IRRITABLE BOWEL SYNDROME IN CHILDREN: PATHOGENESIS, DIAGNOSIS, AND MANAGEMENT
TL;DR
This narrative review summarizes current evidence on the pathogenesis, diagnosis, and long term management of pediatric IBS, with emphasis on gut brain interactions, psychosocial factors, recent pediatric guidelines, and pharmacological and non-pharmacological interventions.
Abstract
Background Irritable bowel syndrome (IBS) is a chronic disorder of gut brain interaction in children associated with recurrent abdominal pain, altered bowel habits, psychological comorbidities, impaired daily functioning, and reduced quality of life. Aim This narrative review summarizes current evidence on the pathogenesis, diagnosis, and long term management of pediatric IBS, with emphasis on gut brain interactions, psychosocial factors, recent pediatric guidelines, and pharmacological and non-pharmacological interventions. Materials and Methods PubMed, Embase, Cochrane Library, and Google Scholar were searched for English language publications from 2010 to 2026. The final search was conducted on June 15, 2026. Fifty studies and guidelines were included in the descriptive synthesis. Results Pediatric IBS has a multifactorial pathogenesis involving disturbances in gut brain communication, visceral hypersensitivity, post infectious mechanisms, alterations in the intestinal microbiota, and psychosocial factors. Diagnosis relies on symptom-based criteria, clinical assessment, and evaluation for alarm features; routine extensive testing is discouraged when alarm features are absent. Management should be individualized and may include education of the child and family, dietary measures, psychological interventions, and symptom directed pharmacotherapy. Cognitive behavioural therapy and gut directed hypnotherapy may reduce symptoms and psychological distress in selected children. Evidence for dietary and pharmacological interventions remains heterogeneous, and microbiome profiles are not established diagnostic biomarkers for routine clinical use. Conclusions Pediatric IBS should be diagnosed clinically and managed according to predominant symptoms, disease severity, psychological comorbidities, and daily functioning. Further pediatric studies are needed to clarify the effectiveness, safety, duration, and optimal sequence of interventions.