A new joint guideline from two leading pediatric gastroenterology societies offers clinicians a framework for treating irritable bowel syndrome and functional abdominal pain–not otherwise specified in children and adolescents.

Published in JPGN Reports and highlighted during the 2025 Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the recommendations were developed in partnership with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). This is the first consensus guideline from both societies focused on disorders of gut–brain interaction in patients aged 4 to 18 years.

Strong support for mind–body interventions

The guideline includes 25 graded recommendations based on 86 randomized controlled trials. Among the most strongly supported therapies were gut-directed hypnotherapy—recommended with moderate-certainty evidence for reducing pain intensity and treatment failure—and cognitive behavioral therapy, which received a strong recommendation despite lower certainty of evidence.

Both therapies aim to modulate the gut–brain axis and are supported by consistent benefit across multiple trials.

Conditional recommendations for select therapies

Several interventions received conditional recommendations, including:

• Multistrain probiotics and synbiotics
• Enteric-coated peppermint oil
• Amitriptyline
• Percutaneous electrical nerve field stimulation (PENFS)

Evidence quality varied, and most therapies lacked long-term safety data in pediatric populations. Amitriptyline was recommended only in low doses for select patients who do not respond to other treatments.

Conversely, therapies such as buspirone, mebeverine, and yoga were not recommended due to insufficient or low-quality evidence. The guideline also advises against surgical intervention.

Emphasis on safety and shared decision-making

The authors recommend a shared decision-making approach among physicians, caregivers, and pediatric patients. They advise caution when considering restrictive diets or medications, particularly those with limited pediatric safety data. An accompanying algorithm outlines a stepwise treatment strategy based on clinical presentation and response to previous therapy.

Need for pediatric-specific research

The guideline also highlights an important evidence gap. Many interventions commonly used in adults with irritable bowel syndrome or abdominal pain have not been studied rigorously in pediatric populations. The authors recommend that future trials prioritize safety, long-term outcomes, and standardized endpoints relevant to children and adolescents.

The full guideline is available in JPGN Reports and is expected to inform global clinical practice in pediatric gastroenterology.

The authors reported no conflicts of interest.

Source: Groen J, Gordon M, Van Tilburg M, et al. Recommendations for the treatment of pediatric functional abdominal pain disorders: a joint ESPGHAN/NASPGHAN guideline. JPGN Rep. 2025;6(3). doi:10.1097/PG9.0000000000000211