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Is there an association between functional gastrointestinal disorders in the first three months of life and maternal psychological problems?
Abstracts / Digestive and Liver Disease 46 (2014) e85–e127
Aim: To analyze the seroprevalence of Helicobacter pylori in pediatric age in rural area and to evaluate some epidemiologic characteristics. Patients and methods: The study included 100 patients (80 males; age range 5–13 years) suffering from different gastrointestinal complaints. Blood serology and stool antigen testing were used for the diagnosis of infection due to H. pylori. We interviewed the children with questionnaire about socioeconomics factors, hygiene, living conditions and their dietary habits. Results: 20 (20%) of the 100 patients were positive for Helicobacter pylori and this positivity had a significantly increasing correlation with age (p < 0.001). A lower frequency of fermented dairy food, fruits and vegetable consumption was registered among infected children. Among infected patients were noted low socioeconomic markers such as crowded living conditions and unclean water. Conclusions: Might decrease the risk of Hp infection the use of vitamin C and antioxidants contained in fruit and vegetables. Risk factors for Hp infection are low socioeconomics factors, hygiene and living conditions. http://dx.doi.org/10.1016/j.dld.2014.07.154 CONSTIPATION, WHAT CAN HIDE? Francesca Graziano 1,∗ , Mimma Caloiero 1 , Francesca Saullo 2 1
Azienda Ospedaliera Giovanni Paolo II, U.O. di Pediatria, Lamezia Terme, Italy 2 Azienda Ospedaliera Giovanni Paolo II, Farmacia, Lamezia Terme, Italy A 1 year old girl comes to our attention for constipation. The child had a history characterized from poor growth, hard stool with blood sometimes and atopic dermatitis; the child often changed formula milk, but never hydrolysed formulae. On physical examination the patient showed meteoric abdomen showed and anal fissures. In the first time patient was submitted to the following diagnostic investigation: complete blood count; tests for celiac disease; stool culture; parasitologic examination of stools: iron deficiency anemia, low ferritin, inflammatory markers were normal levels, only specific IgE levels were highest for cow’s milk. We performed the controlled oral food challenge for food allergy diagnosis with positive result. So we started diet without cow’s milk protein, with good clinical response. After a few months the child arrived at emergency department, with fever, vomiting and diarrhea with blood in the stool. Laboratory studies revealed increased fecal calprotectin, antineutrophil cytoplasm antibody, iron deficiency anemia, low ferritin, inflammatory markers. Then positive rectal swab to detect salmonella. We decided to perform colonoscopy, an additional screening to other disorders exclude. It showed presence of hyperemia of the mucosa with microerosions and spontaneous bleeding upon the procedure. Microscopy an ulcerative colitis. Conclusions: Constipation and good response coinciding with the diet without cow’s milk protein, endorsed by the negativity of inflammatory markers and fecal calprotectin, led us the diagnosis of cow’s milk protein, but a similar clinical symptoms should raise the suspicion of very early onset inflammatory bowel disease (VEOIBD) a form of IBD distinct, that increased in recent years. http://dx.doi.org/10.1016/j.dld.2014.07.155
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CLINICAL RELEVANCE OF ESOPHAGEAL BASELINE IMPEDANCE MEASUREMENT Renato Tambucci ∗ , Nikhil Thapar, Efstratios Saliakellis, Matilde Pescarin, Paolo Quitadamo, Fernanda Cristofori, Keith J. Lindley, Osvaldo Borrelli Neurogastroenterology and Motility Division, Department of Gastroenterology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK Objective: The clinical relevance of baseline esophageal impedance (BI) remains to be determined. In our study we explored the impact of gastro-esophageal reflux disease (GERD) and esophageal dysmotility on BI. Methods: Eighteen children with esophageal atresia (EA), 26 GERD and 17 controls prospectively underwent esophagogastroduodenoscopy and pH-impedance monitoring. BI was measured in both proximal and distal esophagus. GER and bolus transit parameters were defined according to published