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Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment
Bhupinder Kaur Sandhu1, Siba Prosad Paul1
1Bhupinder Kaur Sandhu, Siba Prosad Paul, Department of Pediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom.
Insights
Irritable bowel syndrome (IBS) is a common cause of recurrent abdominal pain in children. Diagnosis relies on Rome III criteria, with reassurance and lifestyle changes often being effective treatments.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
Background:
- Irritable bowel syndrome (IBS) is the most frequent cause of recurrent abdominal pain (RAP) in children globally.
- Defined by Rome III criteria, IBS involves abdominal pain linked to defecation and altered stool form/frequency, without structural or biochemical abnormalities.
- Estimated to affect 10%-15% of older children and adolescents, IBS is considered a brain-gut disorder influenced by environmental and hereditary factors.
Purpose of the Study:
- To summarize the current understanding and management of Irritable Bowel Syndrome (IBS) in children.
- To highlight diagnostic criteria and therapeutic approaches for pediatric IBS.
Main Methods:
- Diagnosis based on Rome III criteria for functional gastrointestinal disorders.
- Exclusion of organic causes of RAP, such as inflammatory bowel disease and celiac disease.
- Assessment of various treatment modalities including reassurance, lifestyle modifications, dietary interventions, probiotics, pharmacological therapies, and biopsychosocial approaches.
Main Results:
- Reassurance that no serious underlying disease is present can be an effective treatment for many children with IBS.
- Lifestyle modifications, stress management, dietary changes, and probiotics may offer benefits.
- Pharmacological therapies (antispasmodics, antidiarrheals) have a role in severe cases, while biopsychosocial therapies show promise but have limited availability.
Conclusions:
- Diagnosis of pediatric IBS involves applying Rome III criteria and ruling out organic conditions.
- A significant proportion of children benefit from reassurance and conservative management strategies.
- Further research is needed to elucidate IBS pathophysiology and develop targeted therapies.
Abstract:
Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.
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