Dietary interventions for recurrent abdominal pain (RAP) in childhood

Abstract

Background: Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis of RAP includes children with different aetiologies for their pain. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.

Objectives: To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children.

Search strategy: The Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, LILACS and JICST were searched using a strategy combining (Recurrent OR synonyms) AND (Abdomen OR synonyms) AND (Pain OR synonyms). Where appropriate, search filters were employed. In addition, researchers working in this area were asked to identify relevant studies.

Selection criteria: Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP, and who were allocated by random or quasi-random methods to any dietary treatment compared with a placebo or no treatment, were selected.

Data collection and analysis: References identified by the searches were screened against the inclusion criteria by two independent reviewers.

Main results: Four trials were included in the review overall. Two comparing fibre supplements with placebo (Christensen 1982, Feldman 1985) were included, with data from one study reported in two papers (Christensen 1982, Christensen 1986). A total of 92 school-aged children participated in the two trials. The pooled odds ratio for improvement in the frequency of abdominal pain was 1.16 (95% CI 0.45-2.87). Two trials (Lebenthal 1981, Dearlove 1983) comparing lactose-containing with lactose-free diets were included. A total of 90 school-aged children participated in these two trials; however, neither trial reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We are continuing to try to contact the authors of the Lebenthal 1981 trial for more data. The authors of Dearlove 1983 reported that raw data from their trial is not available.

Reviewer's conclusions: There is a lack of high quality evidence on the effectiveness or otherwise of dietary interventions. This review suggests that fibre supplements are not effective in the management of RAP, although the trials are small and of variable quality. The trials from lactose-restricting diets are as yet wholly inclusive. There is a need for well-designed trials (which include compliance measures) of all recommended dietary interventions for children with RAP.