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Intervention Review

Dietary 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: 21 JAN 2009

Assessed as up-to-date: 30 NOV 2006

DOI: 10.1002/14651858.CD003019.pub3


How to Cite

Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003019. DOI: 10.1002/14651858.CD003019.pub3.

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: 21 JAN 2009

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Abstract

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

Background

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.

Objectives

To determine the effectiveness of dietary interventions for recurrent abdominal pain 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 2007), 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 . Where appropriate, search filters were employed. Researchers working in this area were asked to identify relevant studies.

Selection criteria

Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria.

Data collection and analysis

Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis.

Main results

Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.26 (0.25, 6.29).
Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial.
Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21).

Authors' conclusions

There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

 

Plain language summary

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

Dietary interventions for stomach ache with no identifiable cause in children

Recurrent abdominal pain is common in childhood and dietary interventions are often recommended but we found no evidence that they are effective.

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 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 but in updating the review we included studies which used these criteria to select participants as well as those using the traditional diagnosis of RAP.

This review attempted to determine the effectiveness of dietary interventions. When the original version was published, only four trials fit the inclusion criteria for the review, two of which looked at fibre supplements and two of which looked at lactose-restriction diets. Results suggest little evidence of effect for either treatment. However, as these results were only reported in a few small trials, the reviewers suggested that more research was needed. In this updated version we found three further trials, all testing the effectiveness of probiotics such as lactobacillus which some studies have suggested may be of benefit in adults with irritable bowel syndrome. One was reported only as an abstract that could not be analysed because of lack of data. These trials provided no clear evidence of any benefit from the use of probiotics in these children, including those classified under the Rome II criteria as having irritable bowel syndrome.

 

摘要

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

背景

兒童反復性腹痛 (recurrent abdominal pain, RAP) 及腸躁症 (irritable bowel syndrome, IBS) 之飲食介入處置

百分之4至25的學齡兒童抱怨反復性腹痛 (RAP) 嚴重到阻礙日常生活的程度目前並不清楚。這個診斷是否含括因為不同病因而疼痛的兒童,大多數的兒童無法由理學檢查或實驗室檢查找到器質性的原因來解釋他們的疼痛。雖然大多數的兒童可以經由再保證以及簡單的方法來處置,仍有很多其他的介入方式曾被推薦。

目標

決定飲食介入處置對於學齡兒童之復發性腹痛的效果。

搜尋策略

我們運用適當的蒐尋過濾方式,搜尋了以下的資料庫,包括Cochrane Library (CENTRAL) 2006 (Issue 4) ,MEDLINE (1966年至2006年12月) ,EMBASE (1980年至2006年12月) ,CINAHL (1982年至2007年12月) ,ERIC (1966年至2006年12月) ,PsycINFO (1872年至2006年12月) , LILACS (1982年至2006年12月) , SIGLE (1980年至2005年3月) ,以及 JICST (1985年至2000年6月) 。此外 ,我們也請研究此領域的學者來確認適合的研究。

選擇標準

以被診斷為RAP或是功能性胃腸疾患的學齡兒童為對象 (符合Rome II criteria) ,比較飲食治療和給予安慰劑或沒有治療的隨機或半乎隨機之研究。

資料收集與分析

2位作者分別評估預收納的試驗,評估品質並萃取數據。適合的研究以隨機效果模式的統合分析來整合。

主要結論

這個回顧收納7個試驗。有2個試驗 (Christensen 1982, Feldman 1985) ,包含83位個案,比較補充纖維和安慰劑的差異;有1研究的數據發表在2篇論文中 (Christensen 1982, Christensen 1986) 。對於腹痛頻率的改善,整合後的勝算比為1.16 (95% CI 0.45 – 2.87) 。另外2個試驗 (Lebenthal 1981, Dearlove 1983) ,包含90位個案,比較含乳酸和不含乳酸的飲食;兩個試驗的數據都沒有辦法用來做統合分析,且前者有45% 的個案失去追蹤。剩下的3個試驗 (Bausserman 2005, Gavronska 2007, Young 1997) 比較添加乳酸菌和安慰劑的差別,符合回顧的選擇標準,但其中只有2篇 (Bausserman 2005, Gavronska 2007) 可提供可分析的數據,包含有168位兒童,對於症狀改善的勝算比為1.17 (95% CI 0.62, 2.21) 。

