Functional abdominal pain disorders (FAPDs) include functional abdominal pain, function dyspepsia, irritable bowel syndrome, and abdominal migraines. Children who have a FAPD often have reduced quality of life, difficulties with depression or anxiety, and increased school absenteeism.
Partly because the pathophysiology of FAPD is not well understood, treatment is largely symptomatic. However, some medications have been marketed to treat patients with FAPD. Do they work?
This week in Pediatrics, we are early releasing a paper by Dr. Robin Rexwinkel, Dr. Clara de Bruijn, and co-authors in the Netherlands and UK entitled, “Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review,” (10.1542/peds.2020-042101) which tackles this question.
This systematic review includes 17 studies (11 systematic reviews and 6 randomized trials), representing 1,197 children aged 3-18 years of age. The medication categories examined included antispasmodics, antidepressants, antibiotics, antihistamines, antiemetics, H2-receptor antagonists, 5-HT4-receptor agonists, melatonin, and buspirone.
The good news is that both antidepressants (amitriptyline and citalopram) and antispasmodics (particularly peppermint oil) seemed to have some treatment success, which was variably defined in the different studies as improved quality of life (particularly with antidepressants) or symptom or pain improvement (particularly peppermint oil). Importantly, patients who received antidepressants or peppermint oil did not experience any adverse events. However, the bad news is that the quality of evidence was rated as very low to low, perhaps partly because the sample sizes in the individual studies was small (the largest had 132 patients).
Clearly, higher quality studies are needed to better understand treatment options for patients who are suffering from FAPD. However, it seems as though a trial of peppermint oil or an antidepressant would be reasonable, given some treatment success and lack of side effects.
There are many other details in this systematic review, particularly with regards to the other medication categories that were reviewed in this paper. This will be important reading, since so many of us struggle with how to appropriately care for these patients. We will hope that higher-quality studies will follow, given the limitations of the studies to date, as noted carefully by the authors of this systematic review.