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Advances in the Evaluation and Management of Childhood Functional Abdominal Pain

  • Gastrology (S Khan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Our objective is to review recent advances in the classification, evaluation, and management of children with functional abdominal pain.

Recent Findings

The Rome IV criteria allow the provider to identify whether a child’s presentation is consistent with a functional abdominal pain disorder. The concept of the multidimensional clinical profile acknowledges that multiple unique factors can contribute to a child’s presentation. There is growing evidence on the use of a number of pharmacological treatments for functional abdominal pain disorders. A diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) can be effective in some children with irritable bowel syndrome. Cognitive behavioral therapy can be as effective as medical treatment of abdominal pain. Neuromodulation-based therapies have shown promise in functional abdominal pain disorder treatment.

Summary

As our understanding of the factors that contribute to functional abdominal pain grows, so too does the feasibility of identifying personalized, effective treatment strategies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PloS one. 2015;10(5):e0126982. This meta-analysis provides a comprehensive review of the epidemiological studies that have been conducted in children worldwide.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Spee LA, Lisman-Van Leeuwen Y, Benninga MA, Bierma-Zeinstra SM, Berger MY. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice. Scand J Prim Health Care. 2013;31(4):197–202.

    Article  PubMed  PubMed Central  Google Scholar 

  3. •• Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: children and adolescents. Gastroenterology. 2016 https://doi.org/10.1053/j.gastro.2016.02.015. The Rome IV criteria for functional gastrointestinal disorders in children and adolescents are presented in this article, along with comments on epidemiology, pathophysiology, and management.

  4. Watson KL Jr, Kim SC, Boyle BM, Saps M. Prevalence and impact of functional abdominal pain disorders in children with inflammatory bowel diseases (IBD-FAPD). J Pediatr Gastroenterol Nutr. 2017;65(2):212–7.

    Article  PubMed  Google Scholar 

  5. Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151–63.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tack J, Drossman DA. What's new in Rome IV? Neurogastroenterol Motil. 2017;29(9). https://doi.org/10.1111/nmo.13053.

  7. Devanarayana NM, Rajindrajith S, Perera MS, Nishanthanie SW, Benninga MA. Gastric emptying and antral motility parameters in children with functional dyspepsia: association with symptom severity. J Gastroenterol Hepatol. 2013;28(7):1161–6.

    Article  PubMed  Google Scholar 

  8. Hoffman I, Tack J. Assessment of gastric motor function in childhood functional dyspepsia and obesity. Neurogastroenterol Motil. 2012;24(2):108–12. e81.

    Article  CAS  PubMed  Google Scholar 

  9. Chitkara DK, Camilleri M, Zinsmeister AR, Burton D, El-Youssef M, Freese D, et al. Gastric sensory and motor dysfunction in adolescents with functional dyspepsia. J Pediatr. 2005;146(4):500–5.

    Article  PubMed  Google Scholar 

  10. Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology. 2004;127(4):1239–55.

    Article  PubMed  Google Scholar 

  11. Mulak A, Paradowski L. Anorectal function and dyssynergic defecation in different subgroups of patients with irritable bowel syndrome. Int J Color Dis. 2010;25(8):1011–6.

    Article  Google Scholar 

  12. Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, et al. The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol. 2004;99(8):1579–84.

    Article  PubMed  Google Scholar 

  13. Simrén M, Törnblom H, Palsson OS, van Tilburg MAL, Van Oudenhove L, Tack J, Whitehead WE. Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts. Gut. 2018;67(2):255–62. https://doi.org/10.1136/gutjnl-2016-312361.

  14. Major G, Pritchard S, Murray K, Alappadan JP, Hoad CL, Marciani L, et al. Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome. Gastroenterology. 2017;152(1):124–33. e2.

    Article  PubMed  Google Scholar 

  15. Le Neve B, Brazeilles R, Derrien M, Tap J, Guyonnet D, Ohman L, et al. Lactulose challenge determines visceral sensitivity and severity of symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2016;14(2):226–33 e1–3.

    Article  PubMed  Google Scholar 

  16. Chumpitazi BP, Weidler EM, Shulman RJ. Lactulose breath test gas production in childhood IBS is associated with intestinal transit and bowel movement frequency. J Pediatr Gastroenterol Nutr. 2017;64(4):541–5.

    Article  CAS  PubMed  Google Scholar 

  17. Camilleri M. Review article: biomarkers and personalised therapy in functional lower gastrointestinal disorders. Aliment Pharmacol Ther. 2015;42(7):818–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30(7):707–17.

    Article  CAS  PubMed  Google Scholar 

  19. •• Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Whear R, et al. Pharmacological interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. 2017;3:CD010973. This systematic review assesses the current evidence available for the use of pharmacological treatment in children with functional abdominal pain.

    PubMed  Google Scholar 

  20. Dehghani SM, Imanieh MH, Oboodi R, Haghighat M. The comparative study of the effectiveness of cimetidine, ranitidine, famotidine, and omeprazole in treatment of children with dyspepsia. ISRN Pediatr. 2011;2011:219287.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rodriguez L, Diaz J, Nurko S. Safety and efficacy of cyproheptadine for treating dyspeptic symptoms in children. J Pediatr. 2013;163(1):261–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Madani S, Cortes O, Thomas R. Cyproheptadine use in children with functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2016;62(3):409–13.

