If you’re a parent, then you are probably familiar with the phrase, “My stomach hurts!”

This is often a self limited problem, but some children do experience recurrent abdominal pain which is often diagnosed as Irritable Bowel Syndrome (IBS).

A recently published study examined the benefits of probiotics for alleviating the symptoms of IBS in children⁽¹⁾. IBS is a common problem in pediatrics, and no safe and effective treatment has been available up until now⁽²⁾.

Suspected Causes of IBS

The symptoms of abdominal bloating, gas, pain and change in stools are very common in both children and adults. Once appropriate tests have ruled out any underlying disorder like ulcers, colitis, or celiac disease, the diagnosis is often IBS.

Between 5 to 20% of kids have IBS, and about one in five adults do, too. It’s not fun, but the good news is that IBS doesn’t lead to more serious problems. It is more about quality of life for the child and the family.

Since the cause is not really known, and the symptoms can vary, IBS can be hard to treat.

Over the years a variety of theories have been offered to explain IBS symptoms in children. These have included emotional stress, intestinal hypersensitivity, altered intestinal motility, dietary intolerances and genetics^(3,4).

In the last several years there has been a shift in the paradigm, and now alterations in the intestinal bacteria are thought to be a major factor leading to IBS.

We are all familiar with the term “food poisoning” — a bout of infectious diarrhea due to the consumption of harmful bacteria in contaminated foods or drinks.

Researchers in the area of IBS noted that many of the people who developed symptoms of IBS had experienced a recent episode of food poisoning⁽⁵⁾. It was theorized that the infection caused a disruption of the healthy intestinal bacteria resulting in ongoing intestinal inflammation and GI symptoms⁽⁶⁾.

Recent studies have supported this association and identified post-infectious irritable bowel syndrome (PI-IBS) as a disorder due to a previous bout of  infectious gastroenteritis. Approximately 30% of individuals with IBS can date the onset of their symptoms following an episode of gastroenteritis⁽⁷⁾.

Pediatric Medical Studies

In February of this year, a study⁽⁸⁾ was published that documented for the first time that exposure to acute gastroenteritis in childhood is associated with an increased risk of IBS in early adulthood. There was an outbreak of infectious gastroenteritis due to drinking contaminated city water. Children were followed for 8 years after the exposure. The children who had a bout of gastroenteritis had a greater than fourfold increase in IBS compared with unexposed children.

This now brings us back to the new medical article that I mentioned at the beginning of this newsletter. The study⁽¹⁾ enrolled children 4 to 18 years of age who fulfilled the criteria for IBS. The children received a probiotic or a placebo. A daily record of their symptoms was maintained. At the end of the study, the results were reviewed.

The group receiving probiotics had a better than 50% improvement in their symptoms of abdominal pain, and bloating compared to the placebo group.  There was also an improvement in the passage of stools. Additionally, no adverse effects were noted in the group taking probiotics.

In 2008, a review article⁽²⁾ on medications to ease the symptoms of IBS in children stated, “The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials.” The new study on childhood IBS, though, does show that probiotics are effective.

Take Home Message

If your child has IBS, probiotics may help to ease their symptoms. Fortunately, there have been no adverse effects associated with their use. Consider using EndoMune Jr for children less than 8 years of age and EndoMune Advanced for older children. It won’t hurt, and it certainly may help!

Eat healthy, exercise and live well!
Dr. Hoberman

(1) VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.Guandalini S, Magazzù G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S, Sibal A, Romano C, Canani RB, Lionetti P, Setty M.J Pediatr Gastroenterol Nutr. 2010 Jul;51⁽¹⁾:24-30.

(2) Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Cochrane Database Syst Rev. 2008 Jan 23;⁽¹⁾.

(3) Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners.Grundmann O, Yoon SL.J Gastroenterol Hepatol. 2010 Apr;25⁽⁴⁾:691-9. Epub 2010 Jan 13.

(4) Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions.Ohman L, Simrén M.Nat Rev Gastroenterol Hepatol. 2010 Mar;7⁽³⁾:163-73. Epub 2010 Jan 26. Review.

(5) The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases.CHAUDHARY NA, TRUELOVE SC. Q J Med. 1962 Jul;31:307-22.

(6) Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis . Wang LH , Fang XC , Pan GZ . Gut 2004 ; 53 : 1096 – 101.

(7) Postinfectious irritable bowel syndrome–a meta-analysis.Halvorson HA, Schlett CD, Riddle MS.Am J Gastroenterol. 2006 Aug;101⁽⁸⁾:1894-9; quiz 1942.

(8) An Outbreak of Acute Bacterial Gastroenteritis Is Associated With an Increased Incidence of Irritable Bowel Syndrome in Children Marroon Thabane, Marko Simunovic, Noori Akhtar-Danesh, Amit X Garg, William F Clark, Stephen M Collins, Marina Salvadori, John K Marshall The American Journal of Gastroenterology 105, 933-939 (23 February 2010).