criteria. Results: Patients with EA showed significantly lower proximal and distal BI values [952 (716–1811) ; 895 (284–1189) , respectively] compared to GERD [3015 (2368–3975) ; 2231 (1770–3032) , p < 0.001 and p < 0.001 respectively] and controls [3699 (3194–4358) ; 3522 (2927–3994) , p < 0.001 and p < 0.001 respectively]. Using linear regression, proximal BI strongly correlated with total bolus transit time (TBTT; r2 = 0.61, p < 0.001) and bolus presence time (BPT; r2 = 0.63, p < 0.001). Distal BI weakly correlated with acid exposure time (AET; r2 = 0.16, p < 0.01) and longstanding reflux episodes (r2 = 0.17, p < 0.01), and strongly with TBTT (r2 = 0.53, p < 0.001) and BPT (r2 = 0.58, p < 0.001). By logistic regression, BPT predicted low proximal BI values (OR 1.052; p < 0.05), whereas both GER parameters (AET: OR 1.56, p < 0.05; longstanding reflux episodes: OR 2.8, p < 0.05) and BPT (OR 1.66, p < 0.01) predicted low distal BI values. Conclusions: Along the length of esophagus, both bolus transit variables and GER significantly affect BI. This suggests that BI may merely mirror phenomena occurring within the esophageal lumen or wall, limiting its value as a discrete clinical entity to replace variables already used for assessing both GERD and esophageal dysmotility. http://dx.doi.org/10.1016/j.dld.2014.07.156 IS THERE AN ASSOCIATION BETWEEN FUNCTIONAL GASTROINTESTINAL DISORDERS IN THE FIRST THREE MONTHS OF LIFE AND MATERNAL PSYCHOLOGICAL PROBLEMS? Damiana Maurogiovanni ∗ Dipartimento di Scienze Mediche ed Oncologia, Sezione di Neonatologia e Terapia Intensiva Neonatale, Azienda Ospedaliera Universitaria Policlinico-Università degli Studi di Bari Aldo Moro, Bari, Italy Objective: To investigate whether functional gastrointestinal disorders (DFGIs), defined according to Rome III criteria, are associated with postpartum mood disorders. Methods: 113 mother/child pairs were enrolled in this perspective, longitudinal study. Maternal depressive symptoms were evaluated at birth, one and three months after delivery using Maternity Blues, Edinburgh Postpartum Depression Score (EPDS) and Symptom Check List for Anxiety and Depression. The Adult Attachment Interview (AAI) was used to determine the attachment style
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of the mother. Any sign/symptom was recorded weekly for the first three months of life, together with type of feeding. Statistical analysis (SPSS software): chi quadro test, Student t-test, linear regression. Results: 37 (32.7%) newborns were exclusively breast feeding. 16 (14.2%) newborns had regurgitation, 10 (9.7%) colics, 4 (3.5%) dischezia and 10 (9.7%) constipation. 60 (53.1%) mothers had postpartum depression and/or anxiety. 53.6% of infants with regurgitations had a depressed mother vs 23% of infants without regurgitations (chi quadro = 10.63, p = 0.003); 45.2% of infants with colics had a depressed mother vs 15.9% of infants without colics (chi quadro = 10.63, p = 0.001). A mother’s insecure attachment style was found in 36% of infants with persistence of regurgitations until third months of life vs 1.8% of infants with mother’s secure attachment style (p < 0.001). Conclusions: Postpartum maternal depressive symptoms and anxiety are associated with infantile colic and regurgitations. Screening and early intervention in cases of postpartum depression could be useful to avoid inappropriate nutritional and pharmacologic treatments, promoting the health of both mother and infant. http://dx.doi.org/10.1016/j.dld.2014.07.157 EARLY “SURGICAL” LIFE EVENTS AND FUNCTIONAL GASTROINTESTINAL DISORDERS (FGID): PYLORIC STENOSIS VS. INGUINAL HERNIA Gabriele Lisi 1,∗ , Luciana Tarallo 1 , Maria Teresa Illiceto 2 , Giuliano Lombardi 2 , Pierluigi Lelli Chiesa 1 1
