Treatment Of Functional Abdominal Pain Research Articles

Effect of Domperidone on Children with Functional Abdominal Pain: A Randomized Controlled Clinical Trial

Background: One of the most common functional problems in children is functional abdominal pain (FAP), and dysmotility is one of the possible causes of FAP. Domperidone is a prokinetic drug that increases gastrointestinal motility. Objectives: The aim of this study was to evaluate the effect of domperidone on the treatment of FAP in children. Methods: In this double-blind clinical trial study, FAP was diagnosed in 80 children aged 5 - 14 years, who were referred to Amirkola Children's Hospital in Babol for one year based on the criteria of the Rome IV. Then, they were randomly divided into two groups of 40 patients. Group A received domperidone tablets (0.25 mg/kg, three-time/day) for two months, and group B received a placebo. The primary outcome was at least a 50% reduction in both frequency and severity of pain, and the secondary outcome was a significant reduction in the duration, frequency, and intensity of pain according to the Wong-Baker scale compared to baseline. Results: A total of 80 children completed the trial (40 with domperidone). The recovery rate was higher in the domperidone group than in the placebo group after eight weeks (71.8% vs. 28.2%; P < 0.0001), and domperidone had significant superiority over the placebo in reducing the duration (4.58 ± 7.71 vs. 24.5 ± 41.45, min/day, P < 0.001), frequency (3.35 ± 3.99 vs. 10.63 ± 10.55, episode/week, P < 0.001), and intensity (2.20 ± 2.16 vs. 5.05 ± 2.37, P < 0.001) of the pain. Conclusions: Based on the results, domperidone can be useful in the treatment of FAP in children.

ADMINISTRATION OF OMNI BIOTIC STRESS REPAIR IN CHILDREN'S AGE

our gastrointestinal tract is home to a huge number of beneficial bacteria known as intestinal microflora changed the understanding of many physiological and pathological processes in the human body. Based on these scientific discoveries, the laboratories of the Allergozan Institute in Austria have created the synbiotic combinations "Omnibiotic", which are specific and aimed at specific problems related to human health. Purpose: The aim of the present study is to investigate the effect of the probiotic Omni Biotic Stress Repair in the treatment of functional abdominal pain (FAP) and some organic gastrointestinal diseases in childhood. Material and Methods: A prospective study has been done on children with FAP and PUD. For one year, we monitored 62 children with functional abdominal pain and duodenal ulcer who received Omni Biotic Stress Repair for 3 months. The causes of children's suffering were reported. Results: There are 39 children with functional abdominal pain, 22 of which are girls and 17 boys, and children with peptic ulcer disease – 23/12 boys and 11 girls/. The FAP group received Omni Biotic Stress Repair as self-therapy for three months. We reported very good results in all children. Only four children did not get the desired effect, and they dropped out of the study in the first month. In children with peptic ulcer disease, the probiotic Omni Biotic Stress Repair is added as a satellite therapy to the main treatment. When clinical remission occurred, the patients continued to take only probiotics for 3 months or more. Conclusions: Based on these scientific discoveries, the laboratories of the Allergozan Institute in Austria have created the synbiotic combinations "Omnibiotic", which are specific and aimed at specific problems related to human health.

Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients.

Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. This clinical trial included 50 patients aged 3-18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Функциональная абдоминальная боль у детей

