The Management of Paediatric Functional Abdominal Pain Disorders: Latest Evidence

Abstract

Recurrent abdominal pain (RAP) is one of the most common health complaints in both children and adults. Although RAP is considered a functional disorder rather than an organic disease, affected children and their families can still experience anxiety and concerns that can interfere with school, sports, and regular daily activities and lead to frequent attendances at pediatric emergency departments or pediatric gastroenterology clinics. Our review shows experts do not agree on a universally proven management that will work on every child presenting with functional abdominal pain (FAP). Treatment strategies include both non-pharmacological and pharmacological options. Non-pharmacological treatments are usually very well accepted by both children and their parents and are free from medication side effects. Nevertheless, they may be as effective as the pharmacological interventions; therefore, according to many experts and based on the majority of current evidence, a non-pharmacological approach should be the first intervention attempt in children with RAP. In particular, the importance of the bio-psychosocial approach is highlighted, as a majority of children will improve with counselling and reassurance that no serious organic pathologies are suspected, especially when the physician establishes a trustful relationship with both the child and their family. Placebo and pharmacological interventions could be attempted when the bio-psychosocial approach is not applicable or not efficacious. In some difficult cases, finding an effective treatment for FAP can be a challenge, and a number of strategies may need to be tried before symptoms are controlled. In these cases, a multidisciplinary team, comprising a pediatric gastroenterologist, dietician, psychologist, and psychotherapist, is likely to be successful.

Functional abdominal pain: an integrative review study from a biopsychosocial view

“…No therapeutic action of mebevirin and citalopram 24 was found in the FAP treatment 25 . Regarding the dietary approach 23 , there were no satisfactory results with probiotics or symbiotics in the FAP treatment 24 . Upon the negative results, the authors suggest two hypotheses for this bad therapeutic answer: 1) short period of usage of the compounds, and 2) the mechanism of action of the disorder would have higher relation with the mental/emotional field.…”

“…However, three studies [16][17][18] pointed out the need to exclude the presence of an organic disease. By contrast, the new edition of the Rome IV 21 criteria brings an innovative concept in the FAP diagnosis, exempting the physician from the need of excluding organic causes for the abdominal pain to provide the diagnosis of abdominal pain functional disorders 22,23 . Thus, in the abdominal pain functional disorders category, according to the Rome IV criteria, functional dyspepsia, irritable bowel syndrome, abdominal migraine, and unspecified FAP are included 22 .…”

Functional abdominal pain: what clinicians need to know

“…Visceral hypersensitivity describes a state of heightened sensitivity to normal gut activity 12. Visceral hypersensitivity is increased in both inflammation and states of psychological stress13; there is limited evidence that the degree of visceral hypersensitivity is related to symptom severity 14. Visceral hypersensitivity is felt to play a significant role in the aetiology of FAP, and its reduction, by alleviating triggers, is felt to be a potential contributor to treatment success with therapies such as probiotics 15…”

Management of abdominal pain in pediatric emergency departments

“…3) 소화기관 용제 기능성 위장장애에 사용하는 대부분의 약은 효과가 증 명되지 않았으며 효과가 있다고 보고한 연구는 소규모이 거나 연구방법이 부적절한 경우가 많으므로 주의해서 사 용한다 33,34) . 항연축제 중 peppermint oil은 과민대장증후군 소아환자 에서 복통의 기간과 빈도를 감소시키고 부작용이 없어 사용 을 권고한다 35) .…”

“…이외에도 ranitidine, cimetidine, omeprazole 등도 소 화불량을 개선하지만 보다 체계적인 연구가 필요하다 44) . 이 외에 melatonin, 칼슘통로차단제인 flunarizine, 세로토닌 길항제인 pizotifen, 항생제인 rifaximin, co-trimoxazole 등에 대한 보고가 있으나 연구가 제한적일 뿐 아니라 대부분 효과도 불확실하다 33) .…”