Integrated Multidisciplinary Approach to the Treatment of Post-Infectious Irritable Bowel Syndrome in Young Children (0–4 Years): A Real-World Observational Study

Integrated Multidisciplinary Approach to the Treatment of Post-Infectious Irritable Bowel Syndrome in Young Children (0–4 Years): A Real-World Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrated Multidisciplinary Approach to the Treatment of Post-Infectious Irritable Bowel Syndrome in Young Children (0–4 Years): A Real-World Observational Study Saikhat Shamsadova This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9612751/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Post-infectious irritable bowel syndrome (PI-IBS) in young children is associated with persistent gastrointestinal symptoms, including abdominal pain, altered bowel habits, and food intolerance. Standard therapeutic approaches often fail to achieve sustained clinical improvement. Epidemiological data suggest that up to 10–30% of children continue to experience symptoms for several months following an acute intestinal infection. Objective To evaluate the effectiveness of an integrated multidisciplinary approach (low-FODMAP diet, enzyme therapy, individualized probiotics) in the management of PI-IBS in children aged 0–4 years in a real-world clinical setting. Methods This observational study included 50 pediatric patients with PI-IBS who had not responded to standard therapy. The treatment protocol consisted of a low-FODMAP diet, enzyme therapy with meals, individualized probiotic selection, and identification of dietary triggers. Patients were followed for 4–8 weeks. Outcomes were assessed based on symptom improvement and remission rates. Pain was assessed by parents using a visual analog scale (VAS). Results Clinical improvement, defined as normalization of bowel habits and a ≥ 50% reduction in abdominal pain, was observed in 74.0% of patients (37/50). Sustained remission (absence of symptoms for at least 4 weeks after completing the active treatment phase) was achieved in 56.0% (28/50). Additional improvements included reduced bloating, resolution of malabsorption signs, and improved food tolerance. Conclusions The integrated multidisciplinary approach demonstrates clinically meaningful effectiveness in pediatric patients with PI-IBS resistant to standard therapy. This strategy is low-cost, scalable, and potentially applicable in primary care settings, including medically underserved areas. Further randomized controlled studies are needed to confirm these findings. Pediatrics Post-infectious irritable bowel syndrome low-FODMAP diet probiotics pediatrics real-world data young children Introduction Post-infectious irritable bowel syndrome (PI-IBS) is a recognized functional gastrointestinal disorder that may develop after an episode of acute intestinal infection [ 1 , 2 ]. In pediatric populations, particularly in children under five years of age, PI-IBS represents a significant clinical challenge due to its impact on nutrition, growth, and quality of life. Clinical manifestations include recurrent abdominal pain, diarrhea, constipation, or alternating bowel habits, often accompanied by bloating, malabsorption, and food intolerance [ 3 , 4 ]. These symptoms may persist for months after the initial infection. The pathophysiology of PI-IBS is multifactorial and involves alterations in gut microbiota, low-grade inflammation, visceral hypersensitivity, and impaired carbohydrate digestion [ 5 , 6 ]. Standard treatment approaches often provide limited benefit. Recent evidence highlights the importance of dietary modification, including low-FODMAP diets, and microbiota-targeted therapies [ 7 , 8 ]. This study evaluates an integrated multidisciplinary treatment approach (low-FODMAP diet + enzyme therapy + probiotics) in young children in a real-world clinical setting. --- Materials and Methods Study Design – This was a real-world observational study based on clinical practice data collected between January 2024 and March 2026. Participants – A total of 50 pediatric patients aged 0–4 years diagnosed with PI-IBS were included. Inclusion Criteria · Persistent gastrointestinal symptoms following acute intestinal infection · Abdominal pain ≥ 3 times per week · Abnormal stool consistency (Bristol Stool Scale types 1–2 or 6–7) · Signs of malabsorption (undigested food, foul-smelling stools) · Food intolerance to at least two food groups · Lack of response to standard therapy (probiotics, enterosorbents, symptomatic treatment) Exclusion Criteria · Organic gastrointestinal diseases (e.g., celiac disease, inflammatory bowel disease) · Congenital