Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.METHODS: Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.RESULTS: Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P , .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate. CONCLUSIONS:Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.

Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a Biopsychosocial Model

“…Cyproheptadine is reported to be effective in a prospective [24], retrospective [25] study and reported as holding promise in a systematic review [26] in FGIDs. These are treatments among the variety of available options used to manage symptoms of FGIDs [1, 23, 26]. In our study, there was no statistical difference noted in improvement in patients who received treatment including cyproheptadine, acid reducer, antispasmodic, laxative or herbal medication.…”

“…This finding compares with IBS being the most common in 37% and two diagnoses in 29% reported in a study that also applied ROME III criteria [22]. We hypothesize that this difference could be related to the understanding that FAP and IBS are possibly different expressions of one underlying disorder [23], or that the two are the most common FGID diagnoses, and a chance occurrence in our cohort. Moreover, the possibility of finding two FGIDs at diagnosis should be kept in mind while evaluating these patients.…”

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

“…Systematic reviews demonstrate higher efficacy of nonpharmacological interventions such as cognitive behavioral therapy (CBT) compared with current pharmacological therapies in children with functional GI disorders (Korterink, Rutten, Venmans, Benninga, & Tabbers, ; Rutten, Korterink, Venmans, Benninga, & Tabbers, ). CBT is based on reversing maladaptive thoughts, behaviors, and emotions that result from ongoing hypervigilance, thereby affecting the altered gut sensation and changing behaviors (Levy et al, ).…”

Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the SEPAHAN study

“…Increasing evidence suggests that high-fat foods or meals induce gastrointestinal symptoms (6,10,11) . Information regarding dietary fibre is controversial (12)(13)(14)(15)(16) . Some studies have reported beneficial effects of fibre on gastrointestinal symptoms (12)(13)(14) , whereas others have not (15,16) .…”

“…Information regarding dietary fibre is controversial (12)(13)(14)(15)(16) . Some studies have reported beneficial effects of fibre on gastrointestinal symptoms (12)(13)(14) , whereas others have not (15,16) . Carbohydrate type might be important in relation to gastrointestinal symptoms.…”