Self-Perceived Food Intolerances Are Common and Associated with Clinical Severity in Childhood Irritable Bowel Syndrome

      Abstract

      Background

      Adults with irritable bowel syndrome (IBS) frequently identify foods as exacerbating their gastrointestinal symptoms. In children with IBS, the prevalence of perceived food intolerances and their impact are unknown.

      Objective

      Our aim was to determine the prevalence of self-perceived food intolerances and the relationship of these intolerances to abdominal pain, psychosocial distress, and quality of life in children with IBS.

      Design

      We conducted a cross-sectional study. Questionnaire and prospective diary data were collected from 2008 to 2014 by trained research coordinators.

      Participants/setting

      Participants were children 7 to 18 years old (pediatric Rome III IBS, n=154; age-sex matched healthy children, n=32) in Houston, TX.

      Measures

      Perceived food intolerances and avoided foods were captured using the Childhood Food and Symptom Association Questionnaire. IBS severity was assessed by a ≥7-day pain diary and validated psychosocial questionnaires assessing quality of life, somatization, functional disability, depression, and anxiety.

      Statistical analyses performed

      We used descriptive Spearman bivariate correlation, χ2, and Poisson log-linear generalized model with Wald χ2 statistics.

      Results

      A greater proportion of children with IBS (143 of 154 [92.9%]) vs healthy children (20 of 32 [62.5%]) identified at least one self-perceived food intolerance (χ2=22.5; P<0.001). Children with IBS identified a greater number (median=4 [25% to 75% quartile=2 to 6]) of perceived symptom-inducing foods than healthy children (median=2 [25% to 75% quartile=0 to 4]; χ2=28.6; P<0.001). Children with IBS avoided more foods (median=2 [25% to 75% quartile=1 to 4]) than healthy children (median=0 [25% to 75% quartile=0 to 2.75]; χ2=20.8; P<0.001). The number of self-perceived food intolerances was weakly associated (r value range= −0.17 to 0.21) with pain frequency, pain severity, somatization, anxiety, functional disability, and decreased quality of life.

      Conclusions

      Children with IBS have a high prevalence of self-perceived food intolerances. The number of these intolerances is weakly associated with measures of IBS severity.

