Eur J Pediatr. 2022 Jul;181(7):2603-2617. doi: 10.1007/s00431-022-04459-y.Epub 2022 Apr 23.

Robyn Rexwinkel ¹, Arine M Vlieger ², Miguel Saps ³, Merit M Tabbers ⁴, Marc A Benninga ⁴

Author information

¹Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands. r.rexwinkel@amsterdamumc.nl.

²Department of Pediatrics, St. Antonius Hospital, Nieuwegein, Netherlands.

³Department of Pediatric Gastroenterology, University of Miami, Miami, FL, USA.

⁴Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands.

Abstract

Disorders of the gut-brain interaction negatively impact quality of life and carry a substantial socioeconomic burden. Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common functional abdominal pain disorders in childhood. The pathophysiology is not fully understood, and high-quality intervention trials and international guidelines are missing. Therefore, the management of these disorders remains challenging. This review aims to provide an up-to-date overview of therapeutic possibilities for pediatric IBS or FAP-NOS and recommends management strategies. To prevent unnecessary referrals and extensive costs, it is fundamental to make a positive diagnosis of IBS or FAP-NOS in children with chronic abdominal pain with only minimal investigations. A tailor-made approach for each patient, based on the accompanying physical and psychological symptoms, is proposed to date.

Conclusion: Shared decision-making including non-pharmacological and pharmacological interventions should be considered and discussed with the family.

What is known: • Irritable bowel syndrome and functional abdominal pain-not otherwise specified are common in childhood. • Although the number of treatment options has grown recently, managing these disorders can be challenging and unsatisfactory, and no evidence-based international management guidelines are available.

What is new: • We suggest using a stepwise individualized approach to management, where after first-line management, both non-pharmacological and pharmacological interventions should be discussed.