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Restricting dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can alleviate symptoms in children with disorders of gut-brain interaction (DGBI). Due to the restrictions of a low FODMAP diet (LFD), a less restrictive FODMAP Gentle diet (FGD) has been suggested. However, the types and amounts of high FODMAP foods and carbohydrates commonly consumed by children have not been studied. We aimed to identify the high FODMAP foods and proportions of FODMAP carbohydrates consumed by children with DGBI and healthy children (HC) and to determine which usually ingested FODMAPs would be restricted on the FGD. Three-day diet records from both children with DGBI and HC were analyzed and compared to assess the type and amount of high FODMAP foods and carbohydrates ingested. Additionally, the ingested FODMAPs that would be restricted on the FGD were determined. Diet records from 77 children with DGBI and 64 HC were analyzed. The number of foods ingested daily was similar between children with DGBI and HC (12.3 ± 4.2 vs 12.9 ± 3.4, respectively); high FODMAP foods comprised most foods eaten in both groups. Children with DGBI (vs. HC) ate fewer high FODMAP foods per day (6.5 ± 2.3 vs 8.7 ± 2.4, P < 0.0001, respectively). Fructans were the most consumed FODMAP carbohydrate in both groups, and children with DGBI (vs. HC) consumed fewer fructans, lactose, fructose, and polyols (all P < 0.0001). The top 3 food categories consumed in both groups were wheat-containing foods, dairy, and fruits/ 100% fruit juices. In children with DGBI, 80.9% of the high FODMAP foods consumed would be limited on the FGD. Children with DGBI consume fewer high FODMAP foods and carbohydrates than HC, with the top consumed FODMAP carbohydrates being fructans, lactose, and fructose. A FGD would restrict most high FODMAP foods consumed by children with DGBI.

The Rome III classification system treats functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) as distinct disorders, but this distinction appears artificial, and the same drugs are used to treat both. This study's hypothesis is that FC and IBS-C defined by Rome III are not distinct entities. In all, 1,100 adults with a primary care visit for constipation and 1,700 age- and gender-matched controls from a health maintenance organization completed surveys 12 months apart; 66.2% returned the first questionnaire. Rome III criteria identified 231 with FC and 201 with IBS-C. The second survey was completed by 195 of the FC and 141 of the IBS-C cohorts. Both surveys assessed the severity of constipation and IBS, quality of life (QOL), and psychological distress. (i) Overlap: if the Rome III requirement that patients meeting criteria for IBS cannot be diagnosed with FC is suspended, 89.5% of IBS-C cases meet criteria for FC and 43.8% of FC patients fulfill criteria for IBS-C. (ii) No qualitative differences between FC and IBS-C: 44.8% of FC patients report abdominal pain, and paradoxically IBS-C patients have more constipation symptoms than FC. (iii) Switching between diagnoses: by 12 months, 1/3 of FC transition to IBS-C and 1/3 of IBS-C change to FC. Patients identified by Rome III criteria for FC and IBS-C are not distinct groups. Revisions to the Rome III criteria, possibly including incorporation of physiological tests of transit and pelvic floor function, are needed.

Background Functional abdominal pain (FAP) of childhood is characterized by, among other things, pain with no known physiological cause, and family patterns of related disorders have been reported. Purpose The purpose of this paper is to trace the development of one FAP research program and highlight some of its key findings from observations of interaction patterns to intervention studies designed to test outcomes of altering these patterns. Methods Studies summarized include observational and experimental research. Results Parental response to child pain behaviors appears to be a key factor in the development and maintenance of FAP, and intervention which includes targeting changes in parental responses can decrease reports of pain and other illness behaviors. Conclusions Research into FAP can provide valuable information for not only FAP and other unexplained pain conditions, but other medical conditions where environmental responses may play an important role in their etiology and maintenance.

Background Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children’s expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration ClinicalTrials.gov NCT05730491. Registered on February 15, 2023.

Background The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach. Methods Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.g., lifetime weight loss, current weight loss behaviors), and completion of the 6-month assessment visit. Results Men comprised 14.2% of participants who responded to non-targeted recruitment efforts, while targeted efforts yielded 50.4% men. Similarly, people of color comprised 12.8% of those who responded to non-targeted approaches, whereas targeted recruitment methods yielded 47.2% people of color. Men recruited through targeted methods were younger ( p  = 0.01) than men recruited through non-targeted means but were otherwise similar. Women of color recruited through targeted methods reported use of fewer weight loss strategies relative to women of color recruited through non-targeted means ( p  = 0.006) but were otherwise similar. There were no differences by recruitment method on retention to the study. Conclusions Using targeted recruitment methods increased the ethnic and gender diversity of the recruited sample without reducing study retention. This targeting also increased the enrollment of women with less weight loss experience who may not have otherwise sought out a weight loss program. Developing and implementing a targeted recruitment plan should be considered early in the clinical trial development process. Trial registration Clinicaltrials.gov, NCT02368002 . Registered on 20 February 2015.

