Hypnotherapy, Cognitive Therapy Help Pediatric Abdominal Pain

Lara C. Pullen, PhD

February 09, 2015

Hypnotherapy, cognitive behavioral therapy, and probiotics are effective in the treatment of pediatric abdominal pain-related functional gastrointestinal disorders. Data are inconclusive, however, with regard to the efficacy of fiber supplements.

Juliette M. T. M. Rutten, MD, from the Academic Medical Center in Amsterdam, the Netherlands, and colleagues published the results of their systematic review online February 9 in Pediatrics. The team reviewed 24 studies of very low to moderate methodologic quality that included 1390 children.

The authors emphasize that the studies have multiple limitations, and therefore the results of their systematic review should be interpreted with caution. Although only eight of the randomized controlled trials reported on adverse events, there were no reports of serious adverse effects.

The systematic review revealed that hypnotherapy and cognitive behavioral therapy both resulted in significant improvement of abdominal pain when compared with a standard care/wait list. Hypnotherapy included suggestions toward control and normalization of gut function, strengthening of ego, and stress reduction. Cognitive behavioral therapy focused on changing attitudes, cognition, and behavior that might improve symptoms.

Written self-disclosure also improved pain frequency at the 6-month follow-up, but not at 3 months. Dr Rutten and colleagues thus suggest written self-disclosure might be a potentially helpful adjunctive tool that can target psychosocial stress.

Probiotics are believed to prevent overgrowth of potentially pathogenic bacteria, thereby maintaining the integrity of gut mucosa and normalizing intestinal inflammatory responses. When compared with placebo, Lactobacillus rhamnosus GG (LGG) and the probiotic medical food VSL#3 were associated with significantly more treatment responders (LGG relative risk, 1.31; 95% confidence interval, 1.08 - 1.59; VSL#3, P < .05).

Guar gum was the only fiber supplement tested that was able to significantly improve irritable bowel syndrome symptom frequency, with 45% of patients reporting reduced frequency compared with 5% in the placebo group at 8 weeks (P = .025). However, it had no effect on pain intensity.

In a pooled analysis of all fiber supplement trials, there was no significant improvement in either "no pain" or "satisfactory improvement" compared with placebo (relative risk, 1.17; 95% confidence interval, 0.75 - 1.81).

Similarly, yoga did not improve functional disability relative to wait-list control.

More than 40% of children with irritable bowel syndrome and functional abdominal pain use complementary and alternative medicine. Despite this, high-quality studies on nonpharmacologic treatments in pediatric abdominal pain-related functional gastrointestinal disorders are lacking, Dr Rutten and colleagues note.

In most instances, pediatric symptoms resolve without active treatment. Thus, physician reassurance and education may be a reasonable first step in treatment.

Many physicians and patients also use dietary interventions to treat abdominal pain-related functional gastrointestinal disorders. They do this because carbohydrates such as fructose and lactose are believed to be prone to malabsorption and intolerance. The authors found no evidence, however, that lactose-free diets relieved symptoms.

The researchers found no studies on lifestyle interventions, prebiotics, fluid intake, or gluten-, histamine-, or carbonic acid-free diets.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 9, 2015.


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