title: A pilot study of S-adenosylmethionine in treatment of functional abdominal pain in children.
abstract: BACKGROUND
  Functional abdominal pain (FAP) is one of the most common functional gastrointestinal disorders (FGIDs) in children. Currently, medical practitioners widely use tricyclic antidepressants to treat FAP. Those antidepressants, however, have been associated with an increased risk of suicidal ideation, and the accompanying side effects often limit the benefits. S-adenosylmethionine (SAM-e) is a dietary supplement that has efficacy as an antidepressant and as a treatment for chronic pain.
  
  
  OBJECTIVE
  The research team hypothesized that during SAM-e exposure (1) participants' pain reports would significantly improve over time, (2) participants' reported quality of life would significantly improve over time, and (3) toxicity measures (liver-function tests and mania and depression scales) would not change significantly.
  
  
  METHODS
  The research team performed an open-label, doseescalation trial of oral SAM-e among children with FAP. Participants came to the research facility for measurements at baseline and after 2 wk, 1 mo, and 2 mo. The research team monitored participants for potential toxicities (liver toxicity, mania, and depression) throughout the trial.
  
  
  METHODS
  The trial was conducted at the University of California, San Diego.
  
  
  METHODS
  The research team recruited children and adolescents with FAP via advertisement at several community general pediatric clinics and at the research team's subspecialty pediatric gastrointestinal clinic at a tertiary care center. The eight resulting participants were children with a median and mean age of 14 y.
  
  
  METHODS
  To treat persistent abdominal pain, all participants received SAM-e at an initial dose of 200 mg/d, with escalation to a maximum dose of 1400 mg/d over the period of 2 mo.
  
  
  METHODS
  The primary outcomes were the participants' self-reports of pain and quality of life. The research team used the multidimensional measure for recurrent abdominal pain (MM-RAP), Wong-Baker FACES Pain Rating Scale, and the PedsQL for those measurements. The team used repeated measures analyses to analyze the data.
  
  
  RESULTS
  Six participants completed the study. The research team demonstrated an improvement in self-pain reports over the 2-mo follow-up period (P = .004). The median dose of SAM-e that participants took at the 2-mo follow-up period was 1400 mg (interquartile range: 950-1400 mg) daily. Liver function tests and assessments for mania and depression did not change over the study period.
  
  
  CONCLUSIONS
  Oral SAM-e demonstrates promise in reducing abdominal pain among children with FAP, with minimal toxicity. The research team needs to conduct larger, placebo-controlled trials to support its initial findings.
authors: Division of Gastroenterology, Department of Pediatrics, UCLD, La Jolla, CA, USA.
authors: Lillian J
authors: LJ
authors: Choi
authors: Jeannie S
authors: JS
authors: Huang
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy*; D000293:Adolescent; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D010147:Pain Measurement; D010865:Pilot Projects; D012436:S-Adenosylmethionine / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D012436:S-Adenosylmethionine