      Keywords

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      References

        • Rasquin A.
        • Di Lorenzo C.
        • Forbes D.
        • et al.
        Childhood functional gastrointestinal disorders: Child/adolescent.
        Gastroenterology. 2006; 130: 1527-1537
        • McOmber M.E.
        • Shulman R.J.
        Recurrent abdominal pain and irritable bowel syndrome in children.
        Curr Opin Pediatr. 2007; 19: 581-585
        • Williams A.E.
        • Czyzewski D.I.
        • Self M.M.
        • Shulman R.J.
        Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders?.
        J Health Psychol. 2013; 14: 921-930
        • Ford A.C.
        • Bercik P.
        • Morgan D.G.
        • Bolino C.
        • Pintos-Sanchez M.I.
        • Moayyedi P.
        Characteristics of functional bowel disorder patients: A cross-sectional survey using the Rome III criteria.
        Aliment Pharmacol Ther. 2014; 39: 312-321
        • Monsbakken K.W.
        • Vandvik P.O.
        • Farup P.G.
        Perceived food intolerance in subjects with irritable bowel syndrome—Etiology, prevalence and consequences.
        Eur J Clin Nutr. 2006; 60: 667-672
        • Bohn L.
        • Storsrud S.
        • Tornblom H.
        • Bengtsson U.
        • Simrén M.
        Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life.
        Am J Gastroenterol. 2013; 108: 634-641
        • Young E.
        • Stoneham M.D.
        • Petruckevitch A.
        • Barton J.
        • Rona R.
        A population study of food intolerance.
        Lancet. 1994; 343: 1127-1130
        • Zuberbier T.
        • Edenharter G.
        • Worm M.
        • et al.
        Prevalence of adverse reactions to food in Germany—A population study.
        Allergy. 2004; 59: 338-345
        • Wilder-Smith C.H.
        • Materna A.
        • Wermelinger C.
        • Schuler J.
        Fructose and lactose intolerance and malabsorption testing: The relationship with symptoms in functional gastrointestinal disorders.
        Aliment Pharmacol Ther. 2013; 37: 1074-1083
        • Simren M.
        • Mansson A.
        • Langkilde A.M.
        • et al.
        Food-related gastrointestinal symptoms in the irritable bowel syndrome.
        Digestion. 2001; 63: 108-115
        • Carlson M.J.
        • Moore C.E.
        • Tsai C.M.
        • Shulman R.J.
        • Chumpitazi B.P.
        Child and parent perceived food-induced gastrointestinal symptoms and quality of life in children with functional gastrointestinal disorders.
        J Acad Nutr Diet. 2014; 114: 403-413
        • Haapalahti M.
        • Mykkanen H.
        • Tikkanen S.
        • Kokkonen J.
        Meal patterns and food use in 10- to 11-year-old Finnish children.
        Public Health Nutr. 2003; 6: 365-370
        • Shulman R.J.
        • Eakin M.N.
        • Jarrett M.
        • Czyzewski D.I.
        • Zeltzer L.K.
        Characteristics of pain and stooling in children with recurrent abdominal pain.
        J Pediatr Gastroenterol Nutr. 2007; 44: 203-208
        • Chumpitazi B.P.
        • Hollister E.B.
        • Oezguen N.
        • et al.
        Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome.
        Gut Microbes. 2014; 5: 165-175
        • Chumpitazi B.P.
        • Cope J.L.
        • Hollister E.B.
        • et al.
        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. 2015; 42: 418-427
        • von Baeyer C.L.
        • Spagrud L.J.
        • McCormick J.C.
        • Choo E.
        • Neville K.
        • Connelly M.A.
        Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity.
        Pain. 2009; 143: 223-227
        • Self M.M.
        • Czyzewski D.I.
        • Chumpitazi B.P.
        • Weidler E.M.
        • Shulman R.J.
        Subtypes of irritable bowel syndrome in children and adolescents.
        Clin Gastroenterol Hepatol. 2014; 12: 1468-1473
        • Walker L.S.
        • Beck J.E.
        • Garber J.
        • Lambert W.
        Children's Somatization Inventory: Psychometric properties of the revised form (CSI-24).
        J Pediatr Psychol. 2009; 34: 430-440
        • Garber J.
        • Walker L.S.
        • Zeman J.
        Somatization symptoms in a community sample of children and adolescents: Further validation of the Children's Somatization Inventory.
        Psychol Assess. 1991; 3: 588-595
        • Williams A.E.
        • Czyzewski D.I.
        • Self M.M.
        • Shulman R.J.
        Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders?.
        J Health Psychol. 2015; 20: 369-379
        • Reynolds C.R.
        • Kamphaus R.W.
        Behavior Assessment System for Children.
        American Guidance Service, Inc, Circle Pines, MN2004
        • Schurman J.V.
        • Danda C.E.
        • Friesen C.A.
        • Hyman P.E.
        • Simon S.D.
        • Cocjin J.T.
        Variations in psychological profile among children with recurrent abdominal pain.
        J Clin Psychol Med Settings. 2008; 15: 241-251
        • Robins P.M.
        • Schoff K.M.
        • Glutting J.J.
        • et al.
        Discriminative validity of the Behavioral Assessment System for Children-Parent rating scales in children with recurrent abdominal pain and matched controls.
        Psychol Schools. 2003; 40: 145-154
        • Walker L.S.
        • Greene J.W.
        The functional disability inventory: Measuring a neglected dimension of child health status.
        J Pediatr Psychol. 1991; 16: 39-58
        • Claar R.L.
        • Walker L.S.
        • Smith C.A.
        Functional disability in adolescents and young adults with symptoms of irritable bowel disease: The role of academic, social, and athletic competence.
        J Pediatr Psychol. 1999; 24: 271-280
        • Rippel S.W.
        • Acra S.
        • Correa H.
        • et al.
        Pediatric patients with dyspepsia have chronic symptoms, anxiety, and lower quality of life as adolescents and adults.
        Gastroenterology. 2012; 142: 754-761
        • Varni J.W.
        • Burwinkle T.M.
        • Lane M.M.
        Health-related quality of life measurement in pediatric clinical practice: An appraisal and precept for future research and application.
        Health Qual Life Outcomes. 2005; 3: 34
        • Varni J.W.
        • Lane M.M.
        • Burwinkle T.M.
        • et al.
        Health-related quality of life in pediatric patients with irritable bowel syndrome: A comparative analysis.
        J Dev Behav Pediatr. 2006; 27: 451-458
      1. IBM SPSS Statistics for Windows [computer program]. Version 22.0. Armonk, NY: IBM Corp; 2013.

