Current evidence for the management of functional abdominal pain in children
| Intervention | Evidence source | Outcome/conclusion |
|---|---|---|
| Psychological therapies | Meta-analysis 201112 | 10 controlled studies were reviewed demonstrating psychological therapies are effective in treating children with chronic abdominal pain (p<0.01) |
| Cochrane systematic review 200910 | There is evidence that cognitive behavioural therapy (in person and online) and relaxation treatments, such as yoga and hypnosis, are effective at reducing CAP in children | |
| RCT of 53 children in 200711 | At 1-year successful treatment was accomplished in 85% of the hypnotherapy group and 25% of the standard medical treatment group (p<.001) | |
| Pharmacological treatment | Cochrane systematic review 20118 | There is no evidence that anti-depressants (amitriptyline trialled) are beneficial in the treatment of recurrent abdominal pain in children and there is a risk of adverse events, some potentially life-threatening |
| Cochrane systematic review 20096 | There is weak evidence that pizotifen reduces the mean number of days in pain in those with abdominal migraine and famotidine with CAP associated with dyspepsia. There is no significant benefit to using peppermint oil capsules in CAP associated with IBS. The overall lack of evidence suggests there is little reason to prescribe drugs unless the pain is severe or used within a clinical trial | |
| APP & NASPGHAN* clinical guidelines for CAP in children 20051 | There is weak evidence for the use of peppermint oil in CAP associated with IBS based on a RCT of 42 children showing an overall reduced pain score in the treatment group at 2-weeks. However, there was no significant difference in the frequency or duration of pain or impact on daily life | |
| Dietary interventions | Meta-analysis 20117 | Lactobacillus rhamnosus GG moderately increases treatment success in children with recurrent abdominal pain, particularly those diagnosed with IBS. For IBS subgroup (n=167) NNT 4. There was no benefit for children with functional abdominal pain or functional dyspepsia |
| Cochrane systematic review 2009 9 | There is no evidence that fibre supplements, lactose free diets or lactobacillus supplements are effective |
*APP, American Academy of Paediatrics; CAP, chronic abdominal pain; IBS, irritable bowel syndrome; NASPGHAN, North American Society for Paediatric Gastroenterology, Hepatology & Nutrition; RCT, randomised controlled trial.