“Irritable bowel syndrome of childhood”

I really enjoyed this summary on paediatric functional abdominal pain disorders published in “Nature Reviews Disease Primers” in November 2020. In my practice I see many children with functional bowel disorders and this summary provided a really good explanatory model.

Essentially, functional bowel disorders are disorders of intermittent abdominal pain (cramps or burning pains) which are not found to be caused by anything specific or serious. Such functional bowel disorders are common in children, occurring in up to 25% of infants and children!

They can be classified into:
– irritable bowel syndrome
– functional dyspepsia (more upper abdominal reflux like symptoms)
– abdominal migraines (intermittent severe abdominal pains lasting hours to days) and
– functional bowel disorders not otherwise specified.

What causes functional abdominal pain?
Functional abdominal pain syndromes can be referred to as disorders of the “microbiota-gut-brain” axis. Let’s look individually at these 3 components:

  1. The microbiota: We are beginning to understand more and more about the importance of a healthy and varied population of microbiota in our guts. A good composition and balance of microbiota is involved in maintaining a healthy gut lining and a healthy gut immune system. Microbiota can be disrupted by antibiotics, use of anti-acids and in certain genetic and dietary patterns.
  2. The gut: The gut is a nervous system unto itself! It has millions of nerve endings, and in some people these may be hypersensitive. These nerves communicate with the brain- which then gets the signal for pain or discomfort. The local gut environment can also lead to problems with the movement or motility of the gut, so that the gut may move in a spasmodic fashion, leading to painful cramps.
  3. The brain: The brain is responsible for interpreting signals coming from the gut. Certain brains may experience increased perception of the stimuli coming from the gut, thus interpreting it as being very bad or disabling. The “over-interpretation” of signals coming from the gut may in part be genetic. It can also be influenced by other factors such early life pain, family stress, parenting factors, anxiety, stress, coping styles and sometimes secondary gain.

Of course, before diagnosing functional bowel disorders, we need to rule out more serious or treatable organic bowel disorders such as constipation, reflux, coeliac disease and inflammatory bowel disease. Frequently the child will require some blood tests and sometimes ultrasounds or Xrays to exclude the more “serious” causes.

But once functional abdominal pain syndrome has been diagnosed, the above “three-factor model” can really help us to understand it.

Publication: Nikhil Thapar et al. Paediatric functional abdominal pain disorders. Nature Reviews Disease Primers. November 2020