TABLE 1

Study Characteristics of Included Studies

StudyParticipantsInterventionOutcome Measures and InstrumentsQuality
Fiber supplements and guar gum
 Christensen36 (1986); DenmarkChildren aged 3–14 y (N = 40)Fibers (ispaghula husk) vs placeboAbdominal pain frequency scoreLow
RAP (at least 10 episodes of abdominal pain during the last 6 wk, organic causes of pain were excluded)Dosage: Visiblin 5 mL twice daily; crushed crisp bread with 66% fiber Improvement: <10 episodes of pain during the study period
Treatment period: 6 wk Instrument: pain diary
 Feldman et al37 (1985); CanadaChildren aged 5–15 y (N = 52)Fiber cookies vs placeboAbdominal pain frequency scoreLow
RAP (organic causes of pain were excluded on the basis of history, examination, and simple laboratory test results)Dosage: 5 g of corn fiber per cookie; 1 cookie twice daily Improvement: 50% decrease in frequency of attack
Treatment period: 6 wkInstrument: pain diary
 Horvath et al38 (2013); PolandChildren aged 7–17 y (N = 90)GNN vs placeboSeverity of painLow
IBS, FAP, and functional dyspepsia (Rome III criteria)Dosage: 2.52 g/d Improvement: no pain or a decrease ≥2/6 points on the FPS-R
Treatment period: 4 wk Instrument: FPS-R
Follow-up: no follow-upSchool absenteeism
Changes in daily activity
 Instrument: self-reported at baseline and final visit
 Romano et al24 (2013); ItalyChildren aged 8–16 y (N = 60)PHGG vs placeboIBS symptomsModerate
IBS-C and IBS-D (Rome III criteria)Dosage: 5 g/d Treatment success: improvement IBS symptoms
Treatment period: 4 wk Instrument: Birmingham IBS Symptom Questionnaire score
Follow-up: 4 wkIntensity of abdominal pain
 Instrument: Wong-Baker FACES Pain Rating Scale
Fructose and lactose
 Dearlove et al39 (1983); United KingdomChildren aged >3 y (N = 21)Lactose vs placeboAbdominal painNA
RAP (> 1/4 d in the last 3 mo)Dosage: 2 g/kg Instrument: reported at final visit (better, worse, same)
Treatment period: 2 wk
Follow-up: 3 mo
 Lebenthal et al40 (1981); United StatesChildren aged 6–14 y (N = 38)Lactose versus lactose-free formulaAbdominal pain (severity and frequency)NA
RAP (intermittent episodes of unexplained abdominal pain, in a 4-mo period)Dosage: 2dd 200 mL Instrument: pain diary
Treatment period: 6 wk
Follow-up: 12 mo
HT
 Gulewitsch et al25 (2013); GermanyChildren aged 6–12 y (N = 38)HT program consists of 4 sessions: 2 children’s sessions and 2 parent’s sessions in a weekly sequenceAbdominal pain indexLow
FAP and IBS (Rome II criteria)Control: wait-list Clinical remission: >80% decrease in days of pain, duration, and intensity of abdominal pain
Treatment duration: 4 wk Instrument: abdominal pain dairy
Follow-up: 3 moQuality of life
 Instrument: German KINDL questionnaire
Disability
 Instrument: Pediatric Pain Disability Index
School absenteeism
 Instrument: abdominal pain dairy
 van Tilburg et al44 (2009); United StatesChildren aged 6–15 y (N = 34)Standard care + guided imagery; 3 biweekly sessions, including 1 booster session + 3 daily sessions. Listen to CD with self exercises ≥5 d/wkImprovement of abdominal painLow
FAP (abdominal pain at least once a week in the past 3 mo)Control: standard care Treatment response: >50% reduction of abdominal pain score
Treatment period: 2 mo Instrument: abdominal pain index
Follow-up: 6 moQuality of life
 Instrument: PedsQL
Disability
 Instrument: Functional Disability Inventory
School absenteeism
 Instrument: abdominal pain dairy
 Vlieger et al30,32 (2007/2012); the NetherlandsChildren aged 8–18 y (N = 53)6 HT sessionsAbdominal pain scoreLow
FAP and IBS (Rome II criteria)Control: Standard medical care + supportive therapy Clinical remission: >80% decrease of intensity and frequency of abdominal pain
Treatment period: 3 mo Instrument: abdominal pain dairy
Follow-up: 1 y and 5 ySchool absenteeism
 Instrument: abdominal pain dairy
CBT
 Duarte et al45 (2006); BrazilChildren aged 5–14 y (N = 32)4 monthly sessions of CBT-familyAbdominal pain intensityLow
RAP (Apley’s criteria)Control: standard care Instrument: red and white VAS
Treatment period: 4 moAbdominal pain frequency
Follow-up: no follow-up Instrument: daily numbers of pain in pain dairy
 Sanders et al46 (1994); AustraliaChildren aged 7–14 y (N = 44)6-session CBT-familyAbdominal pain intensityVery low
