Ital J Pediatr. 2024 Mar 14;50(1):51. doi: 10.1186/s13052-024-01607-y.

Giovanni Di Nardo ¹, Giovanni Barbara ^2 3, Osvaldo Borrelli ⁴, Cesare Cremon ^2 3, Valentina Giorgio ⁵, Luigi Greco ⁶, Michele La Pietra ⁷, Giovanni Marasco ^2 3, Licia Pensabene ⁸, Marisa Piccirillo ¹, Claudio Romano ⁹, Silvia Salvatore ¹⁰, Michele Saviano ⁷, Vincenzo Stanghellini ^2 3, Caterina Strisciuglio ¹¹, Renato Tambucci ¹², Rossella Turco ¹³, Letizia Zenzeri ¹, Annamaria Staiano ¹⁴

Author information

¹Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.

²IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy.

³Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy.

⁴Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK.

⁵Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

⁶General Pediatrician, Heath Care Agency of Bergamo, Bergamo, Italy.

⁷General Pediatrician, Heath Care Agency of Naples, Naples, Italy.

⁸Department of Medical and Surgical Sciences, Pediatric Unit, Magna Graecia University, Catanzaro, Italy.

⁹Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.

¹⁰Pediatric Department, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.

¹¹Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.

¹²Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

¹³Department of Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy.

¹⁴Department of Translational Medical Science, Section of Pediatrics, University Federico II, Via S. Pansini 5, Naples, 80131, Italy. Annamaria.staiano@unina.it.

Abstract

The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered.