Systematic review of treatments for recurrent abdominal pain.
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.
Weydert
Joy A
JA
Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona 85724-5073, USA.
Ball
Thomas M
TM
Davis
Melinda F
MF
D015746:Abdominal Pain / Q000145:classification / Q000628:therapy*; D000293:Adolescent; D001521:Behavior Therapy; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D004043:Dietary Fiber / Q000008:administration & dosage; D015738:Famotidine / Q000627:therapeutic use; D006801:Humans; D036142:Mentha piperita; D010147:Pain Measurement; D010918:Pizotyline / Q000627:therapeutic use; D010938:Plant Oils / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome
D004043:Dietary Fiber; D010938:Plant Oils; D010918:Pizotyline; D015738:Famotidine; C015424:peppermint oil