Абдоминальная боль является одной из самых распространенных жалоб детей в практике педиатра и семейного врача. В большинстве случаев причиной хронической боли в животе является неорганическая, функциональная абдоминальная боль (ФАБ) без объективных признаков основного органического расстройства. В настоящее время среди различных групп спазмолитиков при лечении функциональных расстройств пищеварительного тракта отдают предпочтение селективным миотропным спазмолитикам — блокаторам быстрых натриевых каналов клеточной мембраны миоцита (мебеверин). В клинической практике при лечении пациентов с абдоминальной болью заслуживает внимания мебеверина гидрохлорид (СПАРК®, ПАО «Фармак»). Изучение эффективности применения мебеверина СПАРК® при ФАБ у детей проводилось на базе гастроэнтерологического отделения детской клинической больницы № 19 г. Харькова. Под наблюдением находилось 44 ребенка в возрасте от 10 до 18 лет с ФАБ. В структуре функциональной патологии зарегистрированы: функциональная диспепсия (ФД) — 54,1 %, синдром раздраженного кишечника (СРК) — 20,8 %, функциональные расстройства билиарного тракта (ФРБТ) — 79,2 %; ФД + ФРБТ — 34,1 %, ФД + СРК — 16 %, ФРБТ + СРК — 8,3 %. Диагноз был верифицирован согласно унифицированным протоколам лечения. Пациенты получали комплексную патогенетическую терапию и селективный спазмолитик СПАРК® по 1 капсуле два раза в день на протяжении семи дней. Оценка болевого синдрома проводилась на момент обращения и ежедневно в течение периода наблюдения. Для оценки интенсивности боли использовалась цифровая рейтинговая шкала боли. При наблюдаемой тенденции к купированию абдоминальной боли у всех пациентов из группы наблюдения уже с 5-го дня от начала терапии не отмечали абдоминальной боли дети с незначительно выраженной болью, а с 6-го дня — с умеренно выраженной болью. Более длительно, до 7 суток, сохранялась боль у детей с выраженной болью. Таким образом, абдоминальная боль — одна из наиболее часто встречаемых и сложных проблем в практике врача. Наиболее часто она возникает при функциональных расстройствах желудочно-кишечного тракта. Применение селективных миотропных спазмолитиков (мебеверин) для купирования абдоминальной боли патогенетически обосновано. Полученные результаты показали эффективность препарата СПАРК® при лечении функциональной абдоминальной боли у детей. Побочных эффектов и аллергических реакций при приеме препарата не отмечалось. Мебеверин (СПАРК®) может быть препаратом выбора и рекомендован при абдоминальной боли у взрослых и детей в возрасте от 10 лет.

Use of probiotics in the treatment of functional abdominal pain in children—systematic review and meta-analysis

Functional abdominal pain is a very frequent functional gastrointestinal disorder but still without adequate treatment options. Therefore, the main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on functional abdominal pain in children. This was a systematic review and meta-analysis of randomized controlled trials published in a period up to 1st of April 2020 that analyzed probiotic interventions for pediatric functional abdominal pain. We included 9 randomized controlled trials (a total of 702 children, 506 with functional abdominal pain; 4 to 18years); 8 studies were available for meta-analysis (a total of 641 children). Lactobacillus rhamnosus GG and Lactobacillus reuteri DSM 17938 were the only two probiotic strains investigated. Significant reduction in pain intensity (6 trials, n = 380, mean difference - 1.24, 95% CI - 2.35 to - 0.13) and increase in number of days without pain (2 trials, n = 101, mean difference 26.42, 95% CI 22.67 to 30.17) were found in children taking L. reuteri DSM 17938. For all other outcomes, there were no significant differences between probiotic and placebo.Conclusion: Based on the available evidence, no firm conclusions can be given; however, L. reuteri was proven to decrease the pain intensity in children with functional abdominal pain. Further trials regarding long-term outcomes, possibly involving longer interventions, are needed. What is Known: • Previously published systematic reviews have suggested that probiotics may have an effect on the pain in children with functional gastrointestinal disorders, but limited data exist on strain-specific effects. What is New: • This systematic review provides evidence on the probiotic use on the strain-specific level. • This systematic review showed that the use of Lactobacillus reuteri DSM 17938 modestly reduces the pain intensity in children with functional abdominal pain.

Lactobacillus reuteri DSM 17938 is effective in the treatment of functional abdominal pain in children: Results of the double-blind randomized study.

Possible therapeutic effect of Lactobacillus (L.) reuteri DSM 17938 has been reported in children with functional abdominal pain (FAP) but data are inconclusive. This is a randomized double-blinded controlled trial (RCT) which assessed effect of L. reuteri DSM 17938 (dose 108CFU/day) in children (age 4-18 years) on FAP during an intervention period of 12 weeks and follow-up of 4 weeks. This study was performed after the interim analysis and had different labeling of products and a new randomization. Data presented here are results of this RCT and pooled data from both RCTs (before and after interim analysis). This RCT included 46 children (median age 10.1 vs 10.6 years; 11 vs 13 girls). Abdominal pain was less severe in intervention group during the 4th month of the study and there was significant increase in the number of days without pain. Pooled data from both parts of the study included 101 children. Number of days without pain was significantly higher in the L.reuteri group (mean difference 26.42 days, 95% CI 22.47-30.17). Significant difference in the pain intensity was found after 2nd, 3rd and 4th month of the intervention. There was no difference between groups in the number of children in whom symptoms completely ceased (Risk Ratio 1.09, 95% CI 0.75-1.58). Administration of L.reuteri DSM 17938 was associated with the reduction in the intensity of pain and with significantly increase in pain-free days in children with FAP.

