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Paediatric functional abdominal pain disorders
Nikhil Thapar1,2,3, Marc A Benninga4, Michael D Crowell5
1Neurogastroenterology and Motility Unit, Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK. nikhil.thapar@health.qld.gov.au.
Insights
Paediatric functional abdominal pain disorders, also known as disorders of gut-brain interaction, are common and complex. Management involves combined approaches like mind-targeted therapies and diet, showing favorable impacts on children
Area of Science:
- Pediatric Gastroenterology
- Neurogastroenterology
- Gut-Brain Axis Research
Background:
- Paediatric functional abdominal pain disorders (disorders of gut-brain interaction) are prevalent, affecting 3-16% of children.
- These disorders include irritable bowel syndrome, functional dyspepsia, abdominal migraine, and functional abdominal pain not otherwise specified, per Rome IV criteria.
- Emerging research highlights the interplay of intestinal, central, and extrinsic factors in their aetiopathogenesis.
Purpose of the Study:
- To review the current understanding of paediatric functional abdominal pain disorders.
- To discuss diagnostic challenges and the importance of avoiding invasive procedures.
- To summarize current and emerging management strategies for these conditions in children.
Main Methods:
- Review of current literature on paediatric functional abdominal pain disorders.
- Analysis of diagnostic criteria (Rome IV) and their application.
- Synthesis of evidence for various management strategies, including pharmacological and non-pharmacological interventions.
Main Results:
- Diagnosis relies on clinical symptoms and exclusion of organic causes, emphasizing non-invasive approaches.
- Pharmacological options are limited; combined management strategies are favored.
- Mind-targeted interventions (hypnotherapy, CBT), diet (probiotics), and nerve stimulation show favorable efficacy, improving symptoms and quality of life.
Conclusions:
- Functional abdominal pain disorders in children are multifactorial, involving the microbiota-gut-brain axis.
- Current management focuses on integrated approaches due to limited pharmacological efficacy.
- Further research promises enhanced understanding and improved therapeutic outcomes for these complex pediatric conditions.
Abstract:
Paediatric functional abdominal pain disorders, currently referred to as disorders of gut-brain interaction, comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified, as defined by the Rome IV diagnostic criteria. Functional abdominal pain disorders are common disorders with a prevalence of 3-16% depending on country, age and sex. A greater understanding of aetiopathogenesis and pathophysiology is emerging and includes intestinal components (inflammation, motility and the microbiota), central factors (psychological aspects, sensitization and/or differences in connectivity or activity of certain brain regions) as well as extrinsic factors (infections). In particular, the timing of disruption of the microbiota-gut-brain axis seems to be important. Diagnosis is challenging but is primarily based on clinical symptoms and exclusion of other organic causes, with an emphasis on avoiding unnecessary invasive diagnostic procedures. The available pharmacological interventions are limited in children and, therefore, management has focused on combined approaches, including mind-targeted interventions (hypnotherapy and cognitive behavioural therapy), diet (probiotics) and percutaneous electrical nerve field stimulation. The evidence for their clinical efficacy, although limited, is favourable, with positive impacts on symptoms and overall quality of life. The coming decades hold promise for improved understanding and management of these enigmatic disorders.
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