with gastrointestinal disorders, but the limited and heterogenous data do not currently allow a specific recommendation. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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18 pages, 343 KiB

Open AccessReview

The Mediterranean Diet in Paediatric Gastrointestinal Disorders

by Sabrina Cenni, Veronica Sesenna, Giulia Boiardi, Marianna Casertano, Giovanni Di Nardo, Susanna Esposito and Caterina Strisciuglio

Nutrients 2023, 15(1), 79; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15010079 - 24 Dec 2022

Cited by 5 | Viewed by 2696

Abstract

The Mediterranean diet is considered one of the healthiest dietary patterns worldwide, thanks to a combination of foods rich mainly in antioxidants and anti-inflammatory nutrients. Many studies have demonstrated a strong relationship between the Mediterranean diet and some chronic gastrointestinal diseases. The aim of this narrative review was to analyse the role of the Mediterranean diet in several gastrointestinal diseases, so as to give a useful overview on its effectiveness in the prevention and management of these disorders. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

14 pages, 1059 KiB

Open AccessReview

Nutritional Management of Intestinal Failure due to Short Bowel Syndrome in Children

by Maria Giovanna Puoti and Jutta Köglmeier

Nutrients 2023, 15(1), 62; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15010062 - 23 Dec 2022

Cited by 6 | Viewed by 4652

Abstract

Background: The most common cause of intestinal failure (IF) in childhood remains short bowel syndrome (SBS), where bowel mass is significantly reduced due to a congenital atresia or resection and parenteral nutrition (PN) needed. Home PN has improved outcome and quality of life, but the long-term therapeutic goal is to achieve enteral autonomy whilst avoiding long term complications. This paper is aimed at discussing nutritional strategies available to clinicians caring for these patients. Methods: A literature search was performed from 1992 to 2022 using Pubmed, MEDLINE and Cochrane Database of Systematic Reviews, and recent guidelines were reviewed. In the absence of evidence, recommendations reflect the authors’ expert opinion. Results: Consensus on the best possible way of feeding children with IF-SBS is lacking and practice varies widely between centres. Feeding should commence as soon as possible following surgery. Oral feeding is the preferred route and breast milk (BM) the first milk of choice in infants. Donor BM, standard preterm or term formula are alternatives in the absence of maternal BM. Extensively hydrolysed or amino acid-based feeds are used when these are not tolerated. Solids should be introduced as soon as clinically appropriate. Children are encouraged to eat by mouth and experience different tastes and textures to avoid oral aversion. Aggressive weaning of PN and tube (over-) feeding are now discouraged. Conclusions: To date, uniform agreement on the optimal type of feed, timing of food introduction and feeding regime used is lacking and great difference in practice remains. There is need for more research to establish common treatment protocols. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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10 pages, 570 KiB

Open AccessReview

Intestinal Permeability in Children with Functional Gastrointestinal Disorders: The Effects of Diet

by Valentina Giorgio, Gaia Margiotta, Giuseppe Stella, Federica Di Cicco, Chiara Leoni, Francesco Proli, Giuseppe Zampino, Antonio Gasbarrini and Roberta Onesimo

Nutrients 2022, 14(8), 1578; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14081578 - 11 Apr 2022

Cited by 4 | Viewed by 3148

Abstract

Functional gastrointestinal disorders (FGIDs) are very common and life-impacting in children and young adults, covering 50% of pediatric gastroenterologist consultations. As it is known, FGIDs may be due to alterations in the gut–brain axis, dysbiosis and dysregulation of intestinal barrier, causing leaky gut. This may enhance increased antigen and bacterial passage through a damaged mucosa, worsening the impact of different medical conditions such as FGIDs. Little is known about the role of nutrients in modifying this “barrier disruption”. This narrative review aims to analyze the clinical evidence concerning diet and Intestinal Permeability (IP) in FGIDs in children. We searched the PubMed/Medline library for articles published between January 2000 and November 2021 including children aged 0–18 years old, using keywords related to the topic. Since diet induces changes in the intestinal barrier and microbiota, we aimed at clarifying how it is possible to modify IP in FGIDs by diet modulation, and how this can impact on gastrointestinal symptoms. We found that) is that small changes in eating habits, such as a low-FODMAP diet, an adequate intake of fiber and intestinal microbiota modulation by prebiotics and probiotics, seem to lead to big improvements in quality of life. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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22 pages, 917 KiB

Open AccessReview

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

by Frances Connor, Silvia Salvatore, Enza D’Auria, Maria Elisabetta Baldassarre, Miriam Acunzo, Gaia Di Bella, Ilaria Farella, Simona Sestito and Licia Pensabene

Nutrients 2022, 14(6), 1317; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14061317 - 21 Mar 2022

Cited by 5 | Viewed by 6247

Abstract

Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35–52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows’ milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows’ milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0–17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests, radiological or motility investigations achieve sufficient sensitivity and specificity to screen children for CMA-related constipation. A 4-week cows’ milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet. Full article

(This article belongs to the Special Issue Nutritional Management of Gastrointestinal Dysfunction in Children)

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