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How to manage irritable bowel syndrome in children
Elvira Ingrid Levy1, Charlotte De Geyter1, Abdelhalim Ouald Chaib1
1Vrije Universitiet Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
Insights
Current evidence is insufficient to recommend treatments for pediatric irritable bowel syndrome (IBS), including microbiome manipulation. More rigorous trials are needed to establish effective therapies for this common childhood condition.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Clinical Trial Analysis
Background:
- Pediatric irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder.
- The gastrointestinal microbiome is increasingly recognized as a potential factor in IBS pathophysiology.
Purpose of the Study:
- To review risk factors and management strategies for pediatric IBS.
- To evaluate the role of the gastrointestinal microbiome in pediatric IBS.
- To assess the quality and limitations of existing clinical trials.
Main Methods:
- Systematic literature search of PubMed and Google Scholar.
- Inclusion of English articles focusing on pediatric IBS and microbiome interventions.
- Analysis of randomized controlled trials (RCTs) and study designs.
Main Results:
- Few underpowered RCTs exist for pediatric IBS management, primarily targeting the microbiome.
- Significant heterogeneity in study designs (inclusion criteria, outcomes) precludes definitive recommendations.
- Limited adverse events reported, raising questions about trial conduct or safety reporting.
Conclusions:
- Insufficient evidence supports any therapeutic intervention for pediatric IBS, including microbiome modulation.
- Despite evidence linking dysbiosis to IBS, effective treatments are lacking.
- Further well-designed prospective trials are essential due to the high prevalence of pediatric IBS.
Aim:
This paper discusses the risk factors and management of paediatric irritable bowel syndrome (IBS), with a focus on the role of the gastrointestinal microbiome.
Methods:
English articles of interest published in PubMed and Google Scholar were searched using subject heading and keywords of interest.
Results:
Only few randomised controlled trials on the management of IBS in children have been published. The vast majority of these intervention trials target to change the composition of the gastrointestinal microbiome. Most studies are underpowered. Major heterogeneities in study designs such as differences in inclusion criteria, including patients with different pain-related functional gastrointestinal disorders and differences in primary outcomes, make it impossible to formulate recommendations. Overall, few adverse events are reported what could indicate safety or point to suboptimal conduction of clinical trials and safety reporting. However, it can also not be excluded that some interventions such as the administration of selected probiotic products may result in benefit.
Conclusion:
There is insufficient evidence to recommend any therapeutic intervention in paediatric IBS, including manipulation of the gastrointestinal tract microbiome, despite the evidence that dysbiosis seems an associated pathophysiologic factor. More designed prospective trials are needed since IBS is not a rare condition during childhood.
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