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

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

Summary

Recurrent abdominal pain is common in childhood and dietary interventions are often recommended but we found no evidence that they are effective. 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 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 dietary interventions. When the original version was published, only four trials fit the inclusion criteria for the review, two of which looked at fibre supplements and two of which looked at lactose-restriction diets. Results suggest little evidence of effect for either treatment. However, as these results were only reported in a few small trials, the reviewers suggested that more research was needed. In this updated version we found three further trials, all testing the effectiveness of probiotics such as lactobacillus which some studies have suggested may be of benefit in adults with irritable bowel syndrome. One was reported only as an abstract that could not be analysed because of lack of data. These trials provided no clear evidence of any benefit from the use of probiotics in these children, including those classified under the Rome II criteria as having irritable bowel syndrome.