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Management of children with irritable bowel syndrome in general practice - a systematic review
Erika Anne Mengel1, Gritt Overbeck2
1Faculty of Health and Medical Sciences, University of Copenhagen.
Insights
Pediatric functional abdominal pain, irritable bowel syndrome (IBS) is common in children. General practitioners rarely use Rome Criteria for diagnosis, leading to varied outcomes and infrequent follow-up, indicating a need for improved care strategies.
Area of Science:
- Pediatric Gastroenterology
- General Practice Management
- Functional Abdominal Pain Disorders
Background:
- Irritable bowel syndrome (IBS) is the most prevalent pediatric functional abdominal pain disorder (FAPD).
- IBS significantly impacts children's quality of life, school attendance, and can lead to chronic pain.
- This review focuses on the management of pediatric IBS within general practice settings.
Purpose of the Study:
- To investigate the diagnostic evaluation and management of children with IBS by general practitioners.
- To assess the utilization of Rome Criteria, diagnostic outcomes, referrals, prescriptions, and follow-up practices.
- To identify gaps in care and areas for improvement in managing pediatric IBS.
Main Methods:
- A systematic review was conducted adhering to PRISMA guidelines.
- Studies were identified via a structured PubMed search and screened for eligibility.
- Eligible studies focused on general practitioners' management of children with episodic abdominal pain, including IBS.
Main Results:
- Five observational studies with over 4,300 children were included.
- Functional diagnosis rates varied widely (16%-84%), with infrequent use of Rome Criteria (7%-27%).
- Diagnostic tests, prescriptions, and referrals varied; follow-up care was consistently rare.
Conclusions:
- IBS is the most common FAPD in children, often managed in primary care.
- Current diagnostic and treatment approaches by general practitioners are unclear, with underutilization of Rome Criteria.
- Infrequent follow-up and diagnostic variability suggest potential for overlooked or misclassified cases, necessitating further research into effective biopsychosocial care models.
Introduction:
Irritable bowel syndrome (IBS) is the most frequently reported paediatric functional abdominal pain disorder (FAPD). It impacts quality of life, contributes to school absenteeism and can result in chronic pain. This review investigated the management of children with IBS in general practice regarding diagnostic evaluation, use of the Rome Criteria, diagnostic outcomes, referrals, prescriptions and follow-ups.
Methods:
A systematic review was conducted following the PRISMA guidelines. Studies were identified through a structured PubMed search and screened using predefined inclusion criteria. Eligible studies focused on general practitioners' management of children with episodic abdominal pain, in which IBS could be a subtype. Data were reported narratively due to heterogeneity across studies.
Results:
Five observational studies involving over 4,300 children were included. The proportion of children receiving a functional diagnosis ranged from 16% to 84%, and the Rome Criteria were rarely used (7-27% of cases). Blood and urine tests were commonly used. Prescriptions and referrals differed across studies. Follow-up was rare.
Conclusions:
IBS is the most common FAPD in children. Though often managed by general practitioners, it remains unclear how they diagnose and treat these cases. The Rome Criteria appear to be rarely used, and diagnosis frequency varies, suggesting some children may be overlooked or misclassified. Follow-up is infrequent, and it is unclear whether a biopsychosocial approach is used. More research is needed to understand and improve care in this setting.
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