enzyme deficiencies · Severe comorbid conditions Treatment Protocol · Identification of dietary triggers through detailed history · Low-FODMAP diet [ 7 , 8 ] · Enzyme therapy (pancreatic enzymes) with meals · Individualized probiotic selection [ 9 ] · Gradual food reintroduction and symptom monitoring Follow-Up and Outcome Measures Patients were monitored for 4–8 weeks. Clinical improvement was defined as normalization of stool consistency and a ≥ 50% reduction in abdominal pain (assessed by parents using a visual analog scale, VAS). Sustained remission was defined as absence of symptoms for at least 4 weeks after completing the active treatment phase. Statistical Analysis – Descriptive statistical analysis was performed (percentages and absolute numbers). Ethical Considerations – All patient data were anonymized. The study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a retrospective analysis of anonymized clinical data, formal ethical approval was not required under the laws of the country where the study was performed. --- Results Clinical improvement was observed in 74.0% of patients (37/50). The mean reduction in abdominal pain was approximately 70–80% in the improved group (complete resolution in 62% of those who responded). Sustained remission was achieved in 56.0% (28/50). Additional positive changes included: · Normalization of stool consistency and frequency · Reduction in bloating and flatulence · Resolution of signs of malabsorption (undigested food, foul odor) · Restoration of tolerance to previously excluded foods (vegetables, fruits, certain grains) The proportion of responders significantly exceeded the reported effectiveness of standard therapy (~ 40–50% in the literature [ 3 , 4 ]), suggesting a potential advantage of the integrated approach. Results were reproducible across different age subgroups and baseline symptom severity. --- Discussion This real-world study suggests that an integrated multidisciplinary approach (low-FODMAP diet + enzymes + probiotics) may provide clinically meaningful benefit in young children with PI-IBS resistant to standard therapy. The effectiveness of this approach may be explained by targeting multiple pathogenic mechanisms simultaneously: · Dietary modification (low-FODMAP) reduces osmotic load and fermentation · Enzyme therapy improves carbohydrate and fat digestion, reducing substrate for bacterial fermentation · Probiotics help restore gut microbiota and modulate motility Unlike conventional symptom-based management, this model addresses the multifactorial nature of PI-IBS. The real-world design enhances the applicability of findings in routine pediatric practice, including resource-limited settings. Limitations · Observational design without a control group · Moderate sample size (n = 50) · Lack of long-term follow-up (> 6 months) · Possible selection bias Further randomized controlled trials with larger samples and longer follow-up are needed to confirm these preliminary results. --- Conclusions The integrated multidisciplinary approach demonstrates clinically meaningful effectiveness in young children with post-infectious IBS. High rates of improvement (74.0%) and sustained remission (56.0%) support its clinical relevance. This approach is low-cost, scalable, and potentially applicable in primary care settings, including medically underserved areas. Further research is required to confirm long-term outcomes and to compare this approach head-to-head with standard therapy. --- Declarations Acknowledgements – None. Conflict of Interest – The author declares no conflict of interest. Funding – This research received no external funding. Ethics statement: The need for ethical approval was waived by the Institutional Review Board of the Republican Children's Clinical Hospital named after E.P. Glinka (Grozny, Russian Federation) because the study involved a retrospective analysis of anonymized clinical data and posed no risk to participants. Consent statement: The requirement for patient consent was waived by the same Institutional Review Board for the same reasons (retrospective, anonymized data). References Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26(4):535-544. Schmulson M, Drossman DA. What is new in Rome IV? J Neurogastroenterol Motil. 2017;23(2):151-163. Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016;150(6):1456-1468. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566-2578. Barbara G, Feinle-Bisset C, Ghoshal UC, et al. The intestinal microenvironment and functional gastrointestinal disorders. Gastroenterology. 