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Recurrent Abdominal Pain in Children: Summary Evidence From 3 Systematic Reviews of Treatment Effectiveness

Abbott, Rebecca, A.*; Martin, Alice, E.*,†; Newlove-Delgado, Tamsin, V.; Bethel, Alison*; Whear, Rebecca, S.*; Coon, Jo, Thompson*; Logan, Stuart*

Journal of Pediatric Gastroenterology and Nutrition: February 21, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000001922
Original Article: Gastroenterology: PDF Only

Objectives: Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities.

Methods: We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents.

Results: We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive-behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short-term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions.

Conclusions: Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of well-conducted clinical trials. There is an urgent need for high-quality RCTs to provide evidence to guide management of this common condition.

*NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter

Bristol Royal Hospital for Children, Bristol

University of Exeter Medical School, Exeter, UK.

Address correspondence and reprint requests to Rebecca A. Abbott, PhD, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK (e-mail: r.a.abbott@exeter.ac.uk).

Received 5 October, 2017

Accepted 27 January, 2018

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The authors report no conflicts of interest.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,