Jury Out on Best Treatment for Functional Abdominal Pain Disorders in Kids

By Reuters Staff

May 28, 2021

NEW YORK (Reuters Health) - There is no strong evidence in the literature to recommend any specific pharmacologic agent to treat functional abdominal pain disorders in children, say the authors of a comprehensive literature review.

Functional abdominal pain disorders (FAPDs) are common in childhood, harm quality of life and often keep kids out of school. There are several compounds available for the treatment of FAPDs in children, but their efficacy and safety are unclear due to a lack of head-to-head randomized controlled trials.

To investigate further, Robin Rexwinkel of the University of Amsterdam and colleagues systematically reviewed the efficacy and safety of pharmacologic treatments available for pediatric FAPDs in 17 studies with a total nearly 1,200 children with FAPDs.

The systematic review "clearly reveals the scarcity of high-quality, placebo-controlled trials," they report in Pediatrics.

"When treatment success is used as the primary end point, peppermint oil, cyproheptadine, and tegaserod might be potential effective and safe treatments, but well-designed intervention studies are needed before this conclusion can be made," they say.

There was no evidence that any other drug treatment has a significant role in the treatment of pediatric FAPDs. "Therefore, the current evidence is insufficient to recommend any specific pharmacologic compound to treat FAPDs in children," they conclude.

However, based on the evidence, "antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects," they suggest.

In clinical practice, however, the first step in managing FAPDs in children may center on education, reassurance, and simple dietary advice, the authors say.

"Lately, there is increasing evidence for the effectiveness of nonpharmacologic treatment, such as hypnotherapy and cognitive behavior therapy. These treatments are not hampered by severe adverse events and may be especially effective in children with lasting symptoms," they point out.

"Therefore, based on the majority of current evidence and expert opinion, nonpharmacologic therapy could be the first intervention attempt in pediatric FAPDs. However, because the pathogenesis of these disorders remains unclear in children, the optimal treatment strategy is not known," they acknowledge.

"To date, it is preferable to discuss both pharmacologic therapies and nonpharmacologic options during shared decision consultation. This can be used to make a tailor-made approach for each patient," the study team concludes.

This research had no commercial funding and the authors disclosed no relevant conflicts of interest.

SOURCE: https://bit.ly/3fobziv Pediatrics, online May 26, 2021

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