ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4-18 years.

Abstract

Objectives: Abdominal pain related disorders of gut-brain interaction (AP-DGBIs) such as irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP) are common conditions in children, significantly impacting quality of life. This treatment guideline for IBS and FAP in children of 4-18 years is a collaborative effort of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN and NASPGHAN). We aim to comprehensively review the current evidence on treatment options and offer evidence-based recommendations with utility across all treatment settings worldwide, as well as to provide methodological directions for future research.

Methods: The guideline development followed the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach, which is in accordance with the GRADE handbook and supported by the World Health Organization. The Guideline Development Group (GDG) comprised clinical experts, representing ESPGHAN, NASPGHAN, and Cochrane. Individual members have put forward a final consensus list of treatment options, which were then translated into "patient, intervention, comparison, outcome" (PICO) format options. Prospective agreement on decision thresholds for efficacy and safety outcomes was reached through a Delphi process among the GDG to support GRADEing of the literature. Consensus voting was used to finalize recommendations, and a treatment algorithm was developed.

Results: Systematic literature searches for this output identified 86 original randomized controlled trials assessing treatment of IBS and FAP. Consensus was reached for 25 GRADEd recommendations. Ten best practice statements were formulated, and guidance for future research methodology was proposed.

Conclusion: This guideline represents the first collaborative output of ESPGHAN and NASPGHAN on treatment options for AP-DGBIs. Systematic review of the evidence has exposed major evidence gaps for the treatment of these disorders and incentivizes large pediatric trials, particularly on treatment options for which, to date, no evidence exists.