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Abdominal pain and irritable bowel syndrome – how should they be treated?

06.2024
Author Dr. Martin Claßen, Bremen

Recurrent abdominal pain is one of the most common reasons for children to see a doctor. In most cases, functional complaints are the cause; in particular, irritable bowel syndrome is common, with changes in the nature of stools and a temporal link between abdominal pain and defecation.
Linaclotide has now been tested in a phase 2 study in the USA on children with irritable bowel syndrome according to the Rome III definition and infrequent or difficult bowel movement (1). Linaclotide is a guanylate cyclase activator and has a prosecretory effect on the intestinal mucosa by activating chloride channels, which improves stool consistency. 101 children were included and were given linaclotide in 3 different doses or the placebo. Depending on the dose, there was an increase in spontaneous defecation, but below the significance limit, and there was also an improvement in pain symptoms in the group with the highest dose. Unfortunately, the study was poorly designed statistically due to the division into different age groups and dosages.

Comment: Irritable bowel syndrome occurs regularly and should be diagnosed more frequently in children. In particular, the constipation it causes is easily treatable. In adults, linaclotide is already used to treat constipation-predominant irritable bowel syndrome and is recommended in the guidelines for treatment-resistant cases (2). The substance is also approved for treating chronic constipation in children in the USA.
In Germany, macrogol is currently the drug of first choice in childhood and adolescence for both constipation-predominant irritable bowel syndrome and functional constipation – although there is no scientific evidence to support it. It would be good to evaluate other drugs in future. Linaclotide would have to prove its effectiveness compared to macrogol in larger studies, especially with regard to pain symptoms. It should also be noted at this point that increasing the intake of soluble fibre can influence stool consistency. Cognitive behavioural therapy should always be recommended for irritable bowel syndrome.

Reference:
[1] Di Lorenzo C, Nurko S, Hyams JS, et al. Safety and efficacy of linaclotide in children aged 7–17 years with irritable bowel syndrome with constipation. J Pediatr Gastroenterol Nutr. 2024; 78: 539‐547.
[2] Layer P et al. Update S3-Leitlinie Reizdarmsyndrom. Z Gastroenterol 2021; 59: 1323–1415.

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