Recurrent Abdominal Pain in Children

Abstract

Objectives: Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. Methods: We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents. Results: We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive-behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short-term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions. Conclusions: Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of wellconducted clinical trials. There is an urgent need for high-quality RCTs to provide evidence to guide management of this common condition.

Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review

“…However, the results should be interpreted with caution as the majority of these studies are quite small and heterogeneous with regard to e.g. inclusion criteria, setting, dose and type of delivered treatment and therapist experience (Abbott et al, 2018;Bonvanie et al, 2017).…”

“…Therefore, timely and evidence-based treatment is essential for improving the long-term physical, psychosocial and financial consequences. Across age groups, patient-activating therapies are the most promising treatments, and cognitive behavioural therapy (CBT) has so far been the most prevailing in intervention studies (Abbott et al, 2018;Bonvanie et al, 2017;Henningsen et al, 2018). While moderate to large effect sizes (ES) have been reported for CBT-based treatment for HA (Hedman et al, 2011;Newby et al, 2018;Thomson & Page, 2007;Weck, Neng, Schwind, & Hofling, Third Wave Treatments for Functional Disorders 4 Clinical Psychology in Europe 2019, Vol.1(1), Article e32217 https://doi.org/10.32872/cpe.v1i1.32217 2015), improvements are only small to moderate for FSS in adults (Henningsen et al, 2018;van Dessel et al, 2014).…”

“…In children and adolescents, the use of CBT for HA has only been reported in a single case study (Roberts-Collins, 2016). With regard to FSS, existing studies have almost exclusively focused on CBT-based treatments for single symptoms or syndromes; primarily functional abdominal symptoms, chronic fatigue, tension-type headache, fibromyalgia or mixed pain complaints in children as young as 6 years of age (Abbott et al, 2018;Bonvanie et al, 2017). Overall, the ES are found to be somewhat larger than the corresponding estimates in adult studies (Bonvanie et al, 2017).…”

Probiotics for Children With Recurrent Abdominal Pain

“…low FODMAP -fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are effective in RAP. Our updated search in November 2017 found two additional trials of probiotics; adding these studies did not alter these findings 7 .…”

“…It was not possible to judge the extent of clinical significance of improvement. Post-hoc subgroup analyses of outcomes according to probiotic strain showed there is currently insufficient evidence to guide clinical practice relating to choice of strain, as dosages and regimes were different 7 . Only two included studies measured outcomes at 12 weeks or more.…”