Pharmacological 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 medication 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 but in updating the review we included studies which used these criteria to select participants as well as those using the traditional diagnosis of RAP.

This review attempted to determine the effectiveness of medication. When the original version was published only one paper met the inclusion criteria. In this updated version two more papers were included. All three papers are randomised and two were crossover trials. The interventions assessed (one trial each) were pizotifen, peppermint oil and famotidine.

All three trials were small including 16 (pizotifen), 50 (peppermint oil) and 25 (famotidine) children respectively.

Although the authors of the original trials suggested that pizotifen and famotidine were effective treatments the reviewers conclude that this review provides only weak evidence for the use of drugs in the treatment of RAP and suggest that they should only be used in the context of clinical trials or in children with severe problems refractory to conventional management.