Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review.

Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs). To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs. Electronic databases were searched from inception to February 2021. RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent. Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator. Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics. The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low. On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.

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Copyright © 2021 by the American Academy of Pediatrics.

Déclaration de conflit d'intérêts

POTENTIAL CONFLICT OF INTEREST: Mr Gordon has received travel fees to attend international scientific and training meetings from pharmaceutical companies. Grants included no honoraria, inducement, advisory role, or any other relationship and were restricted to the travel- and meeting-related costs of attending such meetings. These include Digestive Disease Week (May 2017), World Congress of Gastroenterology (October 2017), Digestive Disease Week (May 2018), Advances in Inflammatory Bowel Disease (December 2018), and Digestive Disease Week (May 2019). None of these companies have had any involvement in any works completed by Mr Gordon, and he has not received payments for any other activities for them. Mr Benninga is a consultant for Shire, Norgine, Coloplast, Danone, Takeda, Allergan, FrieslandCampina, United Pharmaceuticals, and HiPP (baby food). The other authors have indicated they have no potential conflicts of interest to disclose.