Journal of Pediatric Gastroenterology & Nutrition:
Letters to the Editor
*Department of Paediatrics
†Department of Paediatric Dietetics St Richard's Hospital, Chichester, West Sussex, UK
To the Editor:
Functional gastrointestinal disorders such as irritable bowel syndrome (IBS) are managed with dietary manipulation, drugs, and stress management. We describe a novel therapy of partially hydrolysed guar gum (PHGG) (Optifibre), which is a 78% soluble fibre (1) in the management of IBS in the paediatric population. Resource Optifibre (Nestlé HealthCare Nutrition, Vevey, Switzerland), previously called Resource Benefibre, is a low viscous galactomannan recommended for intractable malabsorption and short bowel syndrome.
The single-centre cohort consisted of 46 children (26 girls) aged between 1 and 18 years. The stool consistency was determined using the Bristol Stool Form Scale, and stool types 1 to 2 and 6 to 7 were classified as constipated and diarrhoeal stools, respectively. None of the children were considered to have an organic cause for their symptoms such as parasitic infection, coeliac disease, or cow's-milk allergy.
The mode of action, method of administration, and expected benefits were discussed by a paediatric dietitian with the family before starting Optifibre therapy, which was continued for a minimum of 6 to 8 weeks. If adverse effects such as worsening of diarrhoea, constipation, or abdominal pain were noted, the therapy was stopped earlier. The age groups of the patients are presented in Figure 1.
The initial presentation and the outcome after the Optifibre therapy are shown in Table 1. Adverse effects were reported in 8 of 46 children (17%), 3 of whom reported worsening of both stool consistency and abdominal pain.
In a study of 188 adults in Italy presenting with IBS (2), patients were randomly assigned to receive fibre or PHGG for 12 weeks. Patients were allowed to switch groups depending on their subjective evaluation of their symptoms. Fifty percent of patients in the fibre group switched to the PHGG group, whereas only 11% did so from the PHGG to the fibre group. At the end of the study, although both interventions seemed efficacious as per initial protocol, intention-to-treat analysis showed significantly greater success in the PHGG group (60%) than in the fibre group (40%).
In another randomised controlled study of 61 children in Turkey comparing PHGG to lactulose in the treatment of childhood constipation, PHGG was found to be equally effective in relieving stool withholding, stool consistency, and constipation-associated abdominal pain (3). Our study showed that Optifiber is particularly useful in children with alternating constipation and diarrhoea because the diarrhoeal stools can become firmer without making the constipated stools harder or more frequent. Our preliminary findings suggest that PHGG may be useful in some children with IBS.
2. Parisi GC, Zilli M, Miani MP, et al. High-fiber diet supplementation in patients with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum (PHGG). Dig Dis Sci 2002; 47:1697–1704.
3. Üstundag G, Kuloglu Z, Kirbas N, et al. Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation? Turk J Gastroenterol 2010; 21:360–364.