Treatment of pediatric abdominal pain: what is the evidence?

INTRODUCTION: Abdominal pain disorders (APDs), including irritable bowel syndrome (IBS) and functional abdominal pain - not otherwise specified (FAP), are highly prevalent in children and significantly impact quality of life. This review highlights advances addressing the need for standardized, evidence-based management in this population. AREAS COVERED: This review summarizes the first evidence-based treatment guidelines for pediatric IBS and FAP, developed jointly by the European and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The recommendations were based on a systematic review of randomized controlled trials identified through searches in PubMed, Embase, and Cochrane CENTRAL databases 1984 - June 2023. Strong recommendations were issued for hypnotherapy and cognitive behavioral therapy, with conditional suggestions for probiotics, symbiotics, peppermint oil, soluble fiber, and selected pharmacologic agents. To complement this work, we performed an updated literature search covering studies published after June 2023. EXPERT OPINION: These guidelines represent a critical advancement in standardizing the management of pediatric APDs by showing how each recommendation is supported by the available evidence. They offer practical guidance for clinicians navigating a complex and often fragmented treatment landscape. Future efforts should prioritize addressing current knowledge gaps and evaluating the impact of these recommendations on clinical outcomes.