Table 1 All PICO and statements with endorsement, level of evidence, grade of recommendation and agreement
From: Italian guidelines for the management of irritable bowel syndrome in children and adolescents
PICO/Statement number | PICO | Statement | Endorsement | Level of evidence | Strength of recommendation | Agreement |
|---|---|---|---|---|---|---|
Diagnosis | ||||||
1.1 | Are the clinical history and symptoms required for IBS diagnosis in children? | We recommend the assessment of patient’s symptoms and clinical history for diagnosis and management of children with IBS | Yes | NA | Consensus | 100% |
1.2 | Should children with IBS diagnosis be regularly evaluated for psychological comorbidities? | We recommend psychological comorbidities assessment in children with IBS | Yes | NA | Consensus | 100% |
1.3 | Is it more appropriate to approach children with suspected IBS using a positive diagnostic approach as opposed to one of exclusion? | We recommend a positive diagnostic strategy in children with symptoms suggestive of IBS | Yes | NA | Consensus | 100% |
1.4 | Should all children with a diagnosis of IBS be evaluated for occult constipation? | We recommend to rule out occult constipation in children with symptoms suggestive of IBS when therapeutic strategies have failed | Yes | NA | Consensus | 100% |
1.5 | Should children with IBS symptoms be tested for celiac disease (CD)? | We recommend serologic testing for CD in all children with IBS symptoms | Yes | Moderate | Strong | 100% |
1.6 | Can fecal calprotectin, and/or CRP be used to rule out IBD in children with IBS symptoms? | We recommend the use of fecal calprotectin1 and C-reactive protein2 to exclude inflammatory bowel disease in patients with IBS symptoms and diarrhea without alarm features | Yes | 1Very low 2Very low | 1Strong 2Conditional | 94.4% |
1.7 | Should IBS patients be routinely checked for stool pathogens? | We recommend against routine stool testing for enteric pathogens in children with IBS | Yes | Low | Conditional | 100% |
1.8 | When is colonoscopy indicated in patients with IBS symptoms? | We recommend colonoscopy only in patients with IBS symptoms and alarm features | Yes | NA | Consensus | 100% |
1.9 | Should patients be tested for food allergy/intolerance? | We recommend against testing for food allergy/intolerance in children with IBS | Yes | NA | Conditional | 100% |
1.10 | Should patients be tested for SIBO? | We recommend against routine testing for small intestinal bacterial overgrowth in children with IBS symptoms | Yes | Very Low | Strong | 100% |
Treatment | ||||||
2.1 | Should dietary approaches be used in children with IBS? | We recommend traditional dietary advices as a first line dietary approach1. A gluten free diet is not recommended in patients with IBS2 | Yes | 1Very low 2Very low | 1Strong 2Strong | 100% |
2.2 | Should fiber be used to treat global IBS symptoms in children? | We recommend certain fibers supplementation to treat abdominal pain in children with IBS | Yes | Moderate | Conditional | 88.9% |
2.3 | Should probiotics be used to treat global IBS symptoms in children? | We recommend the use of certain probiotic strains to treat global IBS symptoms | Yes | Moderate | Conditional | 88.9% |
2.4 | Should polyethylene glycol be recommended to treat constipation in children with IBS-C? | We recommend to use PEG to treat constipation in children with IBS-C | Yes | NA | Consensus | 100% |
2.5 | Should secretagogues be used to treat IBS-C symptoms in children? | We recommend against the use of intestinal secretagogues for the treatment of pediatric IBS-C | Yes | NA | Consensus | 94.4% |
2.6 | Should 5-HT4 agonists be used to treat IBS-C symptoms? | We suggest against the use of 5-HT4 agonists in pediatric patients with IBS-C | Yes | Low | Conditional | 100% |
2.7 | Should rifaximin be used to treat global IBS symptoms? | The use of rifaximin could be considered in children with IBS without constipation in which other treatments have failed | Yes | Very low | Consensus | 94.5% |
2.8 | Should loperamide be used to treat IBS-D symptoms? | We recommend the use of loperamide to manage diarrhea in IBS-D, although its chronic use must be avoided | Yes | NA | Consensus | 100% |
2.9 | Should antispasmodics be used to treat global IBS symptoms? | The use of antispasmodics could be considered for global symptom improvement in children with IBS when other therapeutic strategies have failed | Yes | Very low | Consensus | 100% |
2.10 | Should gut-brain neuromodulators be used to treat IBS symptoms? | The use of gut-brain neuromodulators, under specialist supervision, could be considered to treat severe abdominal pain in children with IBS in which other treatments have failed | Yes | Moderate | Strong | 94.4% |
2.11 | Should complementary alternative therapies be used to treat IBS symptoms? | The use of certain complementary alternative therapies could be considered to treat IBS symptoms | Yes | Very low | Conditional | 100% |
2.12 | Should psychologically directed therapies be used to treat global IBS symptoms? | We strongly recommend the use of psychologically directed therapies for the treatment of global symptoms | Yes | Low | Strong | 94.4% |