Pediatric Irritable Bowel Syndrome (IBS) Treatment & Management

Updated: Jun 06, 2022
  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD  more...
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Treatment

Approach Considerations

Irritable bowel syndrome (IBS) is a chronic illness and has no cure. [1] Management options range from medications to cognitive behavioral therapy to hypnotherapy, [1] and likely require multimodal pharmacologic and nonpharmacologic management. [3]

Educate the child and parents that irritable bowel syndrome is a chronic illness that cannot be cured. At the same time, reassure them that it is not a life-threatening condition and it does not lead to physical impairment. Tell the patient and the family that the symptoms are real and respond to their worries and concerns. Reassurance is more effective if offered after a careful history and physical examination and a conservative diagnostic evaluation.

Most patients have mild symptoms and maintain normal daily activities and regular school attendance. Address the possible dietary and psychosocial triggering factors. Counseling, dietary modifications, and lifestyle changes are usually effective and sufficient for treatment.

A smaller proportion of patients have moderate-to-severe symptoms with some disruption of their activities and school performance. This group of patients may benefit from pharmacotherapy and behavioral treatment, such as gut-directed hypnotherapy (HT). HT is a special form of hypnotherapy and is a well-established treatment for IBS. Vlieger et al studied the long-term effects of HT compared to standard medical treatment plus supportive medical therapy and found HT to have long-lasting beneficial effects (eg, decreased pain intensity and frequency) in children with IBS. [25] Referral to a psychologist may be required.

Consider further evaluation and a referral to a pediatric gastroenterologist if findings from the patient's history, physical examination, or screening laboratory tests are suggestive of organic disease.

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Medical Care

Treatment may be challenging and even frustrating to the physician, the patient, and the patient's family. The most important component of treatment is to establish an effective and therapeutic relationship with the patient and his or her family.

A recognized association exists between the development of irritable bowel syndrome (functional abdominal pain) and prior severe gastrointestinal infection. One study has shown that the administration of lactobacillus rhamnosus GG (LGG) significantly reduced the frequency and severity of abdominal pain in children with irritable bowel syndrome. [26]

Recent studies have demonstrated safety and efficacy of a percutaneous auricular neurostimulation device which delivers percutaneous electrical nerve field stimulation (PENFS) to the external ear. The studies have shown its efficacy in reducing abdominal pain scores and improving nausea, sleep, disability, somatic complaints, and anxiety. Some effects could last 6-12 months post-treatment. [27, 28]

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Diet

Dietary modification

Some patients with irritable bowel syndrome (IBS) report exacerbation of their symptoms after ingestion of certain foods. Elimination of certain foods, such as sorbitol, fructose, and gas-forming legumes, achieves relief in some patients with irritable bowel syndrome, especially those with excess gas. Attempt lactose restriction in patients with documented lactose malabsorption.

Foods associated with increased flatulence include onions, beans, celery, carrots, prunes, bananas, raisins, brussels sprouts, wheat germ, and bagels.

Dietary alterations are important in the management of IBS and are often the first consideration. Dieticians play a key role in IBS management and are essential in the process of dietary counseling. Proper consultation by a registered dietician is critical in children where limited diet and nutritional deficiencies can negatively impact growth and development. [29]

Fiber supplements

A high-fiber diet or supplement is useful in patients with constipation-predominant irritable bowel syndrome. Several studies have demonstrated that fiber enhances water-retentive properties of stool, increases stool weight, and accelerates colonic transit.

In general, dietary fibers are less soluble and more effective as bulking agents, whereas synthetic fibers are more soluble and increase water retention.

Current recommendations suggest a daily amount of fiber in the region of 10 g/day for young children increasing to around 20 g/day for adolescents. [30]

FODMAP diet

A study in adult patients with irritable bowel syndrome revealed that a diet low in fermentable oligosaccharides, disaccharides, monosaccharide, and polyols (FODMAP) is effective in reducing functional GI symptoms. [31] There is insufficient evidence on the efficacy and safety of using a low-FODMAP diet for the management of irritable bowel syndrome in children. [32]

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