Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.
复制标题
针对儿童复发性腹痛（RAP）和肠易激综合征（IBS）的药物干预。
DOI：
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发表时间：
2008
影响因子：
8.4
通讯作者：
A. Huertas
中科院分区：
文献类型：
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作者：
A. Huertas;S. Logan;C. Bennett;C. Macarthur;A. Huertas
背景
4%至25%的学龄儿童抱怨经常性腹痛（RAP），其严重程度足以干扰日常活动。对于大多数人来说，在体格检查或调查中找不到他们疼痛的器质性原因，尽管大多数儿童可能通过安慰和简单的措施进行管理，但仍建议采取大量干预措施。
目标
确定药物治疗学龄儿童反复腹痛的有效性。
搜索策略
科克伦图书馆（CENTRAL）2006年（第4期），MEDLINE（1966年至2006年12月），EMBASE（1980年至2006年12月），CINAHL（1982年至2007年12月），埃里克使用适当的过滤器检索了PsycINFO（1966年至2006年12月）、LILACS（1982年至2006年12月）、SIGLE（1980年至2005年3月）和JICST（1985年至2000年6月
选择标准
纳入了通过随机或准随机方法分配至药物治疗组与安慰剂组/未治疗组的RAP（阿普利或罗马II胃肠道疾病标准）学龄儿童研究。
数据收集和分析
由两名独立的评审员根据纳入标准筛选通过检索确定的参考文献。使用RevMan 4.2.10提取和分析数据。
主要结果
3项试验符合纳入标准。Symon等报道了一项交叉试验，在16名患有“腹型偏头痛”的儿童中比较了吡唑替芬和安慰剂。交叉前的数据不可用。14名儿童的结果显示，服用活性药物时，平均疼痛天数减少8.21天（95% CI 2.93，13.48）。Kline等人在一项随机试验中对50名RAP和IBS儿童进行了薄荷油胶囊与安慰剂的比较。42名儿童完成了研究。改善的OR为3.33（95% CI 0.93-12.1）See et al在25例RAP和消化不良儿童的随机交叉试验中比较了法莫替丁与安慰剂。交叉前改善的OR为11（95%CI 1.6，75.5）。
作者的结论
这项综述提供了弱证据表明药物治疗对RAP儿童有益。缺乏明确的证据表明任何推荐的药物的有效性表明，没有什么理由在临床试验之外使用它们。临床医生可能会选择对症状严重的儿童开药，这些儿童对简单的治疗没有反应。然而，如果使用药物作为“治疗试验”，临床医生应该意识到，RAP是一种波动性疾病，任何“反应”都可能反映疾病的自然史或安慰剂效应，而不是药物疗效。
BACKGROUND
Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.
OBJECTIVES
To determine the effectiveness of medication for recurrent abdominal pain in school-age children.
SEARCH STRATEGY
The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters
SELECTION CRITERIA
Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasi-random methods to a drug treatment vs. placebo/ no treatment were included.
DATA COLLECTION AND ANALYSIS
References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10.
MAIN RESULTS
Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1)See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia. OR for improvement before cross-over was 11 (95%CI 1.6, 75.5).
AUTHORS' CONCLUSIONS
This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should 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.