U.O. Clinicizzata di Chirurgia Pediatrica, Dipartimento Medicina e Scienze dell’Invecchiamento - Universita’ “G. d’Annunzio”, Chieti-Pescara, Italy 2 U.O.S. di Gastroenterologia ed Endoscopia Digestiva Pediatrica, P.O. “Santo Spirito”, Pescara, Italy Objective: Functional gastro-intestinal disorders (FGID) are common in children. FGID are explained as a result of multiple factors that could be traced early in life, such as surgical procedures. We evaluate the overall incidence of FGID in two common infantile surgical conditions, hypertrophic pyloric stenosis (IHPS) and uncomplicated inguinal hernia (IE). We tested the hypothesis that visceral manipulation and nasogastric drainage could increase the incidence of FGIDs. Methods: Parents of children undergone open pyloromiotomy (123 pts) or open inguinal herniotomy (under 3 months of age, 386 pts) in our department from 2000 to 2009 were invited to participate to a case–control study. To reduce biases, siblings aged 4–20 years were used as controls. The incidence of FGID was evaluated with QPGS-RIII questionnaire, form A or form C according to age. Results: 32 IHPS (10 controls) and 38 IH (27 controls) agreed to participate the study. Cases and control were comparable for gestational age, birth weight, current age. FGID incidence was 31.2% in IHPS cases, 10% in IHPS controls, 23.7% for IH cases, 37% for IH controls (5/18). Conclusions: Early “surgical” life events could increase the incidence of FGID when involving visceral manipulation, nasogastric drainage and relatively short fasting periods in neonatal age, such as in open pyloromiotomy. Given the high prevalence of FGID in the school-aged population, larger sample sizes are needed to confirm these preliminary results and to evaluate the effect of lesser invasive approaches (laparoscopic pyloromiotomy) and different perioperative feeding regimens. http://dx.doi.org/10.1016/j.dld.2014.07.158
EFFECT OF BOWEL CLEANSING ON COLONIC TRANSIT TIME MEASUREMENT IN CONSTIPATED CHILDREN Paolo Quitadamo 1 , Nikhil Thapar 2 , Annamaria Staiano 1 , Renato Tambucci 2 , Matilde Pescarin 2 , Chiara Coluccio 2 , Efstratios Saliakellis 2 , Keith J. Lindley 2 1 Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy 2 Gastroenterology Unit, Great Ormond Street Hospital, London, United Kingdom
Background: Radio-opaque markers (ROM) study is a simple and non-invasive method for assessing colonic transit time (CTT). Confirming the diagnosis of chronic constipation (CC) and discriminating between colonic slow-transit and rectal outlet obstruction, ROM test is helpful in targeting the medical approach. Despite its widespread use, very few data are available on the influence of faecal impaction on CTT measurement. We prospectively evaluated the effect of preliminary bowel preparation on CTT measured by ROM test. Methods: Between March and October 2013 all children with CC referred for ROM-CTT test were considered eligible for the study. All enrolled children underwent 2 subsequent ROM-CTT tests, the first in a cleansed bowel state and the second in an uncleansed bowel state. Results: 24 children (age range: 4–16 years) were enrolled in the study. The mean CTT was significantly longer in the uncleansed state (63 ± 12 h; range: 28.8–72 h) as compared to the cleansed state (42 ± 19.4 h; range: 7–72 h). Therefore, bowel cleansing produced a significant average reduction of total CTT (21 h; p < 0.01). Moreover, the pattern of marker distribution was also significantly changed showing an a broad increase (data not shown). Conclusions: Fluctuations in the filling state of the colon substantially affect colonic transit time. The administration of bowel prep prior to perform colonic marker studies significantly decreases the total CTT and modifies the distribution pattern of radiomarkers throughout the colon. Further prospective study is needed to test whether the bowel preparation prior to ROM test could influence the management of children with chronic constipation. http://dx.doi.org/10.1016/j.dld.2014.07.159 COMPARATIVE EFFICACY OF PROBIOTICS FOR TREATMENT OF IRRITABLE BOWEL SYNDROME IN CHILDREN AND ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS Andrea Lo Vecchio 1 , Fabrizia Chiatto 1,∗ , Sara Viscovo 1 , Eugenia Bruzzese 1 , Dario Bruzzese 2 , Antonietta Giannattasio 3 , Alfredo Guarino 1 1
Department of Translational Medical Science–Section of Pediatrics, University of Naples “Federico II”, Napoli, Italy 2 Department of Public Health, University of Naples “Federico II”, Napoli, Italy 3 Medicine and Health Sciences, University of Molise, Campobasso, Italy Objective: Probiotics may have a role in the treatment of irritable bowel syndrome (IBS). The objective of the study was to systematically review the evidence supporting the use of probiotics in children and adults with IBS, and to perform a meta-analysis of major clinical outcomes in different age ranges.
