Nonpharmacologic Treatment of Functional XXXX : A Systematic Review.

@entity1 @entity344 @entity1132 @entity13349 @entity112 @entity1744 @entity158 @entity490 @entity1905
BACKGROUND AND OBJECTIVE: Various nonpharmacologic treatments are available for pediatric @entity490 -related functional @entity344 (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine. METHODS: Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in @entity1 (aged 3-18 years) with AP-FGIDs were included, and data were extracted on @entity1 , interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach. RESULTS: Twenty-four RCTs were found that included 1390 @entity1 . Significant improvement of @entity490 was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved @entity158 frequency at the 6-month follow-up only. Compared with placebo, @entity1905 (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P < .05). Guar gum significantly improved @entity1744 symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a @entity1132 -free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, @entity112 -, or @entity13349 -free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate. CONCLUSIONS: Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.
