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Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review
Robyn Rexwinkel1,2,3,4, Clara M A de Bruijn5,2,3,4, Morris Gordon6
1Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; r.rexwinkel@amsterdamumc.nl.
Insights
Current evidence is insufficient to recommend specific medications for pediatric functional abdominal pain disorders (FAPDs). Antispasmodics and antidepressants may be considered due to favorable outcomes and safety, but more high-quality trials are needed.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Clinical Trials
Background:
- Functional abdominal pain disorders (FAPDs) are prevalent in children, significantly affecting their quality of life and school attendance.
- Existing pharmacologic treatments for pediatric FAPDs lack clear efficacy and safety data due to insufficient head-to-head randomized controlled trials (RCTs).
Purpose of the Study:
- To systematically review the efficacy and safety of available pharmacologic treatments for pediatric FAPDs.
- To synthesize evidence from randomized controlled trials (RCTs) to inform treatment guidelines.
Main Methods:
- A systematic search of electronic databases was conducted from inception to February 2021.
- Included studies were RCTs or systematic reviews involving children (4-18 years) with FAPDs treated with pharmacologic interventions compared to placebo, no treatment, or other agents.
- Data extraction and quality assessment were performed independently by two reviewers, with disagreements resolved by a third investigator.
Main Results:
- Seventeen articles, including 1197 children with FAPDs, were analyzed.
- Investigated agents included antispasmodics, antidepressants, antibiotics, antihistamines, antiemetics, histamine-2-receptor antagonists, 5-HT4-receptor agonists, melatonin, and buspirone.
- No studies were found on laxatives, antidiarrheals, analgesics, antimigraines, or serotonergics.
Conclusions:
- The overall quality of evidence for the included studies was rated as very low to low.
- Currently, no specific pharmacologic agent can be definitively recommended for pediatric FAPDs.
- Antispasmodics and antidepressants may be considered in clinical practice due to potentially favorable outcomes and safety profiles, pending further high-quality RCTs with standardized outcome measures and long-term follow-up.
Context:
Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs).
Objective:
To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs.
Data Sources:
Electronic databases were searched from inception to February 2021.
Study Selection:
RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent.
Data Extraction:
Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator.
Results:
Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics.
Limitations:
The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low.
Conclusions:
On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.
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