Integrative approaches to common GI disorders

At the Pediatric Academic Societies Meeting 2022, Alexandra Russell, MD discusses best complementary and alternative medicines for pediatric gastrointestinal disorders.

Treatment for gastrointestinal (GI) disorders, such as irritable bowel syndrome, celiac disease (CD), and colitis are limited when it comes to standard medications and other conventional medical interventions. The only real known cure for CD, for example, is a gluten-free diet for life, and irritable bowel syndrome is often treated by adding fiber to a child’s diet, bowel training, and other nonpharmacologic approaches. With this in mind, Alexandra Russell, MD, from Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee, offered a lively and informative discussion of alternative treatments to alleviate the pain and discomfort associated with various GI disorders in