Management Of Functional Abdominal Pain Research Articles

Lactobacillus reuteri in digestive system diseases: focus on clinical trials and mechanisms.

Digestive system diseases have evolved into a growing global burden without sufficient therapeutic measures. Lactobacillus reuteri (L. reuteri) is considered as a new potential economical therapy for its probiotic effects in the gastrointestinal system. We have provided an overview of the researches supporting various L. reuteri strains' application in treating common digestive system diseases, including infantile colic, diarrhea, constipation, functional abdominal pain, Helicobacter pylori infection, inflammatory bowel disease, diverticulitis, colorectal cancer and liver diseases. The summarized literature in this review was derived from databases including PubMed, Web of Science, and Google Scholar. The therapeutic effects of L. reuteri in digestive system diseases may depend on various direct and indirect mechanisms, including metabolite production as well as modulation of the intestinal microbiome, preservation of the gut barrier function, and regulation of the host immune system. These actions are largely strain-specific and depend on the activation or inhibition of various certain signal pathways. It is well evidenced that L. reuteri can be effective both as a prophylactic measure and as a preferred therapy for infantile colic, and it can also be recommended as an adjuvant strategy to diarrhea, constipation, Helicobacter pylori infection in therapeutic settings. While preclinical studies have shown the probiotic potential of L. reuteri in the management of functional abdominal pain, inflammatory bowel disease, diverticulitis, colorectal cancer and liver diseases, its application in these disease settings still needs further study. This review focuses on the probiotic effects of L. reuteri on gut homeostasis via certain signaling pathways, and emphasizes the importance of these probiotics as a prospective treatment against several digestive system diseases.

Consensus Statement on the Diagnosis and Management of Functional Abdominal Pain (FAP) and Related Disorders in Children

Consensus Statement on the Diagnosis and Management of Functional Abdominal Pain (FAP) and Related Disorders in Children

Functional Abdominal Pain in Relation to Behavioral Pattern Triggers in Children

Background: Functional abdominal pain (FAP) in children is a common problem encountered by clinicians. The etiology of FAP is multifactorial and this study explains the correlates of FAP to certain behavioral patterns in children. This is the first Indian study which looks into this area. Methods: Eighteen participants between 4 and 18 years old who had consulted pediatric gastroenterologist with abdominal pain in one single multi-specialty hospital were included. A written consent was obtained from parents. The Child Behavior Checklist (CBCL) was given to the parents to understand the various behavioral problems in the children; and intelligence quotient (IQ) assessments were done in all children. A 5-point Likert scale was used to assess anxiety in children which was rated by the child. Results: The CBCL identified the stressors reported by children such as academic pressure, difficulty to comprehend, need for affection from parents, interpersonal problems at home (frequent arguments between parents, comparison with a brighter sibling) and poor self-esteem. It is observed that 11/18 (61%) children had average or above average IQ and 7/18 (39%) children had low average or dull IQ. The anxiety levels of children in majority, 16 out of 18 children (88.8%) who presented with FAP, were found to be high or very high on a Likert scale. Conclusions: Children with FAP have variable IQ levels and high anxiety levels. The need for clinicians to counsel parents and children in order to address the stressors at home and school is warranted as this may help in management of FAP in children. Further multi-centric research is necessary to understand these findings in Indian children. Int J Clin Pediatr. 2020;9(2):31-34 doi: https://doi.org/10.14740/ijcp371

Su1600 – Management of Functional Abdominal Pain in Pediatric Primary Care Clinics: A Pilot Survey

Su1600 – Management of Functional Abdominal Pain in Pediatric Primary Care Clinics: A Pilot Survey

Probiotics for management of functional abdominal pain disorders in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objectives are to evaluate the efficacy and safety of probiotics for the management of IBS, abdominal migraine and functional abdominal pain in children.

Pediatrics.

Pediatrics.

Lactobacillus reuteri DSM 17938 for the Management of Functional Abdominal Pain in Childhood: A Randomized, Double-Blind, Placebo-Controlled Trial

To determine whether administration of Lactobacillus reuteri DSM 17938 is beneficial in functional abdominal pain (FAP) of childhood. A total of 101 children, aged 6-15years, who fulfilled the Rome III criteria for FAP were enrolled in a randomized double-blind, placebo-controlled trial, and were randomly assigned to receive either L reuteri DSM 17938 or placebo for 4weeks, with further follow-up of additional 4weeks. Response to therapy was based on a self-reported daily questionnaire monitoring frequency and intensity of abdominal pain, using the faces scoring system by Hicks. L reuteri (n=47) was significantly superior to placebo (n=46) in relieving frequency (1.9±0.8 vs 3.6±1.7 episodes/wk, P<.02) and intensity (4.3±2.2 vs 7.2±3.1 Hicks score/wk, P<.01) of abdominal pain following 4weeks of supplementation. There was no difference in school absenteeism rate or other gastrointestinal symptoms, except for a lower incidence of perceived abdominal distention and bloating, favoring L reuteri. L reuteri DSM 17938, compared with placebo, significantly reduced the frequency and intensity of FAP in children. ClicalTrials.gov: NCT01180556.

