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PEDIATRICS Vol. 111 No. 1 January 2003, pp. e1-e11

REVIEW ARTICLE

Systematic Review of Treatments for Recurrent Abdominal Pain

Joy A. Weydert, MD*,{ddagger},§, Thomas M. Ball, MD, MPH*,{ddagger} and Melinda F. Davis, PhD*,{ddagger}

* Department of Pediatrics
{ddagger} Steele Memorial Children’s Research Center
§ Program in Integrative Medicine, University of Arizona Health Sciences Center, Tucson, Arizona

--> Objective. To conduct a systematic review of evaluated treatments for recurrent abdominal pain (RAP) in children.

Methods. Online bibliographic databases were searched for the terms "recurrent abdominal pain," "functional abdominal pain," "children," or "alternative therapies" in articles classified as randomized controlled trials. The abstracts or full text of 57 relevant articles were examined; 10 of these met inclusion criteria. Inclusion criteria required that the study involve children aged 5 to 18 years, subjects have a diagnosis of RAP, and that subjects were allocated randomly to treatment or control groups. The methodology and findings of these articles were evaluated critically, and data were extracted from each article regarding study methods, specific interventions, outcomes measured, and results.

Results. Studies that evaluated famotidine, pizotifen, cognitive-behavioral therapy, biofeedback, and peppermint oil enteric-coated capsules showed a decrease in measured pain outcomes for those who received the interventions when compared with others in control groups. The studies that evaluated dietary interventions had conflicting results, in the case of fiber, or showed no efficacy, in the case of lactose avoidance.

Conclusions. Evidence for efficacy of treatment of RAP in children was found for therapies that used famotidine, pizotifen, cognitive-behavioral therapy, biofeedback, and peppermint oil enteric-coated capsules. The effects of dietary fiber were less conclusive, and the use of a lactose-free diet showed no improvement. There seemed to be greater improvement when therapy (famotidine, pizotifen, peppermint oil) was targeted to the specific functional gastrointestinal disorder (dyspepsia, abdominal migraine, irritable bowel syndrome). The behavioral interventions seemed to have a general positive effect on children with nonspecific RAP. Many of these therapies have not been used widely as standard treatment for children with RAP. Although the mechanism of action for each effective therapy is not fully understood, each is believed to be safe for use in RAP.

Key Words: recurrent abdominal pain • treatment • children • alternative therapies • systematic review

Abbreviations: RAP, recurrent abdominal pain • IBS, irritable bowel syndrome • RCT, randomized controlled trial • SPC, standard pediatric care • CBFI, cognitive-behavioral family intervention • BF, biofeedback • CBI, cognitive-behavioral intervention

Received for publication Jun 12, 2002; Accepted Sep 30, 2002.




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