Implementation of a low FODMAP diet for functional abdominal pain

The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32-5.23] versus 4.63cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.

Implementation of a low FODMAP diet for functional abdominal pain

IntroductionThe low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methodsA table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. ResultsA total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41–3.33] versus 2 [IQR: 1.33–6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32–5.23] versus 4.63cm [IQR: 2.51–6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. ConclusionsThe implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.

Functional gastrointestinal disorders in children and adolescents: Knowledge, practice and attitudes of Australian paediatricians.

To investigate paediatricians' understanding of, and approaches to, the diagnosis and treatment of functional abdominal pain (FAP) and irritable bowel syndrome (IBS) in children. This study used an electronic survey of doctors subscribing to a popular Australian-based paediatrics email forum. Responses about investigation and management in two clinical vignettes were correlated with respondent demographic data, practice setting, attitudes and knowledge. The 327 respondents were mostly female (60.3%), aged <45 years (54.5%), general paediatricians (53.5%), working in public outpatient clinics (50.5%). Awareness of Rome III diagnostic criteria was low (37.2%) but associated with confidence in diagnosing FAP/IBS in the vignettes. Respondents who lacked confidence in diagnosing FAP/IBS requested more investigations (P < 0.05), although most acknowledged they would not be helpful. Most (70.5%) believed that families are unlikely to accept an FAP diagnosis without investigations requested. Fewer than 1 of 3 were aware of clear evidence for the effective therapy of FAP or IBS, although awareness did not influence management options selected. Two-thirds of respondents believe that FAP is a psychological rather than a medical problem, while few (8.8%) believe the same about IBS (P < 0.001). Parental pressure to find an immediate cure was cited as the most frequent challenge to successful management in both FAP (86.6%) and IBS (75.9%). Awareness of the Rome criteria was associated with greater confidence in diagnosing FAP and IBS. Attitudes to FAP and IBS being diagnoses of exclusion are prevalent among paediatricians and associated with more investigations requested. There is a lack of awareness of evidence-based therapies for FAP and IBS.

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

ABSTRACT BACKGROUND AND OBJECTIVES: Abdominal pain is one of the most frequent complaints in Pediatric Gastroenterology and may be considered an intricate symptom difficult of immediate differential diagnosis. To perform an integrative review of functional abdominal pain in children. CONTENTS: It included original and empirical national and international articles, between 2006 and 2016, from the Virtual Health Library, Virtual Health Library - Psychology Brazil (BVS-Psi Brazil) and Pubmed databases, in children aged 6 to 10 years old. The descriptors were: functional abdominal pain, children, gastroenterology. The thematic content was analyzed in the categories: etiology, prevalence, diagnosis process, treatment and intervention strategies and evaluation of coping strategies. Thirty-three articles on functional abdominal pain were found. Factors associated with somatization, anxiety, depression and children’s bowel habits were highlighted and should be carefully evaluated by health professionals. Parents may negatively influence the treatment when they adopt encouraging, monitoring, and hypervigilance attitudes. CONCLUSION: Behavioral, dietary and pharmacological approaches are widely recommended in the treatment of functional abdominal pain. Regarding the emotional behavior, the psychological approach seems to promote good therapeutic results.

Probiotics in Functional Gastrointestinal Disorders.

