ABDOMINAL pain-related disorders of gut-brain interaction (AP-DGBI) affect >300 million children every year across the globe, and whilst there are several treatment options in the clinician’s armoury, RCT evidence quality is not well characterised.
To assess this evidence quality, a recent systematic review and network meta-analysis utilised Embase, MEDLINE, and CENTRAL databases from initiation until the 16th of January 2025, looked at published RCTs evaluating the treatment of AP-DGBIs (functional abdominal pain–otherwise not specified, irritable bowel syndrome, and abdominal migraine) in children aged 4–18 years of age. RCTs solely including children with functional dyspepsia were excluded, however, studies inclusive of children with functional dyspepsia and other AP-DGBIs were included. Author-defined treatment success was the primary outcome.
In total, 19,337 records were identified, of which, 155 records covering 91 RCTs were included in the network meta-analysis. These trials enrolled 4,119 female and 2,673 male participants. The RCTs assessed different treatment modalities: psychosocial treatments (n=35), pharmacological treatments (n=25), probiotic treatments (n=23), and dietary treatments (n=12).
Of the treatments assessed, cognitive behavioural therapy (CBT) and hypnotherapy emerged as probably more effective than control treatments, and the evidence certainty for this was moderate. For CBT, the risk ratio was 1.99; 95% CI: 1.33–2.98, and the effect size was moderate. For hypnotherapy, the risk ratio was 4.99; 95% CI: 2.15–11.57, and the effect size was large. Notably, the analysis found that the other treatments assessed across the trials were either not effective or had very low certainty data, impeding the ability to draw any conclusions on their success.
Whilst this study highlights that moderate certainty exists for AP-DGBI treatment success with CBT and hypnotherapy, there is a need to improve the evidence certainty for all other treatment options through high-powered and well-designed RCTs.
Reference
Sinopoulou V et al. Efficacy of interventions for the treatment of irritable bowel syndrome, functional abdominal pain—not otherwise specified, and abdominal migraine in children: a systematic review and network meta-analysis. Lancet Child Adolesc Health. 2025;9(5):315-24.
