Lactobacillus reuteri DSM 17938 for the Management of Functional Abdominal Pain in Childhood: A Randomized, Double-Blind, Placebo-Controlled Trial

Weizman, Zvi; Abu-Abed, Jaber; Binsztok, Mauricio

doi:10.1016/j.jpeds.2016.04.003

Cited by 69 publications

(50 citation statements)

References 28 publications

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“…However, recent randomised controlled trials demonstrated no significant benefit of probiotics preparations over placebo in the treatment of pain in adults with IBS44 in contrast to the benefit observed in some (but not all) trials in children with regard to frequency and intensity of abdominal pain, for example, with a combination of three Bifidobacterial species45 or a single bacterial species 46…”

Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 95%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

121

122

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This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

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Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 95%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

121

122

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“…Randomised studies have demonstrated evidence for the efficacy of several interventions for FGIDs in adults and children, including the role of cognitive behavioural therapy, gut‐directed hypnotherapy and probiotics in both FAP and IBS and, in addition, low FODMAP diet and peppermint oil in IBS. Although a large proportion of respondents believed there was a lack of clear evidence for effective therapy for FAP and IBS, knowledge of an evidence base did not appear to influence management options selected for either vignette.…”

Section: Discussionmentioning

confidence: 99%

Functional gastrointestinal disorders in children and adolescents: Knowledge, practice and attitudes of Australian paediatricians

Heinsch

Nightingale

2019

J Paediatrics Child Health

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Aim To investigate paediatricians' understanding of, and approaches to, the diagnosis and treatment of functional abdominal pain (FAP) and irritable bowel syndrome (IBS) in children. Methods This study used an electronic survey of doctors subscribing to a popular Australian‐based paediatrics email forum. Responses about investigation and management in two clinical vignettes were correlated with respondent demographic data, practice setting, attitudes and knowledge. Results The 327 respondents were mostly female (60.3%), aged <45 years (54.5%), general paediatricians (53.5%), working in public outpatient clinics (50.5%). Awareness of Rome III diagnostic criteria was low (37.2%) but associated with confidence in diagnosing FAP/IBS in the vignettes. Respondents who lacked confidence in diagnosing FAP/IBS requested more investigations (P < 0.05), although most acknowledged they would not be helpful. Most (70.5%) believed that families are unlikely to accept an FAP diagnosis without investigations requested. Fewer than 1 of 3 were aware of clear evidence for the effective therapy of FAP or IBS, although awareness did not influence management options selected. Two‐thirds of respondents believe that FAP is a psychological rather than a medical problem, while few (8.8%) believe the same about IBS (P < 0.001). Parental pressure to find an immediate cure was cited as the most frequent challenge to successful management in both FAP (86.6%) and IBS (75.9%). Conclusions Awareness of the Rome criteria was associated with greater confidence in diagnosing FAP and IBS. Attitudes to FAP and IBS being diagnoses of exclusion are prevalent among paediatricians and associated with more investigations requested. There is a lack of awareness of evidence‐based therapies for FAP and IBS.

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“…Jadrešin et al 137 demonstrated a reduction in days with pain and pain severity in children with IBS and FAP. In studies focused specifically on FAP, Romano et al 138 reported reduced pain severity and Weizman et al 139 and Maragkoudaki et al 140 both reported reduced pain severity and frequency in those treated with the probiotic compared with placebo.…”

Section: Functional Gi Disordersmentioning

confidence: 99%

The Gut Microbiome in Adult and Pediatric Functional Gastrointestinal Disorders

Shin

Preidis

Shulman

et al. 2019

Clinical Gastroenterology and Hepatology

127

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The importance of gut microbiota in gastrointestinal (GI) physiology was well described, but our ability to study gut microbial ecosystems in their entirety was limited by culture-based methods prior to the sequencing revolution. The advent of high-throughput sequencing opened new avenues, allowing us to study gut microbial communities as an aggregate, independent of our ability to culture individual microbes. Early studies focused on association of changes in gut microbiota with different disease states, which was necessary to identify a potential role for microbes and generate novel hypotheses. Over the past few years the field has moved beyond associations to better understand the mechanistic implications of the microbiome in the pathophysiology of complex diseases. This movement also has resulted in a shift in our focus toward therapeutic strategies, which rely on better understanding the mediators of gut microbiota-host cross-talk. It is not surprising the gut microbiome has been implicated in the pathogenesis of functional gastrointestinal disorders given its role in modulating physiological processes such as immune development, GI motility and secretion, epithelial barrier integrity, and brain-gut communication. In this review, we focus on the current state of knowledge and future directions in microbiome research as it pertains to functional gastrointestinal disorders. We summarize the factors that help shape the gut microbiome in human beings. We discuss data from animal models and human studies to highlight existing paradigms regarding the mechanisms underlying microbiota-mediated alterations in physiological processes and their relevance in human interventions. While translation of microbiome science is still in its infancy, the outlook is optimistic and we are advancing in the right direction toward precise mechanism-based microbiota therapies.

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Lactobacillus reuteri DSM 17938 for the Management of Functional Abdominal Pain in Childhood: A Randomized, Double-Blind, Placebo-Controlled Trial

Cited by 69 publications

References 28 publications

Dietary and pharmacological treatment of abdominal pain in IBS

Dietary and pharmacological treatment of abdominal pain in IBS

Functional gastrointestinal disorders in children and adolescents: Knowledge, practice and attitudes of Australian paediatricians

The Gut Microbiome in Adult and Pediatric Functional Gastrointestinal Disorders

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