Lactobacillus Reuteri in Treatment of Functional Abdominal Pain and Chronic Constipation in Children - Randomized, Double Blind, Placebo Controlled Study

Part I. Lactobacillus reuteri in treatment of functional abdominal pain in children

1. Introduction

Probiotics are defined as live microorganisms which confer a beneficial health effect on a human host. Their beneficial effects are based on: promotion of resistance to enteric pathogens, prevention of small bowel bacterial overgrowth and immune system modulation. The most commonly used probiotics are bacteria of genera Lactobacillus or Bifidobacterium. Other nonpathogenic genera, including Escherichia, Enterococcus and Bacillus, and nonbacterial organisms, such as a nonpathogenic yeast Saccharomyces boulardii, have also been studied.

A probiotic preparation must contain a certain minimum number of colony-forming units (CFU) per dose (4). Doses used in therapeutic and preventive trials vary. A daily intake of 1.000.000 to 1.000.000.000 CFUs is a reported minimum for therapeutic purposes. There is an increasing number of studies on beneficial effects of probiotics in treatment of acute infectious diarrhoea, and prevention of antibiotic associated diarrhoea. Role of probiotics in the treatment of functional GI disorders is still controversial.

Recurrent or chronic abdominal pain affects 10-15% of school-age children. Functional abdominal pain (FAP) is defined as occasional or continuous abdominal pain with a frequency of at least once a weak during at least two months; most frequently the pain is located around umbilicus and not related to meals. Although visceral hypersensitivity plays a certain role in pathogenesis of a pain, FAP is probably a complex disorder. Irritable bowel syndrome is defined as abdominal pain or discomfort associated (in at least 25% of time) with two of these criteria: 1) relief after defecation, 2) change in stool frequency or 3) change in stool consistence.