Management of functional abdominal pain and irritable bowel syndrome in children and adolescents

Abstract

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents. Keywords children; cognitive-behavioral therapy; dietary therapy; functional abdominal pain; irritable bowel syndrome; pharmacotherapy; psychosocial intervention; recurrent abdominal pain Functional abdominal pain (FAP) and irritable bowel syndrome (IBS), both of which typically present with chronic abdominal pain, are common complaints in the pediatric population. Estimates on the prevalence of abdominal pain are varied, but community-and school-based studies have reported that as many as 13-38% of children and adolescents experience abdominal pain weekly, with up to 24% of children reporting symptoms persisting longer than 8 weeks [1,2]. For the vast majority of patients, an underlying inflammatory, anatomic, metabolic or neoplastic cause for recurrent abdominal discomfort is not found on evaluation [3]. A significant proportion of these patients are subsequently diagnosed with FAP or IBS. Both entities are included under the larger heading of functional gastrointestinal disorders (FGIDs), which are characterized by chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities [4]. The diagnosis of FAP or IBS is symptom-based and new criteria have been defined by the Rome III group (BOX 1) [4]. In addition to recurrent abdominal pain, children with IBS also experience disturbances in defecation, ranging from lumpy or hard stools to loose, watery stools or both. Adult patients †

Gastrointestinal and nutritional problems in neurologically impaired children

“…In the majority of patients no organic disease is identified 6 . Despite its benign nature the persistence of symptoms can result in significant stress to children and their families as well as clinicians concerned at the possibility of missing an underlying pathology.…”

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

“…1,2 AP-FGIDs have a significant impact on children and adolescents' quality of life, daily activities, and school absenteeism and can have long-term psychological implications. 3 Moreover, patients with AP-FGIDs are at risk for continued symptoms in adulthood, and the costs are substantial. [4][5][6] Standard medical care consists of reassurance, education, and dietary advice.…”

Systematic Review of Randomized Controlled Trials: Fiber Supplements for Abdominal Pain-Related Functional Gastrointestinal Disorders in Childhood

“…Abdominal pain-related functional gastrointestinal disorders (FGIDs) are common in the pediatric population and affect between 13 and 38% of children and adolescents [1]. No specific serologic markers or laboratory findings exist for functional abdominal disorders, whose evaluation and classification are primarily based on clinical signs.…”

“…The selection of the type of treatment to be administered to patients with FGIDs is further complicated by the fact that while individuals may exhibit similar troublesome gastrointestinal symptoms, the underlying cause in each case may differ [4]. The chronic relapsing nature of these conditions paired with the lack of effective and safe options for treatment have a negative impact on the patients and their families regarding all aspects of their lives [1]. As a result of these factors, the management of FGIDs tends to focus on the amelioration of symptoms rather than on the modification of the course of the disease or on its cure.…”

“…However, Huertas-Ceballos et al [9] identified only 2 studies that employed varying methodological quality, used different types of fiber, and enrolled a heterogeneous population of children in the analysis which supported their conclusion [16,17]. Nevertheless, many clinicians routinely recommend the use of bulking agents or dietary fiber to stimulate regular bowel movements and to improve symptoms associated with FGIDs [1]. With the current systematic review, we aimed to update and synthesize the available clinical trial evidence of the likely effects of dietary fiber in children affected by abdominal pain-related FGID.…”