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

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.

[1]  A. Gasbarrini,et al.  Intestinal Barrier in Human Health and Disease , 2021, International journal of environmental research and public health.

[2]  A. Blikslager,et al.  Probiotics, Prebiotics and Epithelial Tight Junctions: A Promising Approach to Modulate Intestinal Barrier Function , 2021, International journal of molecular sciences.

[3]  Sang-Woon Choi,et al.  Dietary modulation of gut microbiota for the relief of irritable bowel syndrome , 2021, Nutrition research and practice.

[4]  F. Rodríguez-Rodríguez,et al.  The Gut Barrier, Intestinal Microbiota, and Liver Disease: Molecular Mechanisms and Strategies to Manage , 2020, International journal of molecular sciences.

[5]  Qi Yang,et al.  Role of Dietary Nutrients in the Modulation of Gut Microbiota: A Narrative Review , 2020, Nutrients.

[6]  A. Gasbarrini,et al.  Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions , 2019, Nutrients.

[7]  G. Reid,et al.  Probiotics and prebiotics in intestinal health and disease: from biology to the clinic , 2019, Nature Reviews Gastroenterology & Hepatology.

[8]  L. Putignani,et al.  The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions , 2019, Nutrients.

[9]  M. Saps,et al.  The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children , 2018, Nutrients.

[10]  J. Versalovic,et al.  Development of the Pediatric Gut Microbiome: Impact on Health and Disease , 2018, The American journal of the medical sciences.

[11]  G. Marseglia,et al.  Does a low FODMAPs diet reduce symptoms of functional abdominal pain disorders? A systematic review in adult and paediatric population, on behalf of Italian Society of Pediatrics , 2018, Italian Journal of Pediatrics.

[12]  E. Vaughan,et al.  The effect of fiber and prebiotics on children’s gastrointestinal disorders and microbiome , 2017, Expert review of gastroenterology & hepatology.

[13]  Yuan-Pang Wang,et al.  Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review , 2017, World journal of gastroenterology.

[14]  M. Heitkemper,et al.  Psyllium Fiber Reduces Abdominal Pain in Children With Irritable Bowel Syndrome in a Randomized, Double‐Blind Trial , 2017, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[15]  D. Drossman,et al.  What Is New in Rome IV , 2017, Journal of neurogastroenterology and motility.

[16]  F. Scaldaferri,et al.  Validation of an LC-MS/MS Method for Urinary Lactulose and Mannitol Quantification: Results in Patients with Irritable Bowel Syndrome , 2016, Disease markers.

[17]  Stacey Fuller,et al.  New Horizons for the Study of Dietary Fiber and Health: A Review , 2016, Plant Foods for Human Nutrition.

[18]  B. Dallapiccola,et al.  Gut Microbiota Dysbiosis as Risk and Premorbid Factors of IBD and IBS Along the Childhood–Adulthood Transition , 2016, Inflammatory bowel diseases.

[19]  J. Versalovic,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 , 2015, Alimentary pharmacology & therapeutics.

[20]  A. Griffiths,et al.  Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. , 2014, Journal of Crohn's & colitis.

[21]  R. Shulman,et al.  Brain-gut microbiome interactions and functional bowel disorders. , 2014, Gastroenterology.

[22]  N. Oezguen,et al.  Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome , 2014, Gut microbes.

[23]  B. Chang,et al.  The protective effect of VSL#3 on intestinal permeability in a rat model of alcoholic intestinal injury , 2013, BMC Gastroenterology.

[24]  A. McBain,et al.  Strain-Dependent Augmentation of Tight-Junction Barrier Function in Human Primary Epidermal Keratinocytes by Lactobacillus and Bifidobacterium Lysates , 2013, Applied and Environmental Microbiology.

[25]  I. Polanco,et al.  Gastrointestinal Microbiota and Some Children Diseases: A Review , 2012, Gastroenterology research and practice.

[26]  Craig A. Smith,et al.  Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood , 2012, PAIN®.

[27]  K. Whelan,et al.  Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. , 2012, The Journal of nutrition.

[28]  W. Gardner,et al.  The care of constipated children in primary care in different countries , 2012, Acta paediatrica.

[29]  Aleksandar Milosavljevic,et al.  Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. , 2011, Gastroenterology.

[30]  H. Szajewska,et al.  Meta‐analysis: Lactobacillus rhamnosus GG for abdominal pain‐related functional gastrointestinal disorders in childhood , 2011, Alimentary pharmacology & therapeutics.

[31]  E. Lionetti,et al.  A Randomized Controlled Trial of Lactobacillus GG in Children With Functional Abdominal Pain , 2010, Pediatrics.

[32]  Å. Keita,et al.  The intestinal barrier and its regulation by neuroimmune factors , 2010, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[33]  E. Murphy,et al.  Dietary prebiotics: current status and new definition , 2010 .

[34]  Jerrold R. Turner,et al.  Intestinal mucosal barrier function in health and disease , 2009, Nature Reviews Immunology.

[35]  R. Rao,et al.  Probiotics ameliorate the hydrogen peroxide-induced epithelial barrier disruption by a PKC- and MAP kinase-dependent mechanism. , 2008, American journal of physiology. Gastrointestinal and liver physiology.

[36]  P. Sherman,et al.  Lactobacillus rhamnosus Strain GG Prevents Enterohemorrhagic Escherichia coli O157:H7-Induced Changes in Epithelial Barrier Function , 2008, Infection and Immunity.

[37]  D. Jonkers,et al.  Review article: the role of butyrate on colonic function , 2007, Alimentary pharmacology & therapeutics.

[38]  J. Varni,et al.  Health-Related Quality of Life in Pediatric Patients with Irritable Bowel Syndrome:: A Comparative Analysis , 2006, Journal of developmental and behavioral pediatrics : JDBP.

[39]  Peter Holzer,et al.  Neuropeptides and the microbiota-gut-brain axis. , 2014, Advances in experimental medicine and biology.

[40]  J. Slavin,et al.  What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children. , 2012, Advances in nutrition.

[41]  N. Talley.  A Randomized Controlled Trial of Lactobacillus GG in Children With Functional Abdominal Pain , 2011 .

[42]  A. Fasano.  Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. , 2011, Physiological reviews.

[43]  J. Rumessen,et al.  Effect of Nonabsorbed Amounts of a Fructose–Sorbitol Mixture on Small Intestinal Transit in Healthy Volunteers , 2006, Digestive Diseases and Sciences.