Pediatric Irritable Bowel Syndrome Treatment & Management

Updated: Aug 09, 2016
  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD  more...
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Treatment

Medical Care

Irritable bowel syndrome (IBS) is a chronic illness and has no cure.

Treatment may be challenging and even frustrating to the physician, the patient, and the patient's family. The most important component of treatment is to establish an effective and therapeutic relationship with the patient and his or her family.

Educate the child and parents that irritable bowel syndrome is a chronic illness that cannot be cured. At the same time, reassure them that it is not a life-threatening condition and it does not lead to physical impairment. Tell the patient and the family that the symptoms are real and respond to their worries and concerns. Reassurance is more effective if offered after a careful history and physical examination and a conservative diagnostic evaluation.

Most patients have mild symptoms and maintain normal daily activities and regular school attendance. Address the possible dietary and psychosocial triggering factors. Counseling, dietary modifications, and lifestyle changes are usually effective and sufficient for treatment.

A smaller proportion of patients have moderate-to-severe symptoms with some disruption of their activities and school performance. This group of patients may benefit from pharmacotherapy and behavioral treatment, such as gut-directed hypnotherapy (HT). HT is a special form of hypnotherapy and is a well-established treatment for IBS. Vlieger et al studied the long-term effects of HT compared to standard medical treatment plus supportive medical therapy and found HT to have long-lasting beneficial effects (eg, decreased pain intensity and frequency) in children with IBS. [18] Referral to a psychologist may be required.

A recognized association exists between the development of irritable bowel syndrome (functional abdominal pain) and prior severe gastrointestinal infection. One study has shown that the administration of lactobacillus rhamnosus GG (LGG) significantly reduced the frequency and severity of abdominal pain in children with irritable bowel syndrome. [19]

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Consultations

Consider further evaluation and a referral to a pediatric gastroenterologist if findings from the patient's history, physical examination, or screening laboratory tests are suggestive of organic disease.

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Diet

Dietary modification

Some patients with irritable bowel syndrome report exacerbation of their symptoms after ingestion of certain foods. Elimination of certain foods, such as sorbitol, fructose, and gas-forming legumes, achieves relief in some patients with irritable bowel syndrome, especially those with excess gas. Attempt lactose restriction in patients with documented lactose malabsorption.

Foods associated with increased flatulence include onions, beans, celery, carrots, prunes, bananas, raisins, brussel sprouts, wheat germ, and bagels.

Fiber supplements

A high-fiber diet or supplement is useful in patients with constipation-predominant irritable bowel syndrome. Several studies have demonstrated that fiber enhances water-retentive properties of stool, increases stool weight, and accelerates colonic transit.

In general, dietary fibers are less soluble and more effective as bulking agents, whereas synthetic fibers are more soluble and increase water retention.

The recommended daily intake of fiber (in grams) for children is estimated by adding 5 to their age in years.

A recent study in adult patients with irritable bowel syndrome revealed that a diet low in fermentable oligosaccharides, disaccharides, monosaccharide, and polyols (FODMAP) is effective in reducing functional GI symptoms. Studies of the efficacy of low FODMAP diet in treating children with irritable bowel syndrome are lacking. [20]

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