Efficacy and safety of interventions for the treatment of irritable bowel syndrome, functional abdominal pain – not otherwise specified and abdominal migraine in children: systematic review and network meta-analysis

Abstract

Background
Many treatments for abdominal pain-related disorders of gut-brain interaction (AP-DGBI) in children have been studied. We performed the first NMA to assess the efficacy and safety of all known treatment options for pediatric AP-DGBI.
Methods
Randomised controlled trials (RCTs) studying any treatment option for AP-DGBIs (IBS, FAP-NOS and Abdominal Migraine, not functional dyspepsia) in children aged 4-18 years were considered. A literature search using EMBASE, MEDLINE and CENTRAL, were searched until January 16th 2024. Primary outcome was author-defined treatment success. Data extraction and appraisal was performed in duplicate Network meta-analysis methodology was employed within a frequentist framework using multivariate meta-analysis and outcomes assessed using GRADE methodology.
Findings
91 original RCTs (n=7226, 4408 female / 2818 male). were included, of which 12 on dietary treatments (n=730), 25 on pharmacological treatments (n=2140), 23 on probiotic treatments (n=1762) and 35 on psychosocial treatments (n=2952). More treatment success probably occurs (moderate certainty) with hypnotherapy (RR 4·96, 95% CI 2·16 to 11·4, large effect size) and cognitive behavioural therapy (CBT) (RR 1·99, 95% CI 1·32 to 2·95, moderate effect size). CBT probably reduces pain frequency episodes (MD 1·6 less/week, 95% CI 0·7 less/week to 2·7 less/week) and hypnotherapy (MD 5.4 less/week, 95% CI 3·0 less/week to 8·2 less/week, small effect) and dietary fibre (MD 3·4 less/week, 95% CI 1·4 less/week to 5.7 less/week, trivial effect) may reduce pain frequency. All other treatments were either not effective or the data were of very low certainty so no conclusions can be drawn.

Interpretation
Hypnotherapy and CBT show moderate certainty for treatment efficacy with clinically relevant effect sizes. No conclusions can be drawn about the other therapies in our analyses due to very low evidence certainty. Future RCTs should focus on improving the certainty level of those therapies’ impact on core AP-DGBI outcomes.