Rexwinkel Robyn, de Bruijn Clara M A, Gordon Morris, Benninga Marc A, Tabbers Merit M
Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands;
Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Academic Medical Center and Emma Children's Hospital, Amsterdam, The Netherlands.
Pediatrics. 2021 Jun;147(6). doi: 10.1542/peds.2020-042101.
Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs).
To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs.
Electronic databases were searched from inception to February 2021.
RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent.
Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator.
Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics.
The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low.
On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.
功能性腹痛障碍（FAPDs）在儿童时期很常见，会影响生活质量和上学出勤率。有几种化合物可用于治疗儿童FAPDs，但由于缺乏直接对比的随机对照试验（RCTs），其疗效和安全性尚不清楚。
系统评价可用于儿童FAPDs的药物治疗的疗效和安全性。
检索了从数据库建立至2021年2月的电子数据库。
如果研究人员调查了用药物干预治疗FAPDs的儿童（4至18岁）研究人群，并与安慰剂、未治疗或任何其他药物进行比较，则纳入RCTs或系统评价。
两名评价员独立进行数据提取并评估其质量。评价中研究人员之间的任何分歧由第三名调查员解决。
纳入了17篇文章，涉及1197名患有FAPD的儿童。纳入了研究解痉药、抗抑郁药、抗生素、抗组胺药、止吐药、组胺-2受体拮抗剂、5-羟色胺4受体激动剂、褪黑素和丁螺环酮的试验。未发现有关使用泻药、止泻药、镇痛药、抗偏头痛药和5-羟色胺能药物治疗的研究。
根据推荐分级、评估、制定与评价系统，证据的总体质量非常低至低。
根据目前的证据，无法推荐任何特定的药物用于治疗儿童FAPDs。然而，解痉药或抗抑郁药等药物因其良好的治疗效果和缺乏重要副作用，可在日常实践中进行讨论。需要高质量的RCTs来提供充分的药物治疗。对于未来的干预试验，我们建议使用同质的结局指标和工具、大样本量以及长期随访。
