An 8-week period of probiotic therapy with Lactobacillus GG significantly reduced the frequency and severity of abdominal pain, with no significant effects from placebo, in a randomized study of 141 children with irritable bowel syndrome or functional abdominal pain. Benefits persisted for another 8 weeks of follow-up (Pediatrics 2010;126:e1445-52).
There is excellent evidence supporting biofeedback treatment for chronic headaches, and although there are no data for treating abdominal pain, biofeedback seems to work, Dr. Burpee said.
Both amitriptyline and placebo significantly relieved pain and produced a sense of improvement in a 4-week randomized study of 83 children with functional GI disorders. Results did not differ significantly between groups, however, which led the investigators to conclude that both the tricyclic antidepressant and placebo were effective (Gastroenterology 2009;137:1261-9).
"I think most of the things we do with fiber etc. are placebo," Dr. Burpee said. Amitriptyline might be a good choice in a child who has a lot of anxiety around functional abdominal pain, he suggested.
In the latest and probably largest study of antibiotics to treat functional abdominal pain, 1,260 patients were randomized to rifaximin (55 mg three times a day) or placebo for 2 weeks. The proportions of patients who reported relief from pain for at least 2 of the 4 weeks following the start of treatment were 40% with rifaximin and 31% with placebo (N. Engl. J. Med. 2011;364:22-32).
Although the difference between groups was statistically significant, "I’m not really sure of the clinical value of 40% vs. 31% when treating an individual patient," and the antibiotic is very expensive – probably $600 for the treatment course used in the study, Dr. Burpee said.
"Irritable bowel syndrome is not a one-and-done thing," he added, noting that "2 weeks of treatment is probably not a great idea."
There are no great data to support treating functional abdominal pain with acupuncture, Dr. Burpee said. A review of the literature reported about a 30%-40% success rate with real vs. sham acupuncture (Gastroenterol. Clin. North Am. 2011;40:245-53).
Dr. Burpee reported having no relevant financial disclosures.