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Use of probiotics in the treatment of functional abdominal pain in children—systematic review and meta-analysis

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Functional abdominal pain is a very frequent functional gastrointestinal disorder but still without adequate treatment options. Therefore, the main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on functional abdominal pain in children. This was a systematic review and meta-analysis of randomized controlled trials published in a period up to 1st of April 2020 that analyzed probiotic interventions for pediatric functional abdominal pain. We included 9 randomized controlled trials (a total of 702 children, 506 with functional abdominal pain; 4 to 18 years); 8 studies were available for meta-analysis (a total of 641 children). Lactobacillus rhamnosus GG and Lactobacillus reuteri DSM 17938 were the only two probiotic strains investigated. Significant reduction in pain intensity (6 trials, n = 380, mean difference − 1.24, 95% CI − 2.35 to − 0.13) and increase in number of days without pain (2 trials, n = 101, mean difference 26.42, 95% CI 22.67 to 30.17) were found in children taking L. reuteri DSM 17938. For all other outcomes, there were no significant differences between probiotic and placebo.

Conclusion: Based on the available evidence, no firm conclusions can be given; however, L. reuteri was proven to decrease the pain intensity in children with functional abdominal pain. Further trials regarding long-term outcomes, possibly involving longer interventions, are needed.

What is Known:

Previously published systematic reviews have suggested that probiotics may have an effect on the pain in children with functional gastrointestinal disorders, but limited data exist on strain-specific effects.

What is New:

This systematic review provides evidence on the probiotic use on the strain-specific level.

This systematic review showed that the use of Lactobacillus reuteri DSM 17938 modestly reduces the pain intensity in children with functional abdominal pain.

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Lactobacillus rhamnosus GG


Functional abdominal pain


Randomized controlled trials


Functional gastrointestinal disorders


Irritable bowel syndrome


Standard deviations


Confidence interval


Mean difference


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Authors and Affiliations



OJ and IH conceptualized and planned this systematic review and meta-analysis. IT and TN independently searched the literature. IT and TN individually collected the study details and outcome data using a predetermined form. Disagreement was resolved by discussion with IH and OJ. Risk of bias for each study was assessed individually. Analysis was done by IH and revised by IT, TN, and OJ. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Iva Hojsak.

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Conflict of interest

Iva Hojsak received payment/honorarium for lectures or consultation from BioGaia, Nutricia, Nestle, Chr Hansen, Biocodex, Oktal Pharma; Ivana Trivić, Tena Niseteo and Oleg Jadrešin declare no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Not applicable for this manuscript.

Additional information

Communicated by Gregorio Paolo Milani

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Supplemental Figure 1.

Effect of Lactobacillus reuteri DSM 17938 on a) the number of days missed from the school and b) on the number of days without pain. (PNG 341 kb)

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Trivić, I., Niseteo, T., Jadrešin, O. et al. Use of probiotics in the treatment of functional abdominal pain in children—systematic review and meta-analysis. Eur J Pediatr 180, 339–351 (2021).

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