Background and Objectives: The attachment-diathesis model of chronic pain, which associates insecure attachment with pain catastrophizing and worse pain-related outcomes, is well-supported in adults. Although Functional Abdominal Pain Disorders (FAPDs) are common in youth, with symptoms influenced by the parent–child dynamic, an attachment-diathesis model of FAPDs is unexplored. The aim of this study was to investigate if insecure parental attachment is associated with pain catastrophizing and pain-related variables in youth with FAPDs. Methods: Baseline questionnaire data from an RCT of cognitive behavioral therapy for children with FAPDs (n = 200, 73% girls, 93% White, and a mean age of 11.2 years old) were used to examine relationships between parental attachment (subscales include Alienation, Trust, and Communication), catastrophizing, and pain-related variables (depression, disability, and gastrointestinal (GI) symptom severity). Results: Alienation was significantly correlated with depression (r = 0.39), GI symptom severity (r = 0.30), and disability (r = 0.22; ps < 0.05). Trust was also correlated with depression (r = −0.39), GI symptom severity (r = −0.19), and disability (r = −0.19; ps < 0.05). Communication was associated with depression (r = −0.30, p < 0.01). Catastrophizing mediated these associations, accounting for 22–89% of the relationship between attachment and pain-related variables. Conclusions: Children who report a less secure attachment to their parents report more physical and psychological symptomatology than children who describe their attachment as more secure. This association is partly explained by child catastrophizing. Results suggest that parent–child attachment and catastrophizing may be important treatment targets in children with FAPDs.

Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological factors with symptoms at baseline and response to intervention. We are conducting a pilot randomized controlled trial of the CSM-IBD intervention. Participants aged 18-75 years who are experiencing at least 2 symptoms are eligible for inclusion. We plan to enroll 54 participants who will be randomized (2:1) into the CSM-IBD program or usual care. Patients in the CSM-IBD program will have 8 intervention sessions. Primary study outcomes include the feasibility of recruitment, randomization, and data or sample collection, as well as the acceptability of study procedures and interventions. Preliminary efficacy outcome variables include quality of life and symptoms. Outcomes data will be assessed at baseline, immediately post intervention, and 3 months post intervention. Participants in the usual care group will have access to the intervention after study participation. This project is funded by the National Institutes of Nursing Research and reviewed by the University of Washington's institutional review board. Recruitment began in February 2023. As of April 2023, we have enrolled 4 participants. We expect the study to be completed by March 2025. This pilot study will evaluate the feasibility and efficacy of a self-management intervention (a web-based program with weekly check-ins with a registered nurse) that aims to improve symptom management in individuals with IBD. In the long term, we aim to validate a self-management intervention to improve patient quality of life, reduce direct and indirect costs related to IBD, and be culturally appropriate and accessible, particularly in rural and underserved communities. ClinicalTrials.gov NCT05651542; https://clinicaltrials.gov/ct2/show/NCT05651542. PRR1-10.2196/46307.

Irritable bowel syndrome (IBS) runs in families. The aims of this study were (i) to exclude biased perception by a mother with irritable bowel as the explanation for increased gastrointestinal (GI) symptoms in their children, (ii) to determine whether non-GI as well as GI symptoms run in families, and (iii) to determine whether parent IBS status and solicitous responses to illness exert independent effects on children's symptom reports, medical clinic visits, and school absences. Two hundred and eight mothers with irritable bowel and their 296 children (cases: average age 11.9 yr; 48.6% male) and 241 nonirritable bowel mothers and their 335 children (controls: 11.8 yr; 49.0% male) were interviewed. Other factors assessed were stress, mother's and child's psychological symptoms, child's perceived competence, pain coping style, age, and sex. Children were interviewed apart from their parents. Case children independently reported more frequent stomach aches (F(591) = 9.22; p= 0.0025) and non-GI symptoms (F(562) = 21.03; p < 0.001) than control children. Case children also had more school absences (F(625) = 26.53; p < 0.0001), physician visits for GI symptoms (F(602) = 8.09; p= 0.005), and non-GI clinic visits (F(602) = 27.92; p < 0.001) than control children. Children whose mothers made solicitous responses to illness complaints independently reported more severe stomach aches (F(590) = 11.42; p < 0.001), and they also had more school absences for stomach aches (F(625) = 5.33; p < 0.05), but solicitous behavior did not significantly impact non-GI symptom reporting, clinic visits, or school absences. Differences between cases and controls remained significant after adjusting for potential moderators. (i) Frequent GI complaints in children whose mothers have irritable bowel are not explained by the mother's biased perceptions; (ii) children of mothers with irritable bowel have more non-GI as well as GI symptoms, disability days, and clinical visits; (iii) and parent IBS status and solicitous responses to illness have independent effects on the child's symptom complaints.

While much has been written about the relationship between only child status and parents’ behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this study, 227 mothers of 342 children completed measures designed to assess: (a) their children’s school attendance, (b) their own psychological status, and (c) their own responses to their children’s expressions of stomach pain. Parents of only children were more likely to minimize their children’s gastrointestinal symptoms than were parents of children with at least one sibling. In addition, only children were less likely to miss school. Parental protectiveness did not differ as a function of only child status. These findings are somewhat discrepant with commonly held beliefs about parents’ patterns of responding to only children.

The obesity epidemic has been recognized in the professional and lay public as a major health problem in the United States and many other cultures. The gastroenterology literature has recently paid attention to this problem, focusing primarily on either physiological mechanisms of obesity or surgical remedies for obesity. However, behavioral strategies developed from social learning theory have been the most thoroughly tested interventions for the treatment of obesity, as well as the interventions shown most clearly to have clinical benefit. Nevertheless, descriptions of behavioral techniques and their theoretical underpinnings have been minimal in the gastroenterology literature. Here, a brief history and presentation of the theoretical underpinnings of behavioral strategies for obesity management is summarized, emphasizing some of the key components, treatment effectiveness data, and needed areas for further research. Overall, it is concluded that behavior therapy is both the most studied and most effective therapy for treating obesity at present. Gastroenterologists are encouraged to use it as a first line of treatment for most obese patients, and as a key component of therapies that involve pharmacologic and surgical components.