Aim: To analyze the seroprevalence of Helicobacter pylori in pediatric age in rural area and to evaluate some epidemiologic characteristics. Patients and methods: The study included 100 patients (80 males; age range 5–13 years) suffering from different gastrointestinal complaints. Blood serology and stool antigen testing were used for the diagnosis of infection due to H. pylori. We interviewed the children with questionnaire about socioeconomics factors, hygiene, living conditions and their dietary habits. Results: 20 (20%) of the 100 patients were positive for Helicobacter pylori and this positivity had a significantly increasing correlation with age (p < 0.001). A lower frequency of fermented dairy food, fruits and vegetable consumption was registered among infected children. Among infected patients were noted low socioeconomic markers such as crowded living conditions and unclean water. Conclusions: Might decrease the risk of Hp infection the use of vitamin C and antioxidants contained in fruit and vegetables. Risk factors for Hp infection are low socioeconomics factors, hygiene and living conditions. http://dx.doi.org/10.1016/j.dld.2014.07.154 CONSTIPATION, WHAT CAN HIDE? Francesca Graziano 1,∗ , Mimma Caloiero 1 , Francesca Saullo 2 1
Azienda Ospedaliera Giovanni Paolo II, U.O. di Pediatria, Lamezia Terme, Italy 2 Azienda Ospedaliera Giovanni Paolo II, Farmacia, Lamezia Terme, Italy A 1 year old girl comes to our attention for constipation. The child had a history characterized from poor growth, hard stool with blood sometimes and atopic dermatitis; the child often changed formula milk, but never hydrolysed formulae. On physical examination the patient showed meteoric abdomen showed and anal fissures. In the first time patient was submitted to the following diagnostic investigation: complete blood count; tests for celiac disease; stool culture; parasitologic examination of stools: iron deficiency anemia, low ferritin, inflammatory markers were normal levels, only specific IgE levels were highest for cow’s milk. We performed the controlled oral food challenge for food allergy diagnosis with positive result. So we started diet without cow’s milk protein, with good clinical response. After a few months the child arrived at emergency department, with fever, vomiting and diarrhea with blood in the stool. Laboratory studies revealed increased fecal calprotectin, antineutrophil cytoplasm antibody, iron deficiency anemia, low ferritin, inflammatory markers. Then positive rectal swab to detect salmonella. We decided to perform colonoscopy, an additional screening to other disorders exclude. It showed presence of hyperemia of the mucosa with microerosions and spontaneous bleeding upon the procedure. Microscopy an ulcerative colitis. Conclusions: Constipation and good response coinciding with the diet without cow’s milk protein, endorsed by the negativity of inflammatory markers and fecal calprotectin, led us the diagnosis of cow’s milk protein, but a similar clinical symptoms should raise the suspicion of very early onset inflammatory bowel disease (VEOIBD) a form of IBD distinct, that increased in recent years. http://dx.doi.org/10.1016/j.dld.2014.07.155
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CLINICAL RELEVANCE OF ESOPHAGEAL BASELINE IMPEDANCE MEASUREMENT Renato Tambucci ∗ , Nikhil Thapar, Efstratios Saliakellis, Matilde Pescarin, Paolo Quitadamo, Fernanda Cristofori, Keith J. Lindley, Osvaldo Borrelli Neurogastroenterology and Motility Division, Department of Gastroenterology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK Objective: The clinical relevance of baseline esophageal impedance (BI) remains to be determined. In our study we explored the impact of gastro-esophageal reflux disease (GERD) and esophageal dysmotility on BI. Methods: Eighteen children with esophageal atresia (EA), 26 GERD and 17 controls prospectively underwent esophagogastroduodenoscopy and pH-impedance monitoring. BI was measured in both proximal and distal esophagus. GER and bolus transit parameters were defined according to published criteria. Results: Patients with EA showed significantly lower proximal and distal BI values [952 (716–1811) ; 895 (284–1189) , respectively] compared to GERD [3015 (2368–3975) ; 2231 (1770–3032) , p < 0.001 and p < 0.001 respectively] and controls [3699 (3194–4358) ; 3522 (2927–3994) , p < 0.001 and p < 0.001 respectively]. Using linear regression, proximal BI strongly correlated with total bolus transit time (TBTT; r2 = 0.61, p < 0.001) and bolus presence time (BPT; r2 = 0.63, p < 0.001). Distal BI weakly correlated with acid exposure time (AET; r2 = 0.16, p < 0.01) and longstanding reflux episodes (r2 = 0.17, p < 0.01), and strongly with TBTT (r2 = 0.53, p < 0.001) and BPT (r2 = 0.58, p < 0.001). By logistic regression, BPT predicted low proximal BI values (OR 1.052; p < 0.05), whereas both GER parameters (AET: OR 1.56, p < 0.05; longstanding reflux episodes: OR 2.8, p < 0.05) and BPT (OR 1.66, p < 0.01) predicted low distal BI values. Conclusions: Along the length of esophagus, both bolus transit variables and GER significantly affect BI. This suggests that BI may merely mirror phenomena occurring within the esophageal lumen or wall, limiting its value as a discrete clinical entity to replace variables already used for assessing both GERD and esophageal dysmotility. http://dx.doi.org/10.1016/j.dld.2014.07.156 IS THERE AN ASSOCIATION BETWEEN FUNCTIONAL GASTROINTESTINAL DISORDERS IN THE FIRST THREE MONTHS OF LIFE AND MATERNAL PSYCHOLOGICAL PROBLEMS? Damiana Maurogiovanni ∗ Dipartimento di Scienze Mediche ed Oncologia, Sezione di Neonatologia e Terapia Intensiva Neonatale, Azienda Ospedaliera Universitaria Policlinico-Università degli Studi di Bari Aldo Moro, Bari, Italy Objective: To investigate whether functional gastrointestinal disorders (DFGIs), defined according to Rome III criteria, are associated with postpartum mood disorders. Methods: 113 mother/child pairs were enrolled in this perspective, longitudinal study. Maternal depressive symptoms were evaluated at birth, one and three months after delivery using Maternity Blues, Edinburgh Postpartum Depression Score (EPDS) and Symptom Check List for Anxiety and Depression. The Adult Attachment Interview (AAI) was used to determine the attachment style
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of the mother. Any sign/symptom was recorded weekly for the first three months of life, together with type of feeding. Statistical analysis (SPSS software): chi quadro test, Student t-test, linear regression. Results: 37 (32.7%) newborns were exclusively breast feeding. 16 (14.2%) newborns had regurgitation, 10 (9.7%) colics, 4 (3.5%) dischezia and 10 (9.7%) constipation. 60 (53.1%) mothers had postpartum depression and/or anxiety. 53.6% of infants with regurgitations had a depressed mother vs 23% of infants without regurgitations (chi quadro = 10.63, p = 0.003); 45.2% of infants with colics had a depressed mother vs 15.9% of infants without colics (chi quadro = 10.63, p = 0.001). A mother’s insecure attachment style was found in 36% of infants with persistence of regurgitations until third months of life vs 1.8% of infants with mother’s secure attachment style (p < 0.001). Conclusions: Postpartum maternal depressive symptoms and anxiety are associated with infantile colic and regurgitations. Screening and early intervention in cases of postpartum depression could be useful to avoid inappropriate nutritional and pharmacologic treatments, promoting the health of both mother and infant. http://dx.doi.org/10.1016/j.dld.2014.07.157 EARLY “SURGICAL” LIFE EVENTS AND FUNCTIONAL GASTROINTESTINAL DISORDERS (FGID): PYLORIC STENOSIS VS. INGUINAL HERNIA Gabriele Lisi 1,∗ , Luciana Tarallo 1 , Maria Teresa Illiceto 2 , Giuliano Lombardi 2 , Pierluigi Lelli Chiesa 1 1
U.O. Clinicizzata di Chirurgia Pediatrica, Dipartimento Medicina e Scienze dell’Invecchiamento - Universita’ “G. d’Annunzio”, Chieti-Pescara, Italy 2 U.O.S. di Gastroenterologia ed Endoscopia Digestiva Pediatrica, P.O. “Santo Spirito”, Pescara, Italy Objective: Functional gastro-intestinal disorders (FGID) are common in children. FGID are explained as a result of multiple factors that could be traced early in life, such as surgical procedures. We evaluate the overall incidence of FGID in two common infantile surgical conditions, hypertrophic pyloric stenosis (IHPS) and uncomplicated inguinal hernia (IE). We tested the hypothesis that visceral manipulation