Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment

Abstract

Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Keywords: Recurrent abdominal pain; Irritable bowel syndrome; Brain-gut disorder; Lifestyle modifications; Biopsychosocial therapies; Children; Rome III criteria

Core tip: Irritable bowel syndrome (IBS) is the commonest functional gastrointestinal disorder regarding which there is often limited knowledge amongst clinicians. This paper aims to address the clinical challenges that a clinician may face in managing children with IBS. Importance of the application of the Rome III criteria and a focused history is necessary to manage IBS. An evidence-based approach for managing children with IBS is highlighted in this article followed by a section on current best practice-authors’ personal view. We hope the readers will find this article useful in their clinical practice.