Irritable bowel syndrome in children: Current knowledge, challenges and opportunities

Table 1 Rome IV criteria for irritable bowel syndrome in children and subtypes

Diagnostic criteria for irritable bowel syndrome (IBS)[18]

Must include all of the following

Abdominal pain at least 4 d per month associated with one or more of the following:

Related to defecation

A change in frequency of stool

A change in form (appearance) of stool

In children with constipation, the pain does not resolve with resolution of the constipation (children in whom the pain resolves have functional constipation, not irritable bowel syndrome)

After appropriate evaluation, the symptoms cannot be fully explained by another medical condition

Above criteria needs to be fulfilled for at least 2 mo before diagnosis.

Diagnostic criteria for IBS subtypes[31]

IBS with predominant constipation

More than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and less than one fourth (25%) lf bowel movements with Bristol stool form types 6 or 7

IBS with predominant diarrhea

More than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7 and less than one fourth (25%) lf bowel movements with Bristol stool form types 1 or 2

IBS with mixed bowel habits

More than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and more than one fourth (25%) lf bowel movements with Bristol stool form types 6 or 7

IBS unclassified

Patients who meet diagnostic criteria for IBS but whose bowel habits cannot be accurately categorized into 1 of the 3 groups above

Table 2 Potential alarm features in children with irritable bowel syndrome[18]

Family history of inflammatory bowel disease, celiac disease or peptic ulcer disease

Persistent right upper or lower abdominal pain

Dysphagia

Odynophagia

Persistent vomiting

Gastrointestinal blood loss

Nocturnal diarrhea

Arthritis

Perirectal disease

Involuntary weight loss

Deceleration of linear growth

Delayed puberty

Unexplained fever

Table 3 Management options for children with irritable bowel syndrome

Counselling and explanation to parents/child

Control maternal response to child’s pain

Pharmacological interventions

Gastroprokinetics (domperidone)

Antidepressants (amitriptyline, citalopram)

Acid suppressing agents (famotidine, omeprazole)

Antispasmodics (peppermint oil, mebavarine, dotavarine)

Antihistamines (cyproheptadine)

Antibiotics (rifaximin)

Psychological interventions

Guided imagery

Gut directed hypnotherapy

Cognitive behavioral therapy

Yoga therapy

Neuromodulation

Low FODMAP diet

Probiotics