2019;156(5):1359-1369. Camilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med. 2012;367(17):1626-1635. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258. Hill C, Guarner F, Reid G, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. Additional Declarations The authors declare no competing interests. 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Glinka, Grozny, Russian Federation","correspondingAuthor":true,"prefix":"","firstName":"Saikhat","middleName":"","lastName":"Shamsadova","suffix":""}],"badges":[],"createdAt":"2026-05-05 01:10:13","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9612751/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9612751/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108677195,"identity":"4bbb1b4c-b4bd-4428-84e6-c6d96bee98ee","added_by":"auto","created_at":"2026-05-07 08:43:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":119799,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9612751/v1/9f745bb8-4e95-4e3f-b15c-3a8e800309d1.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eIntegrated Multidisciplinary Approach to the Treatment of Post-Infectious Irritable Bowel Syndrome in Young Children (0–4 Years): A Real-World Observational Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePost-infectious irritable bowel syndrome (PI-IBS) is a recognized functional gastrointestinal disorder that may develop after an episode of acute intestinal infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In pediatric populations, particularly in children under five years of age, PI-IBS represents a significant clinical challenge due to its impact on nutrition, growth, and quality of life.\u003c/p\u003e \u003cp\u003eClinical manifestations include recurrent abdominal pain, diarrhea, constipation, or alternating bowel habits, often accompanied by bloating, malabsorption, and food intolerance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These symptoms may persist for months after the initial infection. The pathophysiology of PI-IBS is multifactorial and involves alterations in gut microbiota, low-grade inflammation, visceral hypersensitivity, and impaired carbohydrate digestion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStandard treatment approaches often provide limited benefit. Recent evidence highlights the importance of dietary modification, including low-FODMAP diets, and microbiota-targeted therapies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study evaluates an integrated multidisciplinary treatment approach (low-FODMAP diet\u0026thinsp;+\u0026thinsp;enzyme therapy\u0026thinsp;+\u0026thinsp;probiotics) in young children in a real-world clinical setting.\u003c/p\u003e \u003cp\u003e---\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eStudy Design \u0026ndash; This was a real-world observational study based on clinical practice data collected between January 2024 and March 2026.\u003c/p\u003e \u003cp\u003eParticipants \u0026ndash; A total of 50 pediatric patients aged 0\u0026ndash;4 years diagnosed with PI-IBS were included.\u003c/p\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003cp\u003e\u0026middot; Persistent gastrointestinal symptoms following acute intestinal infection\u003c/p\u003e \u003cp\u003e\u0026middot; Abdominal pain\u0026thinsp;\u0026ge;\u0026thinsp;3 times per week\u003c/p\u003e \u003cp\u003e\u0026middot; Abnormal stool consistency (Bristol Stool Scale types 1\u0026ndash;2 or 6\u0026ndash;7)\u003c/p\u003e \u003cp\u003e\u0026middot; Signs of malabsorption (undigested food, foul-smelling stools)\u003c/p\u003e \u003cp\u003e\u0026middot; Food intolerance to at least two food groups\u003c/p\u003e \u003cp\u003e\u0026middot; Lack of response to standard therapy (probiotics, enterosorbents, symptomatic treatment)\u003c/p\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003e\u0026middot; Organic gastrointestinal diseases (e.g., celiac disease, inflammatory bowel disease)\u003c/p\u003e \u003cp\u003e\u0026middot; Congenital enzyme deficiencies\u003c/p\u003e \u003cp\u003e\u0026middot; Severe comorbid conditions\u003c/p\u003e \u003cp\u003eTreatment Protocol\u003c/p\u003e \u003cp\u003e\u0026middot; Identification of dietary triggers through detailed history\u003c/p\u003e \u003cp\u003e\u0026middot; Low-FODMAP diet [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e\u0026middot; Enzyme therapy (pancreatic enzymes) with meals\u003c/p\u003e \u003cp\u003e\u0026middot; Individualized probiotic selection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e\u0026middot; Gradual food reintroduction and symptom monitoring\u003c/p\u003e \u003cp\u003eFollow-Up and Outcome Measures\u003c/p\u003e \u003cp\u003ePatients were monitored for 4\u0026ndash;8 weeks. Clinical improvement was defined as normalization of stool consistency and a\u0026thinsp;\u0026ge;\u0026thinsp;50% reduction in abdominal pain (assessed by parents using a visual analog scale, VAS). Sustained remission was defined as absence of symptoms for at least 4 weeks after completing the active treatment phase.