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

Eric Chiou; Samuel Nurko

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

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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Financial & competing interests disclosure
The authors deny any conflict of interest or financial support from industry. This work was funded in part by NIH T32DK007477-25 and NIH K24 DK082792A grants. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

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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