A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified

Abstract

Disorders of the gut-brain interaction negatively impact quality of life and carry a substantial socioeconomic burden. Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common functional abdominal pain disorders in childhood. The pathophysiology is not fully understood, and high-quality intervention trials and international guidelines are missing. Therefore, the management of these disorders remains challenging. This review aims to provide an up-to-date overview of therapeutic possibilities for pediatric IBS or FAP-NOS and recommends management strategies. To prevent unnecessary referrals and extensive costs, it is fundamental to make a positive diagnosis of IBS or FAP-NOS in children with chronic abdominal pain with only minimal investigations. A tailor-made approach for each patient, based on the accompanying physical and psychological symptoms, is proposed to date.Conclusion: Shared decision-making including non-pharmacological and pharmacological interventions should be considered and discussed with the family. What is Known:• Irritable bowel syndrome and functional abdominal pain-not otherwise specified are common in childhood.• Although the number of treatment options has grown recently, managing these disorders can be challenging and unsatisfactory, and no evidence-based international management guidelines are available. What is New:• We suggest using a stepwise individualized approach to management, where after first-line management, both non-pharmacological and pharmacological interventions should be discussed.

Celiac Disease and Disorders of Gut–Brain Interaction: What School Nurses Need to Know

“…(Thapar et al, 2020). In general, medications used in the management of DGBIs are not well studied, and evidence may be insufficient in making strong recommendations for use (Rexwinkel et al, 2022).…”

“…DGBIs were previously termed functional gastrointestinal disorders or functional abdominal pain disorders and include conditions such as infant colic, functional dyspepsia, irritable bowel syndrome, and abdominal migraines (Nurko et al, 2022; Pessarelli et al, 2022; Thapar et al, 2020). DGBIs are characterized by chronic abdominal pain and altered bowel movements, including both diarrhea and constipation; however, no underlying structural abnormality exists in the gastrointestinal tract (Murray et al, 2022; Rexwinkel et al, 2022). The causes and pathophysiology of DGBIs are not well understood and are thought to be multifactorial.…”

“…The causes and pathophysiology of DGBIs are not well understood and are thought to be multifactorial. Psychological factors such as stress, food sensitivities, genetics, and/or altered gut microbiota have been implicated as possible causes (Pessarelli et al, 2022; Rexwinkel et al, 2022). What is known is that DGBIs are prevalent in the pediatric population and a frequent complaint of chronic abdominal pain and symptoms (Pessarelli et al, 2022; Rexwinkel et al, 2022; Thapar et al, 2020).…”

“…Manifestations of DGBIs include abdominal pain, abdominal bloating and/or distention, constipation and/or diarrhea, anorexia, and dyspepsia (Rexwinkel et al, 2022; Thapar et al, 2020). Those with abdominal migraines may also experience nausea, vomiting, headache, and photophobia (Thapar et al, 2020).…”

“…Given the complexity of the biopsychosocial factors associated with DGBIs, treatment modalities are multifaceted and include dietary modifications, nonpharmacologic interventions including cognitive-behavioral therapy, and a range of pharmacological agents (Pessarelli et al, 2022; Rexwinkel et al, 2022). Dietary interventions may be helpful for those individuals with DGBIs who have symptoms induced by food or meal intake; however, clear evidence is lacking on whether specific diets are useful (Pessarelli et al, 2022).…”