A new study published in the Cochrane Library examines the evidence surrounding the use of drug therapy in the treatment of school-aged children with recurrent abdominal pain (RAP).
While RAP is generally managed with simple measures when no clear cause is found, a broad range of pharmaceutical agents have also been recommended. In this study, researchers aimed to determine how effective these pharmacological interventions are in school-aged children with RAP.
After an extensive search of several databases, researchers found 16 trials that fit the study criteria (ie, children 5–18 years of age with RAP or an abdominal pain-related functional gastrointestinal disorder [Rome III criteria]). Studies compared drug intervention with placebo, no treatment, waiting list, or standard care. Pain intensity/duration/frequency and improvement were all primary outcome measures; school performance, social/psychological functioning, and quality of life were assessed as secondary outcome measures.
Medications examined in this review included tricyclic antidepressants, antibiotics, 5-HT4 receptor agonists, antispasmodics, antihistamines, H2 receptor antagonists, serotonin antagonists, selective serotonin reuptake inhibitors (SSRIs), a dopamine receptor antagonist, and a hormone. While some studies indicated a positive effect with treatment, most were either too small or had substantial risk of bias and could not be used to prove effectiveness. In addition, none of the positive effects could be reproduced in subsequent studies.
In conclusion, the authors deemed the evidence for the use of medications in the treatment of RAP in children as “low quality”. More studies that use better methods to assess outcomes are needed to evaluate the benefits and risks of using drug therapy for RAP. In the meantime, the authors note, “if a clinician chooses to use a drug as a ‘therapeutic trial’, they and the patient need to be aware that RAP is a fluctuating condition and any ‘response’ may reflect the natural history of the condition or a placebo effect, rather than drug efficacy.”
For more information visit CochraneLibrary.com.