Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and
Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital, Academic Medical Center, Amsterdam, Netherlands; and.
Pediatrics. 2015 Mar;135(3):522-35. doi: 10.1542/peds.2014-2123. Epub 2015 Feb 9.
Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.
Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.
Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P < .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate.
Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.
针对与小儿腹痛相关的功能性胃肠疾病（AP-FGIDs），有多种非药物治疗方法。目前关于这些治疗方法的疗效和安全性的数据有限。本研究旨在总结非药物干预治疗小儿 AP-FGIDs 的证据，包括生活方式干预、饮食干预、行为干预、益生菌和益生元以及替代医学。
检索 Medline 和 Cochrane 图书馆数据库。纳入了关于儿童（3-18 岁）AP-FGIDs 非药物治疗的系统评价和随机对照试验（RCT），并提取了参与者、干预措施和结局的数据。使用 GRADE 方法评估证据质量。
共发现 24 项 RCT，纳入了 1390 名儿童。与标准护理/等待名单方法相比，催眠疗法可显著改善腹痛症状；与各种对照治疗/等待名单方法相比，认知行为疗法也可显著改善腹痛症状。仅在 6 个月随访时，书面自我披露可改善疼痛发作频率。与安慰剂相比，鼠李糖乳杆菌 GG（LGG）和 VSL#3 与更多的治疗应答者相关（LGG：相对风险 1.31 [95%置信区间：1.08 至 1.59]；VSL#3：P <.05）。瓜尔胶可显著改善肠易激综合征症状发作频率；然而，其他纤维补充剂（相对风险 1.17 [95%置信区间：0.75 至 1.81]）或无乳糖饮食对其无效果。与等待名单方法相比，瑜伽并不能显著降低功能障碍。未发现关于生活方式干预、无谷胶、组胺或碳酸饮食、液体摄入或益生菌的研究。未报告严重不良事件。证据质量被认为是极低到中度。
尽管缺乏高质量的研究，但一些证据表明催眠疗法、认知行为疗法和益生菌（LGG 和 VSL#3）对小儿 AP-FGIDs 有效。关于纤维补充剂的数据尚无定论。
