Medically reviewed by Onikepe Adegbola, MD, PhD
Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are two frequent functional abdominal pain diseases in children. The quality of intervention trials is poor, and the pathophysiology is unknown. This complicates the treatment of various illnesses.
Researchers present an overview of the therapy options for pediatric IBS or FAP-NOS, as well as management advice, in this paper. This review was published in the European Journal of Pediatrics.
The authors suggest taking a progressive, customized approach to care, with both non-pharmacological and pharmacological therapies being evaluated after first-line treatment.
Functional abdominal pain disorders consist of four conditions: functional dyspepsia, IBS, abdominal migraine, and functional abdominal pain-not otherwise specified (FAP-NOS).
The number of treatment options for these disorders has grown recently, but managing them can be a challenging and unsatisfactory experience. Scientists searched PubMed, MEDLINE, Embase, PsycINFO, and Cochrane Library for relevant articles. Here are the important treatments they came across:
Diet Management
Diet management is the first line of defense. Including dietary fiber and avoiding gluten can assist to alleviate the symptoms of FAPD. Fibers have been shown to lower intracolonic pressure, speed up gut transit times, and lessen stomach pain. Soluble fibers may help with IBS-C treatment because they draw water into the feces. The prevalence of gluten sensitivity in pediatric patients with IBS is being investigated in a double-blind, placebo-controlled crossover experiment.
Low FODMAP Diet To Decrease The Pain
Adult studies have shown that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can treat IBS. A mechanism of action may involve a reduction in gas production and, consequently, a reduction in luminal distention, thereby reducing pain. However, the low FODMAP diet is difficult to follow and expensive. You need a dietician to achieve nutritional adequacy.
Probiotics And Psychological Interventions
When administered in adequate amounts, probiotics confer health benefits to their hosts. Probiotics’ efficacy and safety in children with FAPDs have been evaluated in a Cochrane review.
Alternatively, psychological interventions have shown considerable success in treating pediatric FAPDs. They include cognitive-behavioral therapy (CBT) and hypnotherapy. The goal of CBT is to change behaviors, cognitions, and emotions that may contribute to IBS symptom escalation or maintenance.
Hypnotherapy (HT)
During HT, the patient was hypnotized. In this state, the patient is guided by the therapist to adjust their subjective experiences, perceptions, emotions, sensations, ideas, or behavior in response to suggestions. Doctors, on the other hand, do not frequently offer this treatment to youngsters.
Other Management Techniques
Yoga: The options include yoga, fecal microbiota transplantation, and antispasmodic.
Antispasmodics: By decreasing the contractions of the gastrointestinal tract, antispasmodics relieve abdominal pain complaints.
Antibiotics: Doctors may occasionally prescribe antibiotics like Rifaximin. Rifaximin has been found to be a safe and efficient treatment for IBS-D symptoms all over the body. Rifaximin is currently not indicated for children with IBS. Rifaximin use is connected with a long-term safety risk, since it may create cross-resistant bacterial strains and damage children’s healthy microbiome.
New therapies for people with IBS-D include opioid mediators, such as eluxadolin, which is both effective and safe. Eluxadoline is now being studied in IBS-D teenagers.
Key Takeaway
Both non-pharmacological and pharmaceutical therapies should be addressed after the diagnosis. Several clinical trials are still underway, intending to improve management options.
However, further studies of intervention in the above-mentioned techniques are needed to guide appropriate clinical management in the future.
Reference:
Rexwinkel, R., Vlieger, A. M., Saps, M., Tabbers, M. M., & Benninga, M. A. (2022). A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. European journal of pediatrics, 10.1007/s00431-022-04459-y. Advance online publication. https://doi.org/10.1007/s00431-022-04459-y
