Low-FODMAP diet for pediatric patients with disorders of gut-brain interaction: A systematic review and meta-analysis

The role of a low-FODMAP diet in pediatric disorders of gut-brain interaction (DGBIs), particularly irritable bowel syndrome (IBS) and functional abdominal pain (FAP), is unclear. This review synthesized evidence on its efficacy in children and adolescents with IBS or FAP.

PubMed, Embase, CENTRAL, and Web of Science were searched through May 2025 following PRISMA guidelines. Randomized and observational studies evaluating a low-FODMAP diet were included. The primary outcome was abdominal pain intensity, evaluated using both continuous and dichotomous measures. Secondary outcomes included pain frequency (also assessed using continuous and dichotomous measures), stool frequency, and patient satisfaction. Random-effects single-arm meta-analyses with subgroup analyses by diagnosis (IBS vs. FAP) were conducted.

Ten studies (N = 612) were included: eight evaluated IBS and six FAP. The diet significantly reduced abdominal pain intensity (SMD -1.37; 95% CI -2.18 to -0.57), with larger effects in IBS. Pain frequency improved in IBS (SMD -1.23; 95% CI -2.01 to -0.45) but not in FAP. Stool frequency showed no significant effect (SMD -0.26; 95% CI -0.97 to 0.45). Overall satisfaction was higher in IBS (83%) than in FAP (43%). Heterogeneity was substantial, and risk of bias was frequent, especially in observational studies.

A low-FODMAP diet may improve abdominal pain and satisfaction in pediatric IBS, while benefits for FAP are less certain. High heterogeneity and methodological limitations highlight the need for further controlled trials to confirm efficacy, evaluate long-term safety, and guide clinical recommendations.