Management of Functional Abdominal Pain and Irritable Bowel Syndrome in Children and Adolescents

Eric Chiou; Samuel Nurko

Disclosures

Expert Rev Gastroenterol Hepatol. 2010;4(3):293-304. 

In This Article

Management of Children with FAP & IBS

Once a diagnosis of FAP or IBS has been made, the management approach should be based on the biopsychosocial model for FGIDs, which highlights the importance of the child's physical and social setting, as well as psychological comorbidities. Success in treating patients with FAP or IBS begins with the establishment of an effective patient–physician relationship. The physician should adopt an 'active listening approach' and an enthusiastic, positive and encouraging attitude towards treatment.[12] The physician should elicit any patient concerns or fears, as well as provide reassurance that a positive diagnosis of FAP or IBS is not a failure to identify an underlying illness. Setting up an expectation for normal results to laboratory testing or investigations, when appropriate, may assist in establishing acceptance of a functional disorder diagnosis. Explaining the pathophysiology of visceral pain and associated complaints in the context of a brain–gut axis can be helpful, but symptoms should be validated as being real. It is also important to make clear that treatment response is often gradual and to set realistic goals, such as improved coping with symptoms and maintenance of normal daily living activities, rather than expectation of a prompt cure. Overall, management should be multidisciplinary and tailored to the patient's specific symptoms and identifiable triggers.

Regardless of the specific therapeutic interventions that are employed, physicians need to be cognizant of the potential power of the placebo effect. In several studies of FAP and IBS, the failure of an intervention to demonstrate significant benefit was not because of an absolute lack of improvement, but may have been due to the observation of a strong placebo effect. For example, in a study by Saps et al., 58% of patients who received placebo reported feeling better at the end of the study, compared with 63% of patients who received amitriptyline.[13] Clearly, engaging in a positive patient–physician relationship is very important, and should be the foundation for promoting a therapeutic response to all treatments for FAP and IBS. The four major therapeutic approaches that will be reviewed here include: dietary, psychosocial, pharmacologic and complementary/alternative medicine interventions.

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