Recurrent abdominal pain, which refers to functional abdominal pain disorders under the Rome IV classification, is a common problem affecting up to 25% of school-age children. As an organic cause is missing with this condition, parents of children affected by functional abdominal pain consider diet and behavioral therapies as methods of managing recurring problems.
Although the treatment of functional abdominal pain in children is inconsistent, dietary interventions are often used by parents and carers as a way to improve symptoms. They include omitting specific food groups or ingredients that trigger gastrointestinal symptoms or adding supplements that include fiber or prebiotics.
Summary evidence from three Cochrane systematic reviews of randomized clinical trials about the effectiveness of dietary, pharmacological and psychological interventions in children concludes that probiotics, cognitive behavioral therapy and hypnotherapy may be effective in treating recurrent abdominal pain.
In the short and medium term, probiotics, cognitive behavioral therapy and hypnotherapy were found to reduce abdominal pain.
Based on 15 studies, probiotics led to a reduction in pain frequency and intensity in the short term (0 to 3 months) with limited evidence for sustained effect up to 3 to 6 months post treatment, when compared with placebo. As not all species and strains had the same effects, however, the authors call for caution before systematically recommending probiotics in children with functional abdominal pain.
No major adverse events were reported. However, the quality of evidence assessed by the GRADE system was low or moderate, due to significant heterogeneity and small numbers of study participants.
On the other hand, fiber-based interventions did not lead to improved pain in the short term when compared with placebo. Furthermore, the quality of this evidence was low.
The evidence for other dietary interventions like FODMAP diet and psychosocial therapies (e.g. hypno- and yoga therapy) was found low-quality. For instance, only two small and short-duration studies showed reductions in pain frequency or pain secondary to a diet restricted in FODMAPs and fructose, respectively.
In addition, the authors reported a lack of effectiveness when using drugs to treat recurrent abdominal pain.
On the whole, available data from randomized clinical trials suggest that probiotics, cognitive behavioral therapy and hypnotherapy might be considered when managing children with functional abdominal pain disorders. Although these strategies might be considered part of the overall management of functional abdominal pain in children, it is still too early to recommend the optimum strain, dosage and length of treatment for probiotics and the best format of behavioral therapies.
Abbott RA, Martin AE, Newlove-Delgado TV, et al. Recurrent abdominal pain in children: summary evidence from 3 systematic reviews of treatment effectiveness. J Pediatr Gastroenterol Nutr. 2018; 67(1):23-33. doi: 10.1097/MPG.0000000000001922.
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