title: Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review.
abstract: OBJECTIVE
  Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.
  
  
  METHODS
  Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.
  
  
  RESULTS
  Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P < .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate.
  
  
  CONCLUSIONS
  Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.
authors: Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and j.m.rutten@amc.nl.
authors: Juliette M T M
authors: JM
authors: Rutten
authors: Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and.
authors: Judith J
authors: JJ
authors: Korterink
authors: Pediatric Association of the Netherlands, Utrecht, Netherlands.
authors: Leonie M A J
authors: LM
authors: Venmans
authors: Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and.
authors: Marc A
authors: MA
authors: Benninga
authors: Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and.
authors: Merit M
authors: MM
authors: Tabbers
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D001521:Behavior Therapy; D002648:Child; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies / Q000379:methods*; D004043:Dietary Fiber / Q000627:therapeutic use; D019587:Dietary Supplements; D005767:Gastrointestinal Diseases / Q000150:complications / Q000628:therapy*; D006801:Humans; D054368:Laxatives; D056692:Prebiotics; D019936:Probiotics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004043:Dietary Fiber; D054368:Laxatives; D056692:Prebiotics
keywords: children; functional abdominal pain; functional gastrointestinal disorders; nonpharmacologic treatment; systematic review