Health: irritable colon in children, first Italian guidelines arrive

Abdominal pain, alterations in intestinal function: symptoms that can have a significant impact on children's quality of life and cause alarm in parents. Irritable bowel syndrome in children is a problem on which there is a lot of attention and for which the first Italian guidelines have now arrived which have as their “primary objective to limit both the indiscriminate use of invasive and useless tests and the use of drugs administered without clear indications”, explains Claudio Romano, president of the Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition (Sigenp), an acronym that launched the document together with the Italian Society of Pediatrics (Sip), Italian Society of Gastroenterology and Endoscopy (Sige) and Italian Society of Eurogastroenterology (Singem).

“There is great media interest, with the involvement of the pharmaceutical world, around pediatric patients with irritable bowel syndrome also known as Ibs, Inflammatory Bowel Syndrome – explains Romano, president of Sigenp – as scientific societies we have decided to clarify by producing an easy-to-use document fruition aimed in particular at local medicine”. The point is to bring order and standardize. “These guidelines – states the promoter of the document, Giovanni Di Nardo, professor of Medicine at the Sapienza University of Rome – suggest a diagnostic approach based above all on the evaluation of symptoms and provide simple and clear indications on the management of the patient which, in the first instance , involves dietary measures and psychosocial support, generally sufficient to manage the symptoms of the child with irritable bowel syndrome and then, only in selected cases and under specialist supervision, a pharmacological treatment may be indicated”.

Recommended dietary and psychological approach, no allergy tests, colonoscopy only in selected cases

Serology for celiac disease, fecal calprotectin and C-reactive protein are the only simple laboratory investigations indicated in the child with suspected symptoms of Inflammatory Bowel Syndrome. The consensus does not recommend testing for intolerances and allergies while colonoscopy is recommended only in patients with warning signs. “It is important to reiterate that as regards treatments, we strongly recommend the dietary and psychological approach; pharmacological therapies are to be reserved for very selected cases and only under specialist supervision – continues Romano – furthermore we have developed specific recommendations to clarify on the use of supplements”.

“The constant increase in the commitment required of the National Health Service for the improper use of tests, often third level and invasive, for example endoscopy, and indiscriminate therapies, even self-prescribed – concludes Renato Tambucci, pediatrician at the Bambino Gesù Hospital in Rome – has made it necessary to develop specific pediatric guidelines aimed at providing clear recommendations on the management of IBS based on current evidence. It is not known what the precise cause of irritable bowel syndrome in children is, but recent evidence suggests that interactions between the brain and the intestine play a decisive role, therefore an accurate anamnesis and an in-depth clinical examination are the key elements to formulate the diagnosis. It is important to carry out an in-depth interview with the family to reassure them about the benignity of the condition, and the pursuit of investigations and useless therapies can only be a source of further stress.”