660 Probiotics for the Management of Functional Abdominal Pain in Children: A Cochrane Systematic Review

Background Functional abdominal pain is pain located in the abdomen that cannot be explained by visible or detectable abnormalties. It is hypothesised that the use of probiotics might alter the growth of bacteria in the bowel, promote normal gut physiology and reduce functional symptoms. Given the recent growth in published studies in this area it is necessary to produce a new and focussed synthesis of this evidence by deploying a robust methodology to ensure that there can be a contemporaneous impact on clinical practice. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and Cochrane Inflammatory Bowel Disease & Functional Bowel Disorders Group Specialised Trial Register were searched (Inception – July 2015). Manufacturers of probiotics were contacted to identify unpublished trials. References of trials were also searched. Abstracts were considered for inclusion if full details to judge inclusion were offered or available from the authors. Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention were eligible for inclusion. Data extraction and assessment of methodological quality of included studies were independently performed by two authors. Analysis was completed in accordance with the intention to treat approach. Results The search yielded 1672 results and nine placebo controlled studies (n = 701) met the inclusion criteria, two as abstracts and seven as published studies. Three studied Lactobacillus GG, three lactobacillus reuteri, one VSL#3, one bacillus coagulans and one bifidobacteria. The studies ranged in length from 4 to 16 weeks. The risk of bias was low for randomisation for seven trials and moderate for two trials. Allocation concealment was low in two studies and unclear in the others. All studies were double blinded, but only four gave details of how this was achieved. The risk of bias was low or unclear in all studies for incomplete outcome data and selective reporting. Meta-analysis of seven studies (n=541) found a statistical significant reduction in the severity of pain using probiotics compared to placebo (MD -0.32; 95% CI -0.38 to -0.25). Meta-analysis of four studies (n=440) found a statistical significant difference in patients reaching treatment success favouring probiotics compared to placebo (OR 1.80; 95% CI 1.20 to 2.69). Metaanalysis of five studies (n=385) found no statistical significant difference in adverse events between probiotics and placebo (OR 0.00; 95% CI -0.07 to 0.06). Conclusions The evidence from the published suggests superior efficacy of probiotics for functional abdominal pain in children when compared with placebo. There is no difference in adverse events, suggesting safety. The evidence base is of moderate quality and relatively small. Further research to investigate the long term impact of probiotic therapy is suggested.

Mechanisms and management of functional abdominal pain.

Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain.

Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome -A case report-

The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.

Management of functional abdominal pain and irritable bowel syndrome in children and adolescents

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents.

Management of Functional Abdominal Pain.

The diagnosis of functional abdominal pain should be made based on the Rome II symptom criteria with only limited testing to exclude other disease. During physical examination the clinician may look for evidence of pain behavior which would be supportive of the diagnosis. Reassurance and proper education regarding the clinical entity of functional abdominal pain is critical for successful treatment and good patient satisfaction. Education should include validation that symptoms are real, and that other individuals experience similar symptoms. No further treatment may be required for those with mild symptoms. For patients with more severe symptoms, a long-term management plan of either pharmacological or psychological treatments is warranted. This will require a commitment by both the patient and the physician to engage in a partnership with active involvement and responsibility by both individuals. The goal of treatment--to decrease pain and increase function over time, not to cure the disorder-- should be explained. Strong consideration should be made for the use of an antidepressant to treat analgesic effects. Tricyclic antidepressants are the mainstay of therapy for functional pain disorders. The analgesic effect is generally quicker in onset and occurs at a lower dose than their effect on mood. To maximize patient compliance, patients should be told the rationale behind their use, warned of the potential side effects, and reassured that many of the side effects will disappear with time. Choice of an antidepressant should be based on the presence of concomitant symptoms (eg, depression), cost, and physician familiarity with specific agents. All patients with functional abdominal pain should be screened for underlying psychiatric disturbance as an untreated mood disorder will adversely affect response to treatment. If a concurrent mood disorder is found, it should be treated by either using a higher dose of the tricyclic antidepressant or by adding another antidepressant agent. Psychological interventions such as cognitive behavioral therapy may be important as adjuvant therapy or as an alternative to treatment with antidepressants for those patients who find antidepressants ineffective or are intolerant to them. Narcotics and benzodiazepines should not be used to treat chronic abdominal pain due to the high risk of physical and psychological dependence.