Infantile colic, constipation, functional abdominal pain (FAP), and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders (FGID). This chapter will review current evidence on the role of probiotics in the treatment of these FGID. The etiology of FGID is considered multifactorial, but the importance of intestinal microbiota in their development has been repeatedly emphasized. As a consequence, the potential role of probiotics in their treatment is being increasingly scrutinized. Presently, the strongest evidence of efficacy is for the use of Lactobacillus reuteri (L reuteri) DSM 17938 at the dose of 108CFU/day for the treatment of infantile colic in breastfed infants. Limited, yet encouraging, evidence exists for Lactobacillus rhamnosus GG (LGG) at the dose of 3×109 CFU and for a multi-strain preparation for the treatment of IBS. In the treatment of FAP, there is some evidence for the use of L reuteri DSM 17938 at the dose of at least 108CFU/day.

Low FODMAP diet: a potential treatment of functional abdominal pain in children.

A child's diet has an important impact on their quality of life, and with functional gastrointestinal disorders becoming an increasing issue, a child's diet has become recognised as an area to be investigated in how to treat such disorders. Katarzyna Miroslawa Boradyn and Katarzyna Eufemia Przybylowicz from the University of Warmia and Mazury explore the potential of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet as an effective treatment for these disorders.Functional gastrointestinal disorders (FGID) are one of the most prevalent disorders diagnosed by paediatricians.[1] Within this wide range, functional abdominal pain (FAP) is a disorder particularly common among school-age children and it can substantially affect their quality of life.[2] A child's diet has a significant influence on the occurrence of symptoms.[1] So far, previously tested therapies have not provided an effective treatment that would alleviate the symptoms and improve the microbiota.[2] Researchers from Monash University in Australia developed a diet based on the elimination, or at least a reduction, of foods high in FODMAP. These compounds are characterised by high resistance to digestion, low level of absorption in the gastrointestinal tract and long fermentation in the gut.[1],[3] Depending on the type of sugar, FODMAPs are found in various foods. Fructo-oligosaccharides are contained among others in wheat, rye, onions, garlic and artichokes and galacto-oligosaccharides are a component of legumes. Lactose is mainly found in milk and other dairy products. The richest food sources of fructose are honey, apples, pears, watermelon and mango; and of sorbitol are: stone fruits, apples, pears and sugar-free mints/gum. Mannitol is found in sugar-free mints/gum and is also one of the components in mushrooms and cauliflower.[4]Existing evidence suggests that the use of a low FODMAP diet is associated with the reduction of the symptoms of irritable bowel syndrome (IBS), Crohn's disease and coexisting functional symptoms.[3],[4] Moreover, an experimental study in children confirmed that a low FODMAP diet reduced abdominal pain in children with IBS by 50%.[1] Interestingly, to our knowledge, no previous studies have investigated the impact of low FODMAP diet in children with FAP.Currently, two approaches have been suggested in planning a low FODMAP diet: bottom-up and top-down. The bottom-up method allows you to specify the patient's limit of FODMAP and is a gradual elimination of single products (or groups of products) from the diet until the symptoms have been alleviated. This progressive method can be applied in (1) patients who have not been diagnosed with IBS, but experience symptoms affecting their life quality; (2) patients who have already started elimination of other components from their diet; or (3) patients who struggle to follow a diet low in FODMAP. …

Treatment of Functional Abdominal Pain With Antidepressants: Benefits, Adverse Effects, and the Gastroenterologist's Role.

Pediatric functional abdominal pain is often treated with tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). The aim is investigating antidepressant use for treatment efficacy, correlation of response to psychiatric factors, and impact of adverse effects in regard to physicians' prescribing patterns. Retrospective review (2005-2013) children (5-21 years old) with functional abdominal pain treated with SSRI or TCA. Of the 531 cases with functional abdominal pain, 192 initiated SSRIs or TCAs while followed by gastroenterology. Charts reviewed for symptoms, adverse effects, and response: decreased pain or increased daily functioning. Sixty-three of 84 (75%) SSRI patients improved, 56 of 92 (61%) TCA patients improved (P = 0.03). Logistic regression controlling for psychiatric factors: SSRI remained significant over TCA (P = 0.04). Thirty-two of 67 (48%) patients with constipation received TCAs and 26 of 45 (58%) patients with diarrhea received SSRIs (P = 0.64). Three SSRI patients reported gastrointestinal effects, all diarrheal-type symptoms, and 2 TCA patients reported gastrointestinal effects, both constipation, in all it led to discontinuation. Thirteen (29%) of diarrheal-type patients reported adverse effects causing discontinuation as compared to 7 (8%) in the constipation group (P = .01). Twenty-one (25%) SSRI patients reported adverse effects with 5 (6%) mood disturbances. Twenty (22%) TCA patients reported adverse effects, 13 (14%) with mood disturbances (P = .07). Overall, 12 (14%) SSRI patients discontinued medication due to adverse effects, whereas 16 (17%) TCA patients (P = 0.24) did. Patients had significantly greater response to SSRIs than TCAs, remaining significant after controlling for psychiatric factors. Little significance is given to patient's associated gastrointestinal symptoms, frequently resulting in adverse effects and termination of medication.

Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study.

Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain-related disorders. The aim of the present study was to investigate the effect of Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children. Children (age 4-18 years) referred to pediatric gastroenterologist at Children's Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L reuteri DSM 17938 10⁸ CFU daily or placebo. The study was a prospective, randomized, double-blind, placebo-controlled parallel study. Symptoms were evaluated using Wong-Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence. Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs 51 days, P = 0.029). Abdominal pain was less severe in children taking probiotics during the second month (P < 0.05) and fourth month (P < 0.01). The 2 groups did not differ in the duration of abdominal pain, stool type, or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from first to fourth month, with the reduction more prominent in the intervention group (P < 0.001 vs P = 0.004). Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.

Maintenance of Pain in Children With Functional Abdominal Pain.

A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.

Progress in Chinese medical diagnosis and treatment of functional abdominal pain in children

Progress in Chinese medical diagnosis and treatment of functional abdominal pain in children

The Efficacy of Citalopram in the Treatment of Functional Abdominal Pain in Children: A Randomized, Double-Blind, Placebo-Controlled Study

Introduction: Limited data are available on the effectiveness of antidepressants in the treatment of functional gastrointestinal disorders in children. We evaluated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Material and Methods: Children with FAP (n=115, aged 6-18 years) received either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point pain rating scale or “no pain”. Depression, anxiety, somatization, and physician-assessed global severity and improvement were also evaluated. Patients were followed for 8 weeks after medication period. Results: Eighty six patients completed the trial (43 in each group). Treatment response rate in the citalopram and the placebo group was 55.8% and 39.5% at week 4 (P=0.097) and 72.0% and 53.4% at week 12 (P=0.059), respectively. Controlling for baseline characteristics, more reduction was observed in pain (z=-2.67, P=0.008) and global severity scores (z=-3.08, P=0.002) in the citalopram group compared with the placebo group. Changes in depression, anxiety, and somatization scores were comparable between the two groups. Receiving citalopram (OR=7.718, P=0.006), father education level (OR=3.179, P=0.040), baseline pain score (OR=5.621, P<0.001), baseline somatization score (OR=0.863, P=0.017), and change in somatization severity (OR=1.168, P=0.039) were predictors of treatment response at week 4. The association of receiving citalopram and treatment response at week 12 was not statistically significant (OR=2.944, P=0.096). Conclusion: Four-week treatment with citalopram is effective in reducing pain in children with FAP, independent from patients’ baseline psychological status or psychotropic effects of the drug. Keywords: Abdominal Pain, Antidepressive Agents, Child, Serotonin Reuptake Inhibitors, Randomized Controlled Trial.

