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Intervention Review

Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

  1. Angela A Huertas-Ceballos1,*,
  2. Stuart Logan2,
  3. Cathy Bennett3,
  4. Colin Macarthur4

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 30 NOV 2006

DOI: 10.1002/14651858.CD003014.pub2


How to Cite

Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C. Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003014. DOI: 10.1002/14651858.CD003014.pub2.

Author Information

  1. 1

    EGA Hospital, Neonatal Unit, London, UK

  2. 2

    Peninsula Medical School, Universities of Exeter & Plymouth, Institute of Health and Social Care Research, Exeter, UK

  3. 3

    University of Leeds, Cochrane UGPD Group, Leeds, West Yorkshire, UK

  4. 4

    Bloorview Research Institute, Toronto, Ontario, Canada

*Angela A Huertas-Ceballos, Neonatal Unit, EGA Hospital, UCLH, Huntley Street, London, WC1E 6DH, UK. Angela.Huertas-Ceballos@uclh.nhs.uk,huertas.angela@googlemail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended.

Objectives

To determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children.

Search methods

The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters.

Selection criteria

Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected.

Data collection and analysis

References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10.

Main results

Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data.

Authors' conclusions

The included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychosocial interventions for children who have stomach ache without an organic cause

Between 4% and 25% of school age children complain of stomach aches / recurrent abdominal pain (RAP) which is severe enough to interfere with their daily activities. For most such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are likely to be managed by reassurance and simple measures, a large range of interventions including dietary manipulation, some medicines and psychological interventions has been recommended. Recently it has been suggested that children previously described as having RAP should be classified according to the pattern of symptoms into a series of sub-groups (the Rome II criteria) including irritable bowel syndrome, functional dyspepsia, functional abdominal pain and abdominal migraine. It is not clear whether these categories describe conditions that really differ in either aetiology or responsiveness to treatment . This review attempted to determine the effectiveness of psychosocial interventions. We found 6 studies (including 167 children), all of which examined interventions broadly based on cognitive behavioural therapy (CBT) and no trials of other types of psychosocial interventions. Five of these trials had interpretable results, although lack of important data and / or clinical differences in either intervention or control groups prevented us from combining them statistically. The included trials were relatively small and had some weaknesses in design and reporting. Each of the included studies reported a statistically significant benefit to participants in the intervention group. CBT may therefore be worth considering for some children with recurrent abdominal pain, but this review points to the need for further, better-quality research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

兒童復發性腹痛 (recurrent abdominal pain, RAP) 與腸躁症 (irritable bowel syndrome, IBS) 之心理社會介入處置

4% 至25% 的學齡兒童抱怨復發性腹痛 (recurrent abdominal pain, RAP) 嚴重至影響日常活動。這些兒童大多無法由理學或實驗室檢查找到器質性來源的疼痛。雖然大多數的兒童可能經由醫師的安心保證或其他簡單的方法來處置,廣泛的心理社會介入,包括認知行為治療以及家族治療也是被建議的方式。

目標

決定對於學齡兒童復發性腹痛與腸躁症的心理社會介入處置之效果

搜尋策略

我們以適當的過濾方式搜尋了The Cochrane Library (CENTRAL) 2006年 第4期;同時也搜尋了MEDLINE (1966年到 2006年12月) 、EMBASE (1980年到2006年12月) 、CINAHL (1982年到2006年12月) 、ERIC (1966年到2006年12月) 、 PsycINFO (1872年到2006年12月) 、LILACS (1982年到2006年12月) 、 SIGLE (1980年到2005年3月) 、JICST (1985年到2000年6月) 等資料庫。

選擇標準

我們選擇了任何符合以下條件的研究:受試者大部分為符合復發性腹痛的診斷準則之學齡兒童 (功能性腸胃疾患以Apley 或Rome II 之準則) ,這些兒童被隨機分配任一種心理社會治療,並與接受標準照護或是尚在等待治療者比較。

資料收集與分析

2位作者各自獨立的篩選符合收案標準的參考文獻,並以RevMan 4.2.10.摘錄分析數據。

主要結論

由10篇論文報告的數據,作者選出6個以認知行為介入的隨機試驗 (randomised trials) (共計有167位受試者) 。其中5個試驗報告,經由各種方式的評估,隨機分配接受認知行為治療的兒童,與接受標準醫療照護或尚在等待治療的兒童比較,對痛有統計上顯著的進步 (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994) 。剩餘的1個試驗 (Hicks 2003) 囊括的兒童其反覆發作疼痛較為多樣,其中只有復發性腹痛的兒童過少,無法提供可詮釋的數據。

作者結論

本回顧收納的試驗較小,且有方法學上的弱點,亦無法提供關於接受評估的兒童人數適當的細節。雖然有這些方法學上的弱點以及臨床上的異質性,報告的一致性和效果的強度仍可以提供證據支持,認知行為治療對復發性腹痛的兒童,可能是一個有用的介入。雖然大部分的兒童,尤其是在家庭醫學的診療中,可以在再保證及時間之下進步。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

4% 至25% 的學齡兒童抱怨復發性腹痛 (RAP) 嚴重至影響日常活動。這些兒童大多無法由理學或實驗室檢查找到器質性來源的疼痛。雖然大多數的兒童可能經由再保證或其他簡單的方法來處置,其他建議的處置包括飲食控制、另類藥物以及社會心理介入。近來有人建議,之前被描述為患反復性腹痛的兒童,應依其症狀的模式再進一步分類 (Rome II criteria) ,包括腸躁症 (irritable bowel syndrome) 、功能性消化不良 (functional dyspepsia) 、功能性腹痛 (functional abdominal pain) 以及腹部偏頭痛 (abdominal migraine) 。目前並不清楚這樣的分類是否真的可以區分不同的病因或是對治療不同的反應。本篇回顧嘗試確認心理社會介入處置的效果。我們找到6篇研究論文 (共包括167位兒童) ,都是檢視以認知行為治療為基礎的介入效果,而沒有包含以其他社會心理介入的試驗。其中5篇研究的結果雖然尚可以詮釋,但因為缺乏介入組或控制組的重要數據和/或臨床差異,以致於無法將它們合併統計。這些收納的研究比較小型,且在實驗設計以及報告上有缺點。每個收納的研究都顯示介入處置對於參加者有明顯統計上的利益。因此,認知行為治療對於某些有復發性腹痛的兒童是值得考慮的治療方式,但是這篇回顧也指出未來仍需要進一步且更高素質的研究。