Abstract
Assessment and management of pain are essential components of pediatric care. Pain in pediatric age is characterized by relevant health and socio-economic consequences due to parental concern, medicalization, and long-term physical and psychological impact in children. Pathophysiological mechanisms of nociception include several pathways in which also individual perception and gut-brain axis seem to be involved. In this narrative review, we analyze the rational and the current clinical findings of probiotic use in the management of functional gastrointestinal disorders (FGID) in pediatric age, with special focus on infantile colic, irritable bowel syndrome, constipation, and gastroesophageal reflux. Some specific probiotics showed a significant reduction in crying and fussing compared to placebo in breastfed infants with colic, although their exact mechanism of action in this disorder remains poorly understood. In irritable bowel syndrome, a limited number of studies showed that specific strains of probiotics can improve abdominal pain/discomfort and bloating/gassiness, although data are still scarce. As for constipation, whilst some strains appear to reduce the number of hard stools in constipated children, the evidence is not adequate to support the use of probiotics in the management of functional constipation. Similarly, although some probiotic strains could promote gastric emptying with a potential improvement of functional symptoms related to gastroesophageal reflux, current evidence is insufficient to provide any specific recommendation for the prevention or treatment of gastroesophageal reflux. In conclusion, probiotics have been proposed as part of management of pain in functional gastrointestinal disorders in pediatric age, but mechanisms are still poorly understood and evidence to guide clinical practice is currently inadequate.
Highlights
Many studies showed that probiotics could have both nutritional and immunomodulatory benefits [5], and that they are potentially useful for preventing and treating numerous intestinal disorders correlated to changes in gut microbiota resulting from a variety of factors [6]
Specific strains of probiotics have been shown to be able to affect the intestinal microbiota, have anti-inflammatory properties [7] and modulate visceral hypersensitivity [8], improving abdominal pain management. This narrative review was conducted searching scientific databases for articles reporting on probiotics, perception of pain, and functional gastrointestinal disorders (FGIDs) in pediatric age
Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a FGID characterized by the association of abdominal pain with alterations in bowel habits and whose etiopathogenesis
Summary
Pain affects millions of people worldwide, impairs mood, social and professional life, and is often difficult to treat. There is increasing evidence that the microbiota-gut-brain axis has a pivotal role in the development and modulation of the central nervous system (CNS) and gastrointestinal functions [1]. The likely correlation between changes in gut microbiota and functional gastrointestinal disorders (FGIDs) could provide preventative as well as therapeutic options in adults and children [3]. Dietary interventions and probiotics can modify the composition and function of the gut microbiota, potentially providing a useful approach in several gastrointestinal conditions [4]. Many studies showed that probiotics could have both nutritional and immunomodulatory benefits [5], and that they are potentially useful for preventing and treating numerous intestinal disorders correlated to changes in gut microbiota resulting from a variety of factors (e.g., diet, antibiotics, lifestyle) [6]. Specific strains of probiotics have been shown to be able to affect the intestinal microbiota, have anti-inflammatory properties [7] and modulate visceral hypersensitivity [8], improving abdominal pain management
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