Format

Send to

Choose Destination
Pediatrics. 2015 Mar;135(3):522-35. doi: 10.1542/peds.2014-2123. Epub 2015 Feb 9.

Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review.

Author information

1
Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and j.m.rutten@amc.nl.
2
Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and.
3
Pediatric Association of the Netherlands, Utrecht, Netherlands.

Abstract

BACKGROUND AND OBJECTIVE:

Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.

METHODS:

Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.

RESULTS:

Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P < .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate.

CONCLUSIONS:

Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.

KEYWORDS:

children; functional abdominal pain; functional gastrointestinal disorders; nonpharmacologic treatment; systematic review

PMID:
25667239
DOI:
10.1542/peds.2014-2123
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center