Pharmacological interventions on early functional gastrointestinal disorders

Abstract

BackgroundFunctional gastrointestinal disorders (FGIDs) are chronic or recurrent gastrointestinal symptoms without structural or biochemical abnormalities. FGIDs are multifactorial conditions with different pathophysiologic mechanisms including altered motility, visceral hyperalgesia, brain-gut disturbance, genetic, environmental and psychological factors.Although in most cases gastrointestinal symptoms are transient and with spontaneous resolution in infancy multiple dietary changes and pharmacological therapy are often started despite a lack of evidence-based data. Our aim was to update and critically review the current literature to assess the effects and the clinical appropriateness of drug treatment in early (occurring in infants and toddlers) FGIDs.MethodsWe systematically searched the Medline and GIMBE (Italian Group on Medicine Based on Evidence) databases, according to the methodology of the Critically Appraised Topics (CATs). We included reviews, clinical studies, and evidence-based guidelines reporting on pharmacological treatments. Systematic reviews and randomized controlled trials (RCTs) concerning pharmacologic therapies in children with early FGIDs were included, and data were extracted on participants, interventions, and outcomes.ResultsWe found no evidence-based guidelines or systematic reviews about the utility of pharmacological therapy in functional regurgitation, infant colic and functional diarrhea. In case of regurgitation associated with marked distress, some evidences support a short trial with alginate when other non pharmacological approach failed (stepped-care approach). In constipated infants younger than 6 months of age Lactulose is recommended, whilst in older ages Polyethylene glycol (PEG) represents the first-line therapy both for fecal disimpaction and maintenance therapy of constipation. Conversely, no evidence supports the use of laxatives for dyschezia. Furthermore, we found no RCTs regarding the pharmacological treatment of cyclic vomiting syndrome, but retrospective studies showed a high percentage of clinical response using cyproheptadine, propanolol and pizotifen.ConclusionThere is some evidence that a pharmacological intervention is necessary for rectal disimpaction in childhood constipation and that PEG is the first line therapy. In contrast, for the other early FGIDs there is a lack of well-designed high-quality RCTs and no evidence on the use of pharmacological therapy was found.

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

“…A review published in 2016 concluded that there was some evidence to support pharmacological interventions for constipation and rectal dis‐impaction as the first‐line therapy 27. However, pharmacological therapy appears to offer no benefit for other FGIDs that occur early in life 28.…”

“…Despite the lack of drug benefits, and the emphasis on parental and nutritional support in the guidelines, there is still widespread overuse of medical management in FGIDs such as regurgitation and infantile colic 26, 27, 29.…”

Diagnóstico y tratamiento de los trastornos gastrointestinales del eje cerebro-intestino en niños menores de 2 años

“…La duración del tratamiento será el tiempo necesario hasta corregir el problema; es decir, iniciar con dosis-respuesta y mensualmente disminuir el medicamento hasta retirarlo y lograr evacuaciones diarias, blandas y sin dolor. 28,29,34,41 Cólico ¿Cómo se define el cólico en niños?…”

The Effect of Probiotics on Symptoms, Gut Microbiota and Inflammatory Markers in Infantile Colic: A Systematic Review, Meta-Analysis and Meta-Regression of Randomized Controlled Trials

“…At least few interventions are known to alleviate excessive crying in colicky neonates, but with no evidence-based recommendations [22]. Historically, antispasmodic drugs, e.g., dicyclomine was found to counteract colicky behavior compared to placebo [23][24][25] but severe adverse effects, including coma [26], excluded the possibility to use the drugs in infants.…”