\u003c/p\u003e \u003cp\u003eStatistical Analysis \u0026ndash; Descriptive statistical analysis was performed (percentages and absolute numbers).\u003c/p\u003e \u003cp\u003eEthical Considerations \u0026ndash; All patient data were anonymized. The study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a retrospective analysis of anonymized clinical data, formal ethical approval was not required under the laws of the country where the study was performed.\u003c/p\u003e \u003cp\u003e---\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eClinical improvement was observed in 74.0% of patients (37/50). The mean reduction in abdominal pain was approximately 70\u0026ndash;80% in the improved group (complete resolution in 62% of those who responded).\u003c/p\u003e \u003cp\u003eSustained remission was achieved in 56.0% (28/50).\u003c/p\u003e \u003cp\u003eAdditional positive changes included:\u003c/p\u003e \u003cp\u003e\u0026middot; Normalization of stool consistency and frequency\u003c/p\u003e \u003cp\u003e\u0026middot; Reduction in bloating and flatulence\u003c/p\u003e \u003cp\u003e\u0026middot; Resolution of signs of malabsorption (undigested food, foul odor)\u003c/p\u003e \u003cp\u003e\u0026middot; Restoration of tolerance to previously excluded foods (vegetables, fruits, certain grains)\u003c/p\u003e \u003cp\u003eThe proportion of responders significantly exceeded the reported effectiveness of standard therapy (~\u0026thinsp;40\u0026ndash;50% in the literature [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]), suggesting a potential advantage of the integrated approach. Results were reproducible across different age subgroups and baseline symptom severity.\u003c/p\u003e \u003cp\u003e---\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis real-world study suggests that an integrated multidisciplinary approach (low-FODMAP diet\u0026thinsp;+\u0026thinsp;enzymes\u0026thinsp;+\u0026thinsp;probiotics) may provide clinically meaningful benefit in young children with PI-IBS resistant to standard therapy.\u003c/p\u003e \u003cp\u003eThe effectiveness of this approach may be explained by targeting multiple pathogenic mechanisms simultaneously:\u003c/p\u003e \u003cp\u003e\u0026middot; Dietary modification (low-FODMAP) reduces osmotic load and fermentation\u003c/p\u003e \u003cp\u003e\u0026middot; Enzyme therapy improves carbohydrate and fat digestion, reducing substrate for bacterial fermentation\u003c/p\u003e \u003cp\u003e\u0026middot; Probiotics help restore gut microbiota and modulate motility\u003c/p\u003e \u003cp\u003eUnlike conventional symptom-based management, this model addresses the multifactorial nature of PI-IBS. The real-world design enhances the applicability of findings in routine pediatric practice, including resource-limited settings.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003e\u0026middot; Observational design without a control group\u003c/p\u003e \u003cp\u003e\u0026middot; Moderate sample size (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003cp\u003e\u0026middot; Lack of long-term follow-up (\u0026gt;\u0026thinsp;6 months)\u003c/p\u003e \u003cp\u003e\u0026middot; Possible selection bias\u003c/p\u003e \u003cp\u003eFurther randomized controlled trials with larger samples and longer follow-up are needed to confirm these preliminary results.\u003c/p\u003e \u003cp\u003e---\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe integrated multidisciplinary approach demonstrates clinically meaningful effectiveness in young children with post-infectious IBS. High rates of improvement (74.0%) and sustained remission (56.0%) support its clinical relevance. This approach is low-cost, scalable, and potentially applicable in primary care settings, including medically underserved areas.\u003c/p\u003e \u003cp\u003eFurther research is required to confirm long-term outcomes and to compare this approach head-to-head with standard therapy.\u003c/p\u003e \u003cp\u003e---\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements – None.\u003c/p\u003e\n\u003cp\u003eConflict of Interest – The author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding – This research received no external funding.