Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2211-2235
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2211
Irritable bowel syndrome in children: Current knowledge, challenges and opportunities
Niranga Manjuri Devanarayana, Shaman Rajindrajith
Niranga Manjuri Devanarayana, Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
Shaman Rajindrajith, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
Author contributions: Devanarayan NM and Rajindrajith S contributed equally for the concept of the paper, data collection, drafting of the manuscript and development of the final script.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Niranga Manjuri Devanarayana, MBBS, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Sri Lanka.
Telephone: +94-11-2961150 Fax: +94-11-2958337
Received: March 26, 2018
Peer-review started: March 27, 2018
First decision: April 11, 2018
Revised: April 26, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: June 7, 2018

Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.

Keywords: Abdominal pain, Functional gastrointestinal disorder, Irritable bowel syndrome, Management, Microbiota, Patho-physiology, Post-infectious

Core tip: Even though irritable bowel syndrome (IBS) is a common worldwide pediatric problem, little is known of its exact patho-physiology and management. Therefore, a large number of children are suffering from its intestinal and extra-intestinal symptoms. Novel research using new advanced technologies based on proposed top-down and bottom-up models of patho-physiology and treatment trials focusing on multiple combined interventions are likely to be more beneficial in understating and treating pediatric IBS. In addition, the time has come to explore possible prevention strategies for this problem.