Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

Huertas-Ceballos A, Logan S, Bennett C, Macarthur C

Summary

Between 4% and 25% of school age children complain of stomach aches / recurrent abdominal pain (RAP) which is severe enough to interfere with their daily activities. For most such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are likely to be managed by reassurance and simple measures, a large range of interventions including dietary manipulation, some medicines and psychological interventions has been recommended. Recently it has been suggested that children previously described as having RAP should be classified according to the pattern of symptoms into a series of sub-groups (the Rome II criteria) including irritable bowel syndrome, functional dyspepsia, functional abdominal pain and abdominal migraine. It is not clear whether these categories describe conditions that really differ in either aetiology or responsiveness to treatment . This review attempted to determine the effectiveness of psychosocial interventions. We found 6 studies (including 167 children), all of which examined interventions broadly based on cognitive behavioural therapy (CBT) and no trials of other types of psychosocial interventions. Five of these trials had interpretable results, although lack of important data and / or clinical differences in either intervention or control groups prevented us from combining them statistically. The included trials were relatively small and had some weaknesses in design and reporting.

Each of the included studies reported a statistically significant benefit to participants in the intervention group. CBT may therefore be worth considering for some children with recurrent abdominal pain, but this review points to the need for further, better-quality research.