From brain to gut Novel insights into the management of pediatric disorders of gut-brain interaction

This thesis investigates how the diagnosis and management of pediatric abdominal pain-related disorders of gut-brain interaction (AP-DGBI) can be improved, with a particular focus on irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS).
The thesis first examines the epidemiology and clinical assessment of AP-DGBI, demonstrating their high global prevalence and identifying factors associated with their occurrence. It also explores whether visual tools can improve communication and symptom assessment during clinical evaluation.
The management of AP-DGBI is subsequently investigated from dietary, pharmacological, economic, and psychological perspectives. The findings suggest that frequently used interventions, including a non-guided low FODMAP diet, peppermint oil, and mebeverine, provide limited benefit over placebo. Additionally, the findings demonstrate the potential therapeutic value of placebo effects in this population. Together, these results emphasize the need for more effective and evidence-based treatment strategies, while also underscoring the importance of contextual factors in treatment outcomes.
Importantly, the thesis demonstrates that treatment outcomes are not determined solely by the pharmacological properties of an intervention. Patients’ expectations can substantially influence treatment success, highlighting the key role of the brain-gut connection in AP-DGBI. The thesis also explores the ethical implications of influencing treatment expectations suggesting that, when accompanied by transparent disclosure, deceptive placebo labeling may be acceptable to patients and their parents.
Overall, this thesis highlights the considerable burden of pediatric AP-DGBI, the limitations of current treatments, the therapeutic potential of placebo effects, and the importance of integrating biological, psychological, and contextual factors to improve future diagnosis, treatment, and research.