Behavioral Therapy for Functional Abdominal Pain

Source: van der Veek SMC, Derkx BHF, Benninga MA, et al. Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial. Pediatrics. 2013; 132(5): e1163– e1172; doi: 10.1542/peds.2013-0242Investigators in the Netherlands conducted a randomized controlled trial to investigate the effectiveness of a 6-session cognitive behavior therapy (CBT) protocol compared with 6 visits to a pediatrician or pediatric gastroenterologist (intensive medical care [IMC]) for the treatment of pediatric functional abdominal pain (FAP). For the study, children aged 7 to 18 years who met the standardized Rome III criteria1 for FAP were enrolled and randomized to either the CBT or IMC treatment group. CBT was delivered primarily by trained master’s degree students in psychology. Pediatrician-delivered IMC consisted of parent and child education and advice regarding FAP, including diet, activity, and medication, if indicated. Assessments were performed pretreatment, posttreatment, and at 6- and 12-month follow-up. The primary outcome was level of abdominal pain (AP) as reported on questionnaires and diaries. Secondary outcomes included other gastrointestinal complaints, functional disability, other somatic complaints, anxiety, depression, and quality of life.Data were analyzed on 104 study children, with 52 randomized to each of the 2 treatment groups. Both CBT and IMC resulted in a significant and essentially equal decrease in AP (P < .001). According to the questionnaire-derived data 1 year after treatment, 60% of children who received CBT had significantly improved or recovered, versus 56.4% of children receiving IMC (P = .47). When diary-derived data was used, improvement was identified in 65.8% of children receiving CBT versus 62.8% of those receiving IMC (P = .14). For nearly all secondary outcomes improvement was noted in study children.The authors conclude that in children with FAP, CBT was as effective as IMC in reducing their pain.Drs Hagin and LeLeiko have disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.FAP is a common and costly pediatric problem,1 accounting for up to 40% to 50% of visits to pediatric gastroenterologists.2 There is some evidence that CBT might be an effective treatment, but unequivocal evidence in support of CBT for the treatment of FAP is lacking (see related article, AAP Grand Rounds, January 2010;23[1]:43).The present RCT was designed to control for the therapeutic effect of receiving increased attention by comparing a 6-session CBT protocol with 6 sessions of intensified medical care. Based on reliable change indices, both groups demonstrated similar improvement in FAP symptoms over time. At 12 months following treatment there was no statistically significant difference between the 2 groups in the number of patients using health care for FAP.There are several weaknesses in the design of the present study that limit interpretation of the results. The study design did not include a “no treatment” control group, limiting the ability to determine how much of the improvement seen between the 2 groups might have been due to the natural course of FAP over time or other factors, such as the effect of using a pain diary to track symptoms. Furthermore, the study did not include data regarding use of medications to treat FAP in the IMC group, including responsiveness to medications, number of medications tried, and number of patients on medications. Including details about medication use is important when interpreting the outcomes of the 2 treatment groups.Despite the limitations, the present study provides evidence that CBT may be an effective treatment for pediatric FAP. The benefits of CBT over IMC in the treatment of FAP were not evaluated in the present study, but it seems obvious that cognitive and behavioral interventions have less risk than pharmacological interventions. It will be important for future research to continue to examine the impact of CBT on pediatric FAP.

枯草杆菌二联活菌肠溶胶囊治疗儿童功能性腹痛60例

目的：评估枯草杆菌二联活菌肠溶胶囊治疗儿童功能性腹痛临床效果。方法：选择120例儿童功能性腹痛患儿随机分成治疗组(60例)和对照组(60例)。两组均予常规治疗，治疗组加服枯草杆菌二联活菌肠溶胶囊，疗程8周，比较两组临床效果。结果：治疗组和对照组临床痊愈率(30.00% vs 11.67%, χ2 = 6.114, P = 0.013)、总有效率(95.00% vs 73.33%, χ2 = 10.568, P = 0.001)比较差异有统计学意义；两组腹痛次数、程度及持续时间比较差异有统计学意义(P < 0.05)。结论：枯草杆菌二联活菌肠溶胶囊治疗儿童功能性腹痛，疗效显著，安全可靠，具有较高的临床应用价值。 Objective: To evaluate the efficacy of live combined Bacillus subtilis and Enterococcus faecium enteric- coated capsules in treatment of children with functional abdominal pain. Methods: 120 cases were randomly divided into treatment group and control group (60 cases for each). Both groups were treated with the same routine treatment, but the treatment group were given live combined Bacillus subtilis and Enterococcus faecium enteric-coated capsules besides routine treatment. All the treatments lasted for 8 weeks. The clinical efficacy of both groups was observed. Results: There was a statistic difference in curative rate (30.00% vs 11.67%, χ2 = 6.114, P = 0.013) and total effective rate (95.00% vs 73.33%, χ2 = 10.568, P = 0.001), the frequency and the degree of abdominal pain and the duration of abdominal pain after treatment of treatment group were much better than that of control group (P < 0.05). Conclusions: Live combined Bacillus subtilis and Enterococcus faecium enteric-coated capsules is a safe and highly effective drug in the treatment of functional abdominal pain in children. It is worthy of application.

Pain management in patients with inflammatory bowel disease: insights for the clinician.

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population.