    Article  CAS  PubMed  Google Scholar 

  23. Acker BW, Cash BD. Medicinal foods for functional GI disorders. Curr Gastroenterol Rep. 2017;19(12):62.

    Article  PubMed  Google Scholar 

  24. Saps M, Youssef N, Miranda A, Nurko S, Hyman P, Cocjin J, et al. Multicenter, randomized, placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders. Gastroenterology. 2009;137(4):1261–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Talley NJ, Locke GR, Saito YA, Almazar AE, Bouras EP, Howden CW, et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter. Randomized Controll Study Gastroenterol. 2015;149(2):340–9. e2.

    CAS  Google Scholar 

  26. Newlove-Delgado TV, Martin AE, Abbott RA, Bethel A, Thompson-Coon J, Whear R, et al. Dietary interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. 2017;3:CD010972.

    PubMed  Google Scholar 

  27. Roohafza H, Pourmoghaddas Z, Saneian H, Gholamrezaei A. Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Neurogastroenterol Motil. 2014;26(11):1642–50.

    Article  CAS  PubMed  Google Scholar 

  28. Xie C, Tang Y, Wang Y, Yu T, Jiang L, Lin L. Efficacy and safety of antidepressants for the treatment of irritable bowel syndrome: a meta-analysis. PLoS One. 2015;10(8):e0127815.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zar-Kessler CAM, Belkind-Gerson J, Bender S, Kuo BM. Treatment of functional abdominal pain with antidepressants: benefits, adverse effects, and the gastroenterologist’s role. J Pediatr Gastroenterol Nutr. 2017;65(1):16–21.

    Article  PubMed  Google Scholar 

  30. Talley NJ, Kellow JE, Boyce P, Tennant C, Huskic S, Jones M. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci. 2008;53(1):108–15.

    Article  CAS  PubMed  Google Scholar 

  31. Scarpellini E, Giorgio V, Gabrielli M, Filoni S, Vitale G, Tortora A, et al. Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2013;17(10):1314–20.

    CAS  PubMed  Google Scholar 

  32. Hyman PE, Di Lorenzo C, Prestridge LL, Youssef NN, Ueno R. Lubiprostone for the treatment of functional constipation in children. J Pediatr Gastroenterol Nutr. 2014;58(3):283–91.

    Article  CAS  PubMed  Google Scholar 

  33. Linzess (R) [package insert]. Forest Pharmaceuticals, Inc., St. Louis, MO; 2012.; Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/202811s000lbl.pdf.

  34. Symon DN, Russell G. Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Arch Dis Child. 1995;72(1):48–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Chumpitazi BP, Cope JL, Hollister EB, Tsai CM, McMeans AR, Luna RA, et al. Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Aliment Pharmacol Ther. 2015;42(4):418–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Chumpitazi BP, McMeans AR, Vaughan A, Ali A, Orlando S, Elsaadi A, Shulman RJ. Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2017. https://doi.org/10.1016/j.cgh.2017.09.043.

  37. van der Veek SM, Derkx BH, Benninga MA, Boer F, de Haan E. Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial. Pediatrics. 2013;132(5):e1163–72.

    Article  PubMed  Google Scholar 

  38. •• Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Thompson-Coon J, Whear R, et al. Psychosocial interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. 2017;1:CD010971. This systematic review assesses the current evidence available for the use of psychosocial interventions in children with functional abdominal pain.

    PubMed  Google Scholar 

  39. Evans S, Lung KC, Seidman LC, Sternlieb B, Zeltzer LK, Tsao JC. Iyengar yoga for adolescents and young adults with irritable bowel syndrome. J Pediatr Gastroenterol Nutr. 2014;59(2):244–53.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Korterink JJ, Ockeloen LE, Hilbink M, Benninga MA, Deckers-Kocken JM. Yoga therapy for abdominal pain-related functional gastrointestinal disorders in children: a randomized controlled trial. J Pediatr Gastroenterol Nutr. 2016;63(5):481–7.

    Article  PubMed  Google Scholar 

  41. Lu PL, Teich S, Di Lorenzo C, Skaggs B, Alhajj M, Mousa HM. Improvement of quality of life and symptoms after gastric electrical stimulation in children with functional dyspepsia. Neurogastroenterol Motil. 2013;25(7):567–e456.

    Article  CAS  PubMed  Google Scholar 

  42. Islam S, McLaughlin J, Pierson J, Jolley C, Kedar A, Abell T. Long-term outcomes of gastric electrical stimulation in children with gastroparesis. J Pediatr Surg. 2016;51(1):67–71.

    Article  PubMed  Google Scholar 

  43. Kovacic K, Hainsworth K, Sood M, Chelimsky G, Unteutsch R, Nugent M, et al. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017;2(10):727–37.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Peter L. Lu & Miguel Saps

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  1. Peter L. Lu
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  2. Miguel Saps
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Correspondence to Peter L. Lu.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Gastrology

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Lu, P.L., Saps, M. Advances in the Evaluation and Management of Childhood Functional Abdominal Pain. Curr Pediatr Rep 6, 79–85 (2018). https://doi.org/10.1007/s40124-018-0159-6

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  • DOI: https://doi.org/10.1007/s40124-018-0159-6

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