Ability of probiotics to reduce functional abdominal pain in children

Article information

Clin Exp Pediatr. 2022;65(12):585-586

Publication date (electronic) : 2022 October 6

doi : https://doi.org/10.3345/cep.2022.00913

Department of Pediatrics, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea

Corresponding author: Ji Sook Park, MD, PhD. Department of Pediatrics, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79 Gangnam-ro, Jinju 52727, Korea Email: csassi@gnu.ac.kr

Received 2022 July 1; Revised 2022 July 1; Accepted 2022 September 26.

See the Original "Ability of polymicrobial probiotic and mono-strain probiotic to reduce functional abdominal pain in children: a randomized clinical trial" in Volume 65 on page 589.

Key message

∙ The ability of probiotics to relieve pain caused by functional abdominal pain disorders (FAPD) in children is unclear.

∙ Lactobacillus reuteri may effectively reduce pain caused by childhood FAPD.

∙ Since the routine use of probiotics cannot be recommended due to a lack of clinical evidence, research into probiotic mixtures or symbiotics remains necessary.

Functional abdominal pain disorders (FAPD) in children are frequently encountered in clinics; however, adequate treatment options for them are lacking. The prevalence of FAPD is reported 0.2%–23%, and its underlying etiology is poorly understood [1]. The gut microbiota is an essential factor in the development of functional gastrointestinal disorders, and compositional alterations are correlated with many gastrointestinal illnesses [2,3]. This randomized controlled clinical trial evaluated the ability of polymicrobial probiotics (PMP) and mono-strain probiotics (MSP) to relieve childhood functional abdominal pain according to Rome IV Diagnostic Criteria for Irritable Bowel Syndrome. Children were randomly assigned to receive PMP containing a mixture of 6×10⁹ units of Bifidobacterium lactis, Lactobacillus acidophilus, Bifidobacterium bifidum, and Lactobacillus rhamnosus, or MSP containing 8×10⁸ units of Lactobacillus reuteri for 4 weeks. Pain scores in the PMP and MSP groups decreased at 7 weeks after study initiation [4]. However, intergroup differences in pain scores were not significant at any time point. Due to the lack of a placebo group in this study, the reduction of pain intensity with time was insufficient to conclude the effectiveness of probiotics for childhood functional abdominal pain.

The use of probiotics has been an attractive clinical topic for controlling pain related to FAPD or other functional gastrointestinal disorders such as irritable bowel syndrome and functional constipation for several decades because dysbiosis is considered a contributing factor in many functional abdominal disorders [2,3]. Recent studies of the effects of probiotics on childhood functional abdominal pain reported the efficacy of probiotics to be widely heterogeneous, and clinical evidence is still lacking due to the inclusion of diverse probiotic strains [1,4,5]. Among them, L. reuteri might effectively reduce pain intensity in children [6-8]. Dysbiosis seems to be associated with pathophysiological factor in FAPD, and previous randomized controlled trials suggested that L. reuteri may be able to reduce FAPD-related pain in children [6-8]. However, recent recommendations do not encourage the routine use of probiotics to treat childhood functional gastrointestinal disorders due to a lack of evidence [9,10].

The current randomized clinical trial investigated the ability of multi- versus mono-strain probiotics to reduce FAPD-related pain in children. However, it failed to prove that multi-strain L. reuteri probiotics were more effective in relieving pain in children with FAPD than mono-strain probiotics; moreover, data on probiotic mixtures or synbiotics remained limited. Therefore, a well-controlled large-scale clinical study is required to further elucidate this issue.

Notes

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

References

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