Lgg inchildren with functional abdominal pain

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In this randomized 8 week trial Lactobacillus GG ameliorated pain significantly among pediatric IBS / functional abdominal pain patients.

In this randomized 8 week trial Lactobacillus GG ameliorated pain significantly among pediatric IBS / functional abdominal pain patients.

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  • 1. A Randomized Controlled Trial of Lactobacillus GG in Children With Functional Abdominal Pain Francavilla R et al. Pediatrics 2010; 126; 1445-1452 www.pronutritionist.net Page Francavilla R et al. Pediatrics 2010; 126: 1445-1452
  • 2. Pronutritionist’s background
    • Recurrent abdominal pain affects 4-25% of school-aged children
    • There is a lack of high quality evidence for the benefit of dietary manipulation in children with abdominal pain ( Huertas-Ceballos 2009 )
    • Most data on the use of probiotics in functional disorders are derived from studies of adults with IBS
    • In adult studies, probiotics relieve symptoms among IBS patients according to a recent meta-analysis, number needed to treat (NNT) being 4 ( Moayyedi PT et al . 2010)
    Page Francavilla R et al. Pediatrics 2010; 126: 1445-1452 www.pronutritionist.net
  • 3. Methods
    • a randomized, double-blind, placebo-controlled trial
    • n = 141 children
      • age 5-14 years with history of symptoms circa 2 years
      • irritable bowel syndrome (IBS) or functional abdominal pain (FAP) according to Rome II criteria
      • Dyspepsia patients were excluded
    • LGG or placebo for 8 weeks, follow-up for 8 weeks
    • The primary outcome was overall pain at the end of the intervention period
      • a combination of the self-reported visual analog scale (VAS) and the Faces Pain Scale (FPS) was used
    • At entry and at the end of the trial, children underwent intestinal permeability test
      • measures ability of mannitol and lactulose to permeate the intestinal lining  helps to identity possible malabsorption or increased permeability and weakness of the intestinal lining barrier
    Page Francavilla R et al. Pediatrics 2010; 126: 1445-1452 www.pronutritionist.net
  • 4. Results (1/2)
    • LGG caused a significant reduction of both frequency (p =0,01) and severity (p = 0,01) of abdominal pain
    • Effect was still seen at the end of follow-up
      • Only in children with IBS
    • At entry, 59% of the children had abnormal results from the intestinal permeability test (IPT)
    • At week 12, LGG, but not placebo, resulted in a significant reduction of intestinal permeability in children with IBS (p = 0.02)
      • The effect was mainly seen in children with IBS
    • LGG was well tolerated, and no adverse effects were reported
    www.pronutritionist.net Francavilla R et al. Pediatrics 2010; 126: 1445-1452 Page
  • 5. Results (2/2): treatment success* www.pronutritionist.net Francavilla R et al. Pediatrics 2010; 126: 1445-1452 Page * a decrease of at least 50% in the number of episodes and intensity of pain n = 141 children, 8 weeks’ placebo controlled trial, 8 weeks open label follow up
  • 6. Pronutritionist’s discussion
    • In this rather large trial, LGG provided a placebo-subtracted benefit of circa 20 %, in other words more than 7/10 patients get pain relief on LGG while 5/10 patients get relief on placebo
    • This magnitude of effect is in line with previous studies conducted with prescription drugs in IBS ( Spiller 1999)
    • If multi-strain probiotics have even better effect remains unknown. Previous evidence from RCT trials suggest the improved effect of multi-strain preparations ( Chapman et al . 2011)
    • One of the possible mechanisms accounting for pain relief is decreased small intestine hyperpermeability through tight junction integrity as took place in the recent study
    • Even if some previous studies have not shown consistent results with the present study ( Bausserman et al . 2005), testing probiotic in children with IBS or functional abdominal pain seems justified taken into account favourable safety profile of LGG
    www.pronutritionist.net Francavilla R et al. Pediatrics 2010; 126: 1445-1452 Page