Pharmacological interventions on early functional gastrointestinal disorders.

Silvia Salvatore,Osvaldo Borrelli,Massimo Landi,Vito Leonardo Miniello,Alberto Martelli,Dora Di Mauro,Annamaria Staiano,Giovanni Simeone,Elvira Verduci,Salvatore Barberi,Maria Assunta Zanetti,Ruggiero Francavilla,Carmen Verga,Mattia Doria,Annamaria Castellazzi,Giuseppe Di Mauro

doi:10.1186/s13052-016-0272-5

Abstract

BackgroundFunctional gastrointestinal disorders (FGIDs) are chronic or recurrent gastrointestinal symptoms without structural or biochemical abnormalities. FGIDs are multifactorial conditions with different pathophysiologic mechanisms including altered motility, visceral hyperalgesia, brain-gut disturbance, genetic, environmental and psychological factors.Although in most cases gastrointestinal symptoms are transient and with spontaneous resolution in infancy multiple dietary changes and pharmacological therapy are often started despite a lack of evidence-based data. Our aim was to update and critically review the current literature to assess the effects and the clinical appropriateness of drug treatment in early (occurring in infants and toddlers) FGIDs.MethodsWe systematically searched the Medline and GIMBE (Italian Group on Medicine Based on Evidence) databases, according to the methodology of the Critically Appraised Topics (CATs). We included reviews, clinical studies, and evidence-based guidelines reporting on pharmacological treatments. Systematic reviews and randomized controlled trials (RCTs) concerning pharmacologic therapies in children with early FGIDs were included, and data were extracted on participants, interventions, and outcomes.ResultsWe found no evidence-based guidelines or systematic reviews about the utility of pharmacological therapy in functional regurgitation, infant colic and functional diarrhea. In case of regurgitation associated with marked distress, some evidences support a short trial with alginate when other non pharmacological approach failed (stepped-care approach). In constipated infants younger than 6 months of age Lactulose is recommended, whilst in older ages Polyethylene glycol (PEG) represents the first-line therapy both for fecal disimpaction and maintenance therapy of constipation. Conversely, no evidence supports the use of laxatives for dyschezia. Furthermore, we found no RCTs regarding the pharmacological treatment of cyclic vomiting syndrome, but retrospective studies showed a high percentage of clinical response using cyproheptadine, propanolol and pizotifen.ConclusionThere is some evidence that a pharmacological intervention is necessary for rectal disimpaction in childhood constipation and that PEG is the first line therapy. In contrast, for the other early FGIDs there is a lack of well-designed high-quality RCTs and no evidence on the use of pharmacological therapy was found.

Highlights

Functional gastrointestinal disorders (FGIDs) are chronic or recurrent gastrointestinal symptoms without structural or biochemical abnormalities
There is a lack of evidences concerning drug treatment in infant rumination syndrome, functional diarrhea and infant dyschezia
Infant regurgitation Regurgitation is the passage of refluxed contents into the pharynx or mouth

Summary

Introduction

Functional gastrointestinal disorders (FGIDs) are chronic or recurrent gastrointestinal symptoms without structural or biochemical abnormalities. FGIDs are multifactorial conditions with different pathophysiologic mechanisms including altered motility, visceral hyperalgesia, brain-gut disturbance, genetic, environmental and psychological factors. Our aim was to update and critically review the current literature to assess the effects and the clinical appropriateness of drug treatment in early (occurring in infants and toddlers) FGIDs. Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities [1]. In the first few months of life FGIDs occur in up to 50 % of subjects with regurgitation and infantile colic representing the two most common conditions that usually spontaneously resolve or improve by 6 to 8 months of age. Other early (occurring in infants and toddlers) FGIDs include dyschezia, infant rumination syndrome, functional diarrhea, cyclic vomiting syndrome (CVS) and functional constipation (Table 1)

Objectives

Methods

Results

Discussion

Conclusion