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Review
. 2024 Mar 14;50(1):51.
doi: 10.1186/s13052-024-01607-y.

Italian guidelines for the management of irritable bowel syndrome in children and adolescents : Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM)

Giovanni Di Nardo  1 , Giovanni Barbara  2   3 , Osvaldo Borrelli  4 , Cesare Cremon  2   3 , Valentina Giorgio  5 , Luigi Greco  6 , Michele La Pietra  7 , Giovanni Marasco  2   3 , Licia Pensabene  8 , Marisa Piccirillo  1 , Claudio Romano  9 , Silvia Salvatore  10 , Michele Saviano  7 , Vincenzo Stanghellini  2   3 , Caterina Strisciuglio  11 , Renato Tambucci  12 , Rossella Turco  13 , Letizia Zenzeri  1 , Annamaria Staiano  14
Affiliations
Review

Italian guidelines for the management of irritable bowel syndrome in children and adolescents : Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM)

Giovanni Di Nardo et al. Ital J Pediatr. .

Abstract

The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered.

Keywords: Children; Chronic abdominal pain; Constipation; Diarrhea; Functional gastrointestinal disorders; Irritable bowel syndrome.

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Conflict of interest statement

The following authors declare the following paid or unpaid consultancies, business interests or sources of honoraria payments for the past three years, and anything else which could potentially be viewed as a conflict of interest:

GB: Aboca, AB Biotics, Agave, Alfa Sigma, AGPharma, Bayer, Bromatech, Cadigroup, Biocodex, Sanofi, GE Healthcare, Mayoly, Diadema, Sofar;

CC: Sofar, Interalia Pharma, Schwabe Pharma; consultation fees from Alfa Sigma;

AS: is clinical investigator for Janssen Biologics B.V., Eli Lilly Cork Limited and Novalac; consultant for Aboca, Abbott, Angelini e Novalac; was clinical investigator for Aboca and PAREXEL International.

VS: Alfa Sigma, Bayer, Coloplast, GE Healthcare, Menarini, Norgine.

All the other authors declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Diagnostic approach to children with Irritable Bowel Syndrome (IBS). Legend: *only in patients with IBS diarrhea subtype
Fig. 2
Fig. 2
Therapeutic strategies in children with Irritable Bowel Syndrome (IBS). Legend: *in children with IBS without constipation in which other treatments have failed; °when other therapeutic strategies have failed; §in children with IBS in which other treatments have failed and only under specialist supervision
See this image and copyright information in PMC

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