How to manage irritable bowel syndrome in children

Abstract

Aim This paper discusses the risk factors and management of paediatric irritable bowel syndrome (IBS), with a focus on the role of the gastrointestinal microbiome. Methods English articles of interest published in PubMed and Google Scholar were searched using subject heading and keywords of interest. Results Only few randomised controlled trials on the management of IBS in children have been published. The vast majority of these intervention trials target to change the composition of the gastrointestinal microbiome. Most studies are underpowered. Major heterogeneities in study designs such as differences in inclusion criteria, including patients with different pain‐related functional gastrointestinal disorders and differences in primary outcomes, make it impossible to formulate recommendations. Overall, few adverse events are reported what could indicate safety or point to suboptimal conduction of clinical trials and safety reporting. However, it can also not be excluded that some interventions such as the administration of selected probiotic products may result in benefit. Conclusion There is insufficient evidence to recommend any therapeutic intervention in paediatric IBS, including manipulation of the gastrointestinal tract microbiome, despite the evidence that dysbiosis seems an associated pathophysiologic factor. More designed prospective trials are needed since IBS is not a rare condition during childhood.

Features of drug therapy for functional gastrointestinal disorders in children of preschool and primary school age

“…Эта передача сигналов может также модулировать нисходящую регуляцию моторики, секреции и передачи сигналов кишечника и мозга [13]. Открытие оси «кишечникмозг -микробиом» обозначило в качестве мишени терапии в лечении ФРОП коррекцию микробиоты [14,15]. Наряду с перечисленными выше механизмами, передача сигналов осуществляется также с помощью опиоидных рецепторов [16], которые принадлежат к суперсемейству семиспиральных трансмембранных рецепторов, связанных с G-белком (GPCR) [17].…”

Irritable Bowel Syndrome: Treating the Gut and Brain/Mind at the Same Time

“…Furthermore, it is to be noted that the administration of prebiotics is not advised for the management of functional gastrointestinal disorders (FGIDs) in pediatric patients. A study conducted in a sample of 71 children by Levy et al, which administrated a prebiotic treatment consisting of 900 mg inulin twice daily for a duration of four weeks, did not yield significant results [ 43 ].…”

“…The dose of the prebiotic used is a crucial factor in the treatment of IBS. Based on data obtained from four clinical trials conducted on adults, it has been observed that lower doses may be effective and high doses may have a negative impact on symptoms [ 43 , 44 ].…”

Synbiotics in the Management of Pediatric Gastrointestinal Disorders

“…A 2021 systematic review (23) on the different treatments of irritable bowel syndrome (IBS) identified only 1 trial that evaluated a synbiotic treatment (24). In this trial, a synbiotic treatment [ B. lactis B94 (5 × 10 9 CFU) and 900 mg inulin] was compared to a probiotic (5 × 10 9 CFU B. lactis B94) or a prebiotic (900 mg inulin) twice daily for 4 weeks, in 71 children with IBS (24).…”