Pharmacological interventions for pediatric irritable bowel syndrome

ABSTRACT

Introduction

Irritable bowel syndrome is a common functional gastrointestinal disorder in children, characterized by recurrent abdominal pain associated with altered bowel habits in terms of both frequency and consistency. According to change in stool consistency it is categorized into 4 subtypes. From the etiological perspective, it is a combination of factors takes part in symptoms’ generation, the overall treatment response rate is often unsatisfactory if a multidisciplinary is not pursued.

Areas covered

The aim of this manuscript is to summarize the current pharmacotherapy in pediatric irritable bowel syndrome in order to aid clinicians in treating this challenging disorder.

Expert opinion

Most evidence involving pediatric populations rely on open label or retrospective studies and/or are not specifically designed for irritable bowel syndrome but tend to generalize their results to mixed populations of children with functional gastrointestinal disorders. A high placebo response rate combined with poor patients’ selection could account for the overall weak evidence supporting the use of pharmacological agents in pediatric irritable bowel syndrome. Given the multifaceted nature of the disorder, multidisciplinary approaches combining pharmacotherapy with alternative treatments is highly recommendable.

KEYWORDS:

• Irritable bowel syndrome
• functional abdominal pain disorders
• pediatric
• pharmacotherapy
• antidepressants
• antispasmodics
• multidisciplinary approach

Article highlights

• Irritable bowel syndrome is a common functional abdominal pain disorder in children, distinguished by chronic abdominal pain associated with a change in frequency and consistency of bowel habit. It can be subdivided into 4 subtypes according to these features.

• Even if the underlying pathophysiological mechanisms are still not fully understood, irritable bowel syndrome is considered a disorder of the gut-brain axis and biopsychosocial model plays a key role. Symptoms mirror which factors of the gut-brain axis are altered and to what degree.

• The cornerstone of irritable bowel syndrome management is a multidisciplinary approach. Both pharmacological and non-pharmacological strategies should be involved largely directed toward improving the bothersome symptoms

• There is currently scarcity of evidence to endorse use of one medication over another.

• Many challenges make it difficult to evaluate efficacy of current available medications in children. The most crucial is that majority of trials have lumped all functional abdominal pain disorders together rather than assessing it in patients with irritable bowel syndrome, specifically.

• Further trials are required to support the efficacy of treatments that have already demonstrated efficacy and to evaluate new pharmacological options.

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Disclosure statement

O Borrelli has received consultancy and lecture fees from Danone, Nutricia and Mead Johnson. 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This manuscript has not been funded.