作者結論

欠缺高素質的證據來證實飲食介入處置的效果。這篇回顧無法提供證據顯示纖維補充、不含乳酸的飲食或是添加乳酸菌對治療兒童RAP有效果

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

反覆性的腹痛在兒童是常見的,飲食介入常被建議,但我們找不到可以支持其效果的證據。百分之4至25的學齡兒童抱怨胃痛反復性腹痛 (RAP) 嚴重到阻礙日常生活。對於大多數這樣的兒童,無法由理學檢查或實驗室檢查找到器質性的原因來解釋他們的疼痛。雖然大多數的兒童可以經由再保證以及簡單的方法來處置,仍有很多其他的介入方式被推薦,包括飲食調整。近來有人建議之前被描述為患RAP的兒童應依症狀區分成更小的分類 (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) 。 這樣的分類是否可以區分真的不同的病因或是對治療不同的反應,目前並不清楚,但是在更新此篇回顧時,我們同時收納了使用傳統RAP診斷準則以及新的準則來篩選個案的研究。這篇回顧嘗試要決定飲食介入的效果。當原來的版本發表時,只有4個試驗符合收納條件,2個檢視纖維補充,2個檢視限制乳酸的飲食,結果顯示2種治療方式都幾乎沒有有效的證據。然而,因為這些結果只有在少數小型的試驗中發表,回顧者建議需要進一步的研究。在此篇更新的版本,我們找到了3個進一步的試驗,都在測試如乳酸菌等益生素的效果,之前一些研究推測乳酸菌對成人的腸躁症有幫助。其中一個研究只有以摘要形式報告,欠缺數據因此無法分析。這些研究顯示對於反覆性腹痛的小孩,包括以Rome II criteria診斷的腸躁症,沒有明顯的證據顯示益生素有幫助。

 

Plain language summary

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

Prehrambene intervencije za ponavljanu trbušnu bol i sindrom iritabilnog crijeva u djetinjstvu

Prehrambene intervencije za ponavljanu trbušnu bol i sindrom iritabilnog crijeva u djetinjstvu

Ponavljana trbušna bol česta je u djetinjstvu i često se preporučuju različite prehrambene intervencije, međutim nisu nađeni dokazi da su one učinkovite.

Između 4% i 25% djece školske dobi žali se na bolove u trbuhu, odnosno ponavljanu trbušnu bol, koja je dovoljno teška da ometa svakodnevne aktivnosti. Kod većine djece se pregledom tijela i pretragama ne može pronaći organski uzrok boli. Iako se većina takve djece liječi potporom i jednostavnim mjerama, djeci se preporučuje i niz različitih intervencija, uključujući različite promjene prehrane. Nedavno je predloženo da bi se djeca koja su prethodno imala ponavljanu trbušnu bol trebala podijeliti u nekoliko podskupina (Rim II kriteriji), ovisno o simptomima koje opisuju, uključujući sindrom iritabilnog crijeva, funkcionalnu dispepsiju, funkcionalnu trbušnu bol i abdominalnu migrenu. Nije jasno da li ove kategorije opisuju stanja koja se uistinu razlikuju po svojim uzrocima ili odgovoru na terapiju, ali obnavljajući ovaj sustavni pregled uključili smo studije u kojima su korišteni ovi kriteriji za izbor ispitanika, kao i studije koje su koristile tradicionalnu dijagnozu ponavljane trbušne boli.

U ovom Cochrane sustavnom pregledu autori su pokušali istražiti učinkovitost prehrambenih intervencija. Kada je objavljena originalna verzija ovoga sustavnoga pregleda, samo su 4 istraživanja ispunjavala kriterije uključenja u sustavni pregled, od kojih su dva istražila dodavanje biljnih vlakana prehrani, a dva su istražila prehranu u kojoj se ograničava unos laktoze. Rezultati su pokazali da ima malo dokaza za učinkovitost ove dvije intervencije. Međutim, kako su rezultati istraženi u nekolicini malenih studija, autori su preporučili da je potrebno provesti nova istraživanja. U ovoj obnovljenoj verziji sustavnoga pregleda pronađena su 3 dodatna klinička ispitivanja, i sva tri su istražila učinkovitost probiotika kao što je lactobacillus, za koje su neke studije pokazale da bi mogli pomoći odraslima sa sindromom iritabilnog crijeva. Jedno od ta 3 ispitivanja objavljeno je samo kao sažetak pa ga nije bilo moguće analizirati zbog manjka podataka. Ova istraživanja nisu dala jasne dokaze o ikakvoj koristi od uzimanja probiotika u djece, uključujući djecu koja su prema Rim II kriterijima svrstana u skupinu oboljelih od sindroma iritabilnog crijeva.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports