Systematic Review of Randomized Controlled Trials: Fiber Supplements for Abdominal Pain-Related Functional Gastrointestinal Disorders in Childhood

Abstract

Background: A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies. Aim: To systematically evaluate the effect of dietary fibers for treating abdominal pain-related FGIDs in children. Methods: In December 2011, MEDLINE, EMBASE and the Cochrane Library were searched for randomized controlled trials (RCTs) evaluating fiber supplementation in children with FGIDs. Results: Only 3 RCTs were identified, which enrolled a total of 167 children and adolescents (5–17 years old) with recurrent abdominal pain. Only 1 study used the Rome III criteria. Patients were supplemented with different dietary fiber types for 4–6 weeks. The use of dietary fibers did not influence the proportion of responders to treatment, and improvement did not occur in reported clinically relevant outcomes such as no pain or a significant decrease in pain intensity (risk ratio 1.17, 95% confidence interval 0.75–1.81). Conclusion: There is no evidence that supplementation with fiber as a dietary manipulation may be useful for treating children with FGIDs. However, one should not overlook the fact that the main limitation for recommendation of the routine fiber use in clinical practice derives from the weak quality and paucity of available studies.

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

“…Twenty-nine articles were excluded because of the following: adult study population (n = 6), irrelevant outcome measures, such as improvement in rectal sensitivity or gastrointestinal symptoms without abdominal pain (n = 2), no systematic review or RCT (n = 15), or inclusion only of trials that were already included by another systematic review (n = 6). Thirteen articles remained for analysis: 7 systematic reviews 11,12,15,16,18,22,23 (including 18 RCTs) and 6 RCTs. [24][25][26][27][28][29] Two included trials concerned follow-up studies, 26,30 which will be discussed by using their original studies.…”

“…Information about abdominal pain was collected through the use of diaries, but the authors did not clarify how these diaries were analyzed. The systematic review by Horvath et al 16 included a third trial with 90 children 38 Pain severity was assessed by using the Faces Pain Scale-Revised (6 faces ranging from relaxed to intense pain). 51 School absenteeism and changes in daily activities were self-reported.…”

“…14 Two previous systematic reviews reported that fiber supplements are ineffective in treating AP-FGIDs, whereas conclusions were contradictory regarding probiotics. 15,16 Treatment of children who have AP-FGIDs can be challenging, especially because highquality evidence for pharmacologic interventions is lacking. 17 Although several systematic reviews summarizing different nonpharmacologic interventions exist, 11,15,18 the present systematic review provides an up-to-date overview regarding the efficacy and safety of all nonpharmacologic treatments for pediatric AP-FGIDs.…”

Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews

“…Most reviews (n = 19; 40.4%) included variations of mixed chronic pain populations (e.g., abdominal pain, headaches or migraines, widespread pain/fibromyalgia, complex regional pain syndrome, neuropathic pain, sickle cell disease, cancer pain, back pain, and/or pelvic pain). 8,37,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Reviews focused on single populations most frequently examined abdominal pain (n = 10; 21.3%), 10,35,39,40,57,[59][60][61]77,78 headaches or migraines (n = 5; 10.6%), [62][63][64][65][66] rheumatological conditions (e.g., juvenile idiopathic arthritis, lupus; n = 4; 8.5%), [67][68][69][70] cancer-related pain (n = 3; 6.4%), [71][72][73] or sickle cell disease (n = 2; 4.3%). 74,75 Single reviews focused on patellar tendon pain/Osgood-Schlatter's (n = 1; 2.1%), 76 cerebral palsy (n = 1; 2.1%), …”

Approach to a Child with Irritable Bowel Syndrome: A Review

“…Clinical trials found no convincing evidence that the commonly-used bulking agents were more effective than placebo at relieving global IBS symptoms. Although the efficacy of fiber supplements has not been proven 23 , some improvement has been demonstrated in patients with IBS whose primary complaints are abdominal pain and constipation. Dose of fibre is age plus 5 grams of fiber daily.…”