Management of Abdominal Pain and IBS in Children and Adolescents

Complementary & Alternative Therapies

Approximately 36–41% of children with gastrointestinal complaints use complementary and alternative medicine (CAM) each year.^[69–71] By definition, complementary medicine is used alongside conventional medicine, while alternative medicine is used in place of conventional medicine. CAM includes techniques such as acupuncture, chiropractics, homeopathy, herbal medicine and spiritual healing. It is important for clinicians to be aware of some of the more common forms of CAM, especially since some therapies can have adverse effects and may interfere with conventional, allopathic medications. Not surprisingly, evidence to support the use of CAM modalities in children is lacking, and there is a serious need for further research in this area.

Several herbal preparations, including Chinese herbal medications, ginger, bitter candytuft monoextract and peppermint oil (which was discussed previously in this article) have been employed for the treatment of FGIDs. Bensoussan et al. found that adults with IBS who received Chinese herbal medications in a randomized double-blind trial of 116 patients had significant improvements in bowel symptom scores as rated by patients (p = 0.03) and by gastroenterologists (p = 0.001) when compared with placebo.^[72] Patients receiving Chinese herbal medications also reported significantly higher overall scores on a global improvement scale. On the other hand, in a later study by Leung et al., traditional Chinese herbal medications were not found to be superior to placebo in terms of symptoms and quality of life in adult patients with diarrhea-predominant IBS.^[73]

Acupuncture, also adapted from traditional Chinese medicine, is postulated to have effects on acid secretion, gastrointestinal motility and sensation of visceral pain, possibly mediated through the release of opioid peptides in the CNS and enteric nervous system. Two recent adult trials, however, did not find evidence to support the superiority of acupuncture compared with sham acupuncture in the treatment of IBS.^[74,75] There have been no studies using acupuncture to treat children with FAP or IBS. A small, noncontrolled study of 17 children with chronic constipation reported an increased frequency of bowel movements with true acupuncture compared with placebo acupuncture.^[76] Massage therapy has been hypothesized to reduce excitation of visceral afferent fibers and possibly dampen central pain perception processing, but there are limited data on the usefulness of massage therapy for FAP or IBS.

Cite this: Management of Functional Abdominal Pain and Irritable Bowel Syndrome in Children and Adolescents - Medscape - Jun 01, 2010.

Box 1. Diagnostic Rome III criteria for functional abdominal pain and irritable bowel syndrome.
Diagnostic criteria for childhood functional abdominal pain Must include all of the following criteria, fulfilled at least once per week for at least 2 months prior to diagnosis:
Episodic or continuous abdominal pain Insufficient criteria for other functional gastrointestinal disorders No evidence of an inflammatory, anatomic, metabolic or neoplastic process that explains the subject's symptoms
Diagnostic criteria for childhood irritable bowel syndrome
Must include both of the following criteria, fulfilled at least once per week for at least 2 months prior to diagnosis:
Abdominal discomfort or pain associated with two or more of the following at least 25% of the time: Improvement with defecation Onset associated with a change in frequency of stool Onset associated with a change in the form (appearance) of stool No evidence of an inflammatory, anatomic, metabolic or neoplastic process that explains the subject's symptoms
Data from.^[4]

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