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

Five-year View

Over the next 5 years, refinements in the Rome III diagnostic criteria for FAP and IBS will be reflected in more studies targeting specific phenotypes of symptoms, rather than recurrent abdominal pain in general. These changes will hopefully continue to shed light on potential etiological pathways, as well as guide research into new therapies. Increased recognition of the biopsychosocial model as the main framework for the evaluation and treatment of children with FAP and IBS will change the focus of their evaluation and management, moving away from FGIDs being perceived as a diagnosis of exclusion, and therefore obviating costly, unnecessary and potentially invasive testing and therapies. Psychosocial interventions will no doubt continue to remain an important tool in the management of FAP and IBS, especially as our understanding of the placebo effect in children with FGIDs improves. Ideally, studies will be able to elucidate the specific factors that influence or enhance the placebo response. Pharmacologic interventions hold the greatest potential for growth and development, with several candidate medications already in the pipeline based on recent advances in our understanding of neurotransmitters in the brain–gut axis. These include drugs that act on the serotonin receptor and transporter system: antidepressants, norepinephrine-reuptake inhibitors, opioids, cholecystokinin antagonists, neurokinin antagonists, chloride channel activators, guanylate cyclase C agonists, atypical benzodiazepines, probiotics and antibiotics.[77] More sophisticated methods for evaluating gastrointestinal motility and transit may also prove helpful in demonstrating therapeutic efficacy in addition to subjective measures of improvement.

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