Ten to 17% of children 4-16 years have recurrent abdominal pain (RAP). Of these, up to 68% meet the criteria for irritable bowel syndrome (IBS), which also affects 15- 20% of adults. Up to 66% of children with RAP develop IBS as adults. This project focuses on developing treatments and understanding the pathophysiology in children with RAP (IBS-type). Using a randomized, double blind, placebo controlled design, our Specific Aims are, in children with RAP-IBS, to: 1) Characterize the effectiveness of soluble fiber versus a probiotic compared with placebo in improving symptoms (number of pain episodes, mean rating of pain severity, pain-induced interference with activities, and percent of stools that are normal;primary endpoints);2) Identify potential mechanisms whereby soluble fiber or a probiotic improve symptoms in children with RAP-IBS by measuring gastrointestinal (Gl) function tests: Gl transit time, breath hydrogen production, Gl permeability, and fecal calprotectin concentration;secondary endpoints);and 3) Define the potential contribution of psychological constructs (child anxiety, somatization, coping, and parental somatization, coping, and illness interaction) in explaining the response to the treatments (number of pain episodes, mean rating of pain severity, pain-induced interference with activities). We Hypothesize that: 1) Administration of soluble fiber or a probiotic will improve reported symptoms associated with RAP-IBS compared with placebo;2) Soluble fiber and/or a probiotic will improve Gl function tests: normalize Gl transit time, decrease breath hydrogen production, Gl permeability, and fecal calprotectin concentration;and 3) After controlling for the effects of treatment and Gl function tests, psychological constructs will serve as moderators of treatment effects as measured by a change in the number of pain episodes, mean rating of pain severity, and interference with activities. The results of this proposal likely will benefit the large numbers of children with RAP-IBS and potentially provide insight into its prevention or symptom amelioration. Identification of factors influencing symptoms in children is likely to apply to adults. Interventions in childhood may prevent or ameliorate symptoms in adults by changing the physiological and the learning/conditioning and adaptive experience of these children. We anticipate these data can used to address the significant emotional and economic burdens of these disorders, which in adults is near eight billion dollars per year.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Study Section
Nursing Science: Children and Families Study Section (NSCF)
Program Officer
Tully, Lois
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Baylor College of Medicine
Schools of Medicine
United States
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Chumpitazi, Bruno P; Weidler, Erica M; Shulman, Robert J (2016) Lactulose Breath Test Gas Production in Childhood IBS is Associated with Intestinal Transit and Bowel Movement Frequency. J Pediatr Gastroenterol Nutr :
Chumpitazi, B P; Self, M M; Czyzewski, D I et al. (2016) Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterol Motil 28:443-8
Czyzewski, Danita I; Self, Mariella M; Williams, Amy E et al. (2016) Maintenance of Pain in Children With Functional Abdominal Pain. J Pediatr Gastroenterol Nutr 62:393-8
Shulman, Robert J; Hollister, Emily B; Cain, Kevin et al. (2016) Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol :
Chumpitazi, Bruno P; Shulman, Robert J (2016) Dietary Carbohydrates and Childhood Functional Abdominal Pain. Ann Nutr Metab 68 Suppl 1:8-17
Chumpitazi, B P; Cope, J L; Hollister, E B et al. (2015) Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Aliment Pharmacol Ther 42:418-27
Self, M M; Williams, A E; Czyzewski, D I et al. (2015) Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome. Neurogastroenterol Motil 27:1110-9
Williams, Amy E; Czyzewski, Danita I; Self, Mariella M et al. (2015) Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders? J Health Psychol 20:369-79
Wong, G K; Shulman, R J; Chumpitazi, B P (2015) Gastric emptying scintigraphy results in children are affected by age, anthropometric factors, and study duration. Neurogastroenterol Motil 27:356-62
Hollister, Emily B; Riehle, Kevin; Luna, Ruth Ann et al. (2015) Structure and function of the healthy pre-adolescent pediatric gut microbiome. Microbiome 3:36

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