        • Eswaran S.
        • Tack J.
        • Chey W.D.
        Food: The forgotten factor in the irritable bowel syndrome.
        Gastroenterol Clin North Am. 2011; 40: 141-162
        • Castilloux J.
        • Noble A.
        • Faure C.
        Is visceral hypersensitivity correlated with symptom severity in children with functional gastrointestinal disorders?.
        J Pediatr Gastroenterol Nutr. 2008; 46: 272-278
        • Jarrett M.
        • Heitkemper M.
        • Czyzewski D.
        • et al.
        Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome.
        J Pain. 2012; 13: 477-484
        • Heitkemper M.M.
        • Chang L.
        Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?.
        Gend Med. 2009; 6: 152-167
        • Connelly M.
        • Bickel J.
        An electronic daily diary process study of stress and health behavior triggers of primary headaches in children.
        J Pediatr Psychol. 2011; 36: 852-862
        • Czyzewski D.I.
        • Eakin M.N.
        • Lane M.M.
        • et al.
        Recurrent abdominal pain in primary and tertiary care: Differences and similarities.
        Child Health Care. 2007; 36: 137-153
        • Levy R.L.
        • Whitehead W.E.
        • Walker L.S.
        • et al.
        Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms.
        Am J Gastroenterol. 2004; 99: 2442-2451
        • Bowling A.
        Mode of questionnaire administration can have serious effects on data quality.
        J Public Health. 2005; 27: 281-291
        • van der Valk J.P.
        • Gerth van Wijk R.
        • Dubois A.E.
        • et al.
        Multicentre double-blind placebo-controlled food challenge study in children sensitised to cashew nut.
        PLoS One. 2016; 11: e0151055
        • Chogle A.
        • Sztainberg M.
        • Bass L.
        • et al.
        Accuracy of pain recall in children.
        J Pediatr Gastroenterol Nutr. 2012; 55: 288-291

      Biography

      B. P. Chumpitazi is an assistant professor, Department of Pediatrics, Baylor College of Medicine, Houston, TX; and director, Neurogastroenterology and Motility Program, Texas Children’s Hospital, Section of Gastroenterology, Hepatology, and Nutrition, Houston.

      Biography

      E. M. Weidler is a senior research coordinator, Department of Pediatrics, Baylor College of Medicine, Houston, TX; senior research coordinator, Children’s Nutrition Research Center, Houston, TX; and senior research coordinator, Texas Children’s Hospital, Section of Gastroenterology, Hepatology, and Nutrition, Houston.

      Biography

      D. Y. Lu is a research coordinator, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

      Biography

      C. M. Tsai is a research coordinator, Department of Pediatrics, Baylor College of Medicine, Houston, TX; and research coordinator, Texas Children’s Hospital, Section of Gastroenterology, Hepatology, and Nutrition, Houston.

      Biography

      R. J. Shulman is a professor, Department of Pediatrics, Baylor College of Medicine, Houston, TX; professor, Children’s Nutrition Research Center, Houston, TX; and attending physician, Texas Children’s Hospital, Section of Gastroenterology, Hepatology, and Nutrition, Houston.