RAP (Apley’s criteria)Control: standard care Instrument: VAS
Treatment period: 8 wk
Follow-up: 6 and 12 mo
 Robins et al47 (2005); United StatesChildren aged 6–16 y (N = 69)5-session CBT-family + standard careAbdominal painLow
RAP (Apley’s criteria)Control: standard care Instrument: Abdominal pain index
Treatment period: 10 moDisability
Follow-up: 3 and 6 mo Instrument: Functional Disability Inventory
School absenteeism
 Instrument: Record of school attendance
 Levy et al26,31 (2010/2013); United StatesChildren aged 7–17 y (N = 200)3-session social learning + CBT-familyAbdominal pain intensityVery low
RAP (≥3 episodes of abdominal pain during a 3-mo period)Control: education + support intervention Instrument: FPS-R
Treatment period: 3 wkDisability
Follow-up: 12 mo Instrument: Functional Disability Inventory
 Alfvén and Lindstrom48 (2007); SwedenChildren aged 6–18 y (N = 48)Psychological + psychotherapyAbdominal pain intensityVery low
RAP (Apley’s criteria)Control: physiotherapy Instrument: VAS
Treatment period: at least 2 sessions, according to the expressed needsPain score at 1-year follow-up
Follow-up: 12 mo Instrument: VAS + duration (min) + frequency (per week)
 Humphreys and Gevirtz49 (2000); United StatesChildren aged 4–18 y (N = 64)4 groups:Abdominal pain intensityModerate
RAP1. Fiber + biofeedback + CBT + parental support Instrument: VAS
2. Fiber + biofeedback + CBTSchool absenteeism
3. Fiber + biofeedback Instrument: Record of school attendance
4. Fiber
Treatment period: 8-session CBT
Dosage: 10+ g/d fiber cookies or bars
Follow-up: no follow-up
 Groß and Warschburger28 (2013); GermanyChildren aged 6–12 y (N = 29)6-session CBT (group sessions) + listen to CD with self exercisesAbdominal pain intensityLow
CAP (Rome III criteria)Control: wait-list Instrument: VAS
Treatment period: 2 moAbdominal pain frequency (times per day)/duration (hours per day)
Follow-up: 3 mo Instrument: pain diary
Quality of life
 Instrument: PedsQL
WSD
 Wallander et al29 (2011); United StatesChildren aged 11–17 y (N = 63)WSD + standard care: 3 writing sessions of 20 minAbdominal pain frequencyLow
RAP (Apley’s criteria)Control: standard care Instrument: abdominal pain frequency rating
Treatment period: 5 dQuality of life
Follow-up: 6 mo Instrument: PedsQL
Probiotics
 Bausserman and Michail41 (2005); United StatesChildren aged 6–17 y (N = 64)LGG versus placeboAbdominal pain severityModerate
IBS (Rome II criteria)Dosage:1010 CFU, twice daily Responders: decreased pain score of ≥1 point
Treatment period: 6 wk Instrument: severity of symptom scale
Follow-up: no follow-up
 Francavilla et al43 (2010); ItalyChildren aged 5–14 y (N = 141)LGG vs placeboAbdominal pain (frequency ⁄severity)Moderate
IBS and FAP (Rome II criteria)Dosage: 3 × 109 CFU, twice daily Treatment success: a decrease of at least 50% in the number of episodes and intensity of pain
Treatment period: 8 wk Instrument: VAS
Follow-up: 8 wk
 Gawrońska et al42 (2007); PolandChildren aged 6–16 y (N = 104)LGG versus placeboAbdominal pain intensityModerate
FAP, functional dyspepsia, and IBSDosage: 3 × 109 CFU, twice daily Improvement: no pain or a change in the FPS-R by at least 2 faces
(Rome II criteria)Treatment period: 4 wk Instrument: FPS-R
Follow-up: no follow-upSchool absenteeism
 Instrument: Record of school attendance
 Guandalini et al27 (2010); Italy and IndiaChildren aged 4–18 y (N = 59)VSL#3 vs placeboAbdominal pain score (frequency and intensity)Very low
IBS (Rome II criteria)Dosage: 4–11 y, 1 sachet; 12–18 y, 2 sachets Responders: decreased pain score of ≥1 point
Treatment period: 6 wk Instrument: self-administered questionnaire
Follow-up: no follow-up
Alternative medicine
 Kuttner et al50 (2006); CanadaChildren aged 11–18 y (N = 25)Yoga intervention for 1 h followed by daily home practice guided by a videoAbdominal pain intensityVery low
IBS (Rome I criteria)Control: wait-list Instrument: numeric rating scale
Treatment period: 4 wkDisability
Follow-up: no follow-up Instrument: Functional Disability Inventory
  • CAP, chronic abdominal pain; FD, functional dyspepsia; FPS-R, Faces Pain Scale–Revised; GNN, glucomannan; IBS-C, irritable bowel syndrome, constipation predominant; IBS-D, irritable bowel syndrome, diarrhea predominant; NA, not applicable; PedsQL, Pediatric Quality of Life Inventory.