Clinical question
How effective are pharmacological interventions for recurrent abdominal pain in children of school age?
Bottom line
There was no evidence for the use of medications to improve symptoms or the child’s quality of life. Studies were conducted in 7 countries, and follow-up ranged from 2 weeks to 4 months. Medications included tricyclic antidepressants, antibiotics, 5-HT4 receptor agonists, antispasmodics, antihistamines, histamine H2-receptor antagonists, serotonin antagonists, selective serotonin reuptake inhibitors, a dopamine receptor antagonist and melatonin.
Caveat
Although some single studies reported treatments were effective, all of these studies were either small or had key methodological weaknesses with a substantial risk of bias. None of these “positive” results were reproduced in subsequent studies. The evidence of effectiveness was of low quality.
Context
Between 4% and 25% of school-aged children, at some stage, complain of recurrent abdominal pain of sufficient severity to interfere with their daily lives. When no clear organic cause is found, the children are managed with reassurance and simple measures; a large range of pharmacological interventions have been recommended for use in these children.
Cochrane Systematic Review
Martin AE et al. Pharmacological interventions for recurrent abdominal pain in childhood. Cochrane Reviews, 2017, Issue 3. Art. No.: CD010973.DOI: 10.1002/14651858. CD010973.pub2. This review contains 16 studies involving 1024 participants.
PEARLS No. 564, November 2017, written by Brian R McAvoy.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health. Brian McAvoy is an honorary/adjunct professor of general practice at the Universities of Auckland, Melbourne, Monash and Queensland. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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