Bruno P. Chumpitazi

Background We sought to determine how a low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet (LFD) affected high FODMAP food intake, nutrient intake, and diet quality in children with functional abdominal pain disorders (FAPD). Methods Children (ages 7–13 years) with Rome IV FAPD began a dietitian‐guided LFD. Three‐day food records were captured at baseline and 2–3 weeks into the LFD. Intake of high FODMAP foods, energy, macronutrients, micronutrients, food groups, and ultra‐processed foods were determined. Key results Median age of participants was 11 years, and 19/31 (61%) were female. Twenty‐eight (90%) decreased high FODMAP food intake on the LFD: overall median (25–75%) high FODMAP foods/day decreased from 5.7 (3.6–7.3) to 2 (0.3–3.7) ( p < 0.001). A more adherent subset ( n = 22/71%) of participants consumed on average ≤3 high FODMAP foods per day during the LFD. Baseline nutritional intake and quality were generally poor with several micronutrient deficiencies identified. Diet quality improved on the LFD with increased servings of vegetables and protein and decreased consumption of ultra‐processed foods, trans‐fatty acids, and added sugars. On the LFD, there were significant decreases in total carbohydrates and thiamin (remained within recommended intake) and significant increases in vitamin B6 ( p = 0.029), vitamin C ( p = 0.019), and vitamin E ( p = 0.009). Children more adherent to the LFD further increased vitamin D, magnesium, potassium, and fat servings. Conclusions and Inferences The majority of children with FAPD on a dietitian‐led LFD successfully decreased high FODMAP food intake. Children with FAPD on the LFD (vs. baseline) modestly improved micronutrient intake and diet quality.

Background Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. Methods Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re‐administered within 3 months. Inter‐rater and intra‐rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. Key Results Thirty‐four raters completed the initial survey of whom thirty‐one (91%) completed the repeat survey. Overall inter‐rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra‐rater agreement was 76%. In contrast, overall inter‐rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra‐rater agreement was only 57%. Between‐physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2–2.0, p = 0.015). Higher intra‐rater agreement was noted for diagnostic testing in faculty when compared to fellows ( p = 0.009). Conclusions & Inferences In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing.