Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus

Abstract

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Impact of Probiotics on the Prevention and Treatment of Gastrointestinal Diseases in the Pediatric Population

“…To date, nutritional interventions based on thickened feedings and anti-regurgitation formulas, especially those with digestible carbohydrates, seems to be the primary treatment option for infants with functional regurgitation [89]. Interestingly, based on scientific evidence about therapeutic use of probiotics, experts suggest that this type of infant formula should be supplemented with Lactobacillus reuteri (now Limosilactobacillus reuteri) DSM 17938, enhancing its nutritional quality and gastric emptying rate in order to offer potential benefits in functional regurgitation treatment [90].…”

Alleviating Gasto-Intestinal Discomfort in Infants: Quest for Effective Interventions

“…As with any functional disorder, parental and caregiver reassurance, counseling, support, and education are integral aspects of the management of infantile FGIDs. 35 Treatment approaches can be broadly categorized into pharmacological therapies and dietary interventions.…”

“…32 Pharmacotherapy is not recommended for the management of FGIDs such as infant regurgitation and colic due to a lack of evidence and the potential risk of adverse events. 35 Drug therapy can be considered for functional constipation. 27 Scientific and medical experts have developed and Alleviating Gasto-Intestinal Discomfort in Infants discussed practical recommendations and algorithms to manage FGIDs (Table 2).…”

“…27 Scientific and medical experts have developed and Alleviating Gasto-Intestinal Discomfort in Infants discussed practical recommendations and algorithms to manage FGIDs (Table 2). 1,35,41,[71][72][73][74] Infant formulas containing partially or extensively hydrolyzed proteins, fortified with prebiotics (GOS/FOS) and/or probiotic strains such as L reuteri DSM 17938 and Bifidobacterium longum, and without palm oil as the main source of fat in the oil blend In the absence of alarm signs, trial of a formula with L reuteri DSM 17938 might be considered for 2-4 weeks…”

Prevalencia de cólico infantil: experiencia del grupo de trabajo en trastornos del eje cerebro-intestino de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP)

“…40 El papel de evitar la lactosa en el cólico infantil es discutible debido a la falta de evidencia clínica y no debe recomendarse como tratamiento de rutina. 41…”