and nasogastric drainage could increase the incidence of FGIDs. Methods: Parents of children undergone open pyloromiotomy (123 pts) or open inguinal herniotomy (under 3 months of age, 386 pts) in our department from 2000 to 2009 were invited to participate to a case–control study. To reduce biases, siblings aged 4–20 years were used as controls. The incidence of FGID was evaluated with QPGS-RIII questionnaire, form A or form C according to age. Results: 32 IHPS (10 controls) and 38 IH (27 controls) agreed to participate the study. Cases and control were comparable for gestational age, birth weight, current age. FGID incidence was 31.2% in IHPS cases, 10% in IHPS controls, 23.7% for IH cases, 37% for IH controls (5/18). Conclusions: Early “surgical” life events could increase the incidence of FGID when involving visceral manipulation, nasogastric drainage and relatively short fasting periods in neonatal age, such as in open pyloromiotomy. Given the high prevalence of FGID in the school-aged population, larger sample sizes are needed to confirm these preliminary results and to evaluate the effect of lesser invasive approaches (laparoscopic pyloromiotomy) and different perioperative feeding regimens. http://dx.doi.org/10.1016/j.dld.2014.07.158
EFFECT OF BOWEL CLEANSING ON COLONIC TRANSIT TIME MEASUREMENT IN CONSTIPATED CHILDREN Paolo Quitadamo 1 , Nikhil Thapar 2 , Annamaria Staiano 1 , Renato Tambucci 2 , Matilde Pescarin 2 , Chiara Coluccio 2 , Efstratios Saliakellis 2 , Keith J. Lindley 2 1 Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy 2 Gastroenterology Unit, Great Ormond Street Hospital, London, United Kingdom
Background: Radio-opaque markers (ROM) study is a simple and non-invasive method for assessing colonic transit time (CTT). Confirming the diagnosis of chronic constipation (CC) and discriminating between colonic slow-transit and rectal outlet obstruction, ROM test is helpful in targeting the medical approach. Despite its widespread use, very few data are available on the influence of faecal impaction on CTT measurement. We prospectively evaluated the effect of preliminary bowel preparation on CTT measured by ROM test. Methods: Between March and October 2013 all children with CC referred for ROM-CTT test were considered eligible for the study. All enrolled children underwent 2 subsequent ROM-CTT tests, the first in a cleansed bowel state and the second in an uncleansed bowel state. Results: 24 children (age range: 4–16 years) were enrolled in the study. The mean CTT was significantly longer in the uncleansed state (63 ± 12 h; range: 28.8–72 h) as compared to the cleansed state (42 ± 19.4 h; range: 7–72 h). Therefore, bowel cleansing produced a significant average reduction of total CTT (21 h; p < 0.01). Moreover, the pattern of marker distribution was also significantly changed showing an a broad increase (data not shown). Conclusions: Fluctuations in the filling state of the colon substantially affect colonic transit time. The administration of bowel prep prior to perform colonic marker studies significantly decreases the total CTT and modifies the distribution pattern of radiomarkers throughout the colon. Further prospective study is needed to test whether the bowel preparation prior to ROM test could influence the management of children with chronic constipation. http://dx.doi.org/10.1016/j.dld.2014.07.159 COMPARATIVE EFFICACY OF PROBIOTICS FOR TREATMENT OF IRRITABLE BOWEL SYNDROME IN CHILDREN AND ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS Andrea Lo Vecchio 1 , Fabrizia Chiatto 1,∗ , Sara Viscovo 1 , Eugenia Bruzzese 1 , Dario Bruzzese 2 , Antonietta Giannattasio 3 , Alfredo Guarino 1 1
Department of Translational Medical Science–Section of Pediatrics, University of Naples “Federico II”, Napoli, Italy 2 Department of Public Health, University of Naples “Federico II”, Napoli, Italy 3 Medicine and Health Sciences, University of Molise, Campobasso, Italy Objective: Probiotics may have a role in the treatment of irritable bowel syndrome (IBS). The objective of the study was to systematically review the evidence supporting the use of probiotics in children and adults with IBS, and to perform a meta-analysis of major clinical outcomes in different age ranges.