\u003c/p\u003e\n\u003cp\u003eEthics statement: The need for ethical approval was waived by the Institutional Review Board of the Republican Children's Clinical Hospital named after E.P. Glinka (Grozny, Russian Federation) because the study involved a retrospective analysis of anonymized clinical data and posed no risk to participants.\u003c/p\u003e\n \u003cp\u003eConsent statement: The requirement for patient consent was waived by the same Institutional Review Board for the same reasons (retrospective, anonymized data).\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26(4):535-544.\u003c/li\u003e\n\u003cli\u003eSchmulson M, Drossman DA. What is new in Rome IV? J Neurogastroenterol Motil. 2017;23(2):151-163.\u003c/li\u003e\n\u003cli\u003eHyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016;150(6):1456-1468.\u003c/li\u003e\n\u003cli\u003eFord AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566-2578.\u003c/li\u003e\n\u003cli\u003eBarbara G, Feinle-Bisset C, Ghoshal UC, et al. The intestinal microenvironment and functional gastrointestinal disorders. Gastroenterology. 2019;156(5):1359-1369.\u003c/li\u003e\n\u003cli\u003eCamilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med. 2012;367(17):1626-1635.\u003c/li\u003e\n\u003cli\u003eHalmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.\u003c/li\u003e\n\u003cli\u003eGibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258.\u003c/li\u003e\n\u003cli\u003eHill C, Guarner F, Reid G, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Republican Children's Clinical Hospital named after E.P.Glinka, Grozny, Russian Federation","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Post-infectious irritable bowel syndrome, low-FODMAP diet, probiotics, pediatrics, real-world data, young children","lastPublishedDoi":"10.21203/rs.3.rs-9612751/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9612751/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-infectious irritable bowel syndrome (PI-IBS) in young children is associated with persistent gastrointestinal symptoms, including abdominal pain, altered bowel habits, and food intolerance. Standard therapeutic approaches often fail to achieve sustained clinical improvement. Epidemiological data suggest that up to 10–30% of children continue to experience symptoms for several months following an acute intestinal infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate the effectiveness of an integrated multidisciplinary approach (low-FODMAP diet, enzyme therapy, individualized probiotics) in the management of PI-IBS in children aged 0–4 years in a real-world clinical setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis observational study included 50 pediatric patients with PI-IBS who had not responded to standard therapy. The treatment protocol consisted of a low-FODMAP diet, enzyme therapy with meals, individualized probiotic selection, and identification of dietary triggers. Patients were followed for 4–8 weeks. Outcomes were assessed based on symptom improvement and remission rates. Pain was assessed by parents using a visual analog scale (VAS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical improvement, defined as normalization of bowel habits and a ≥ 50% reduction in abdominal pain, was observed in 74.0% of patients (37/50). Sustained remission (absence of symptoms for at least 4 weeks after completing the active treatment phase) was achieved in 56.0% (28/50). Additional improvements included reduced bloating, resolution of malabsorption signs, and improved food tolerance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe integrated multidisciplinary approach demonstrates clinically meaningful effectiveness in pediatric patients with PI-IBS resistant to standard therapy. This strategy is low-cost, scalable, and potentially applicable in primary care settings, including medically underserved areas. Further randomized controlled studies are needed to confirm these findings.\u003c/p\u003e","manuscriptTitle":"Integrated Multidisciplinary Approach to the Treatment of Post-Infectious Irritable Bowel Syndrome in Young Children (0–4 Years): A Real-World Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 08:42:44","doi":"10.21203/rs.3.rs-9612751/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd6741ee-ff92-4d37-bd07-a1781ebbc796","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67691936,"name":"Pediatrics"}],"tags":[],"updatedAt":"2026-05-07T08:42:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 08:42:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9612751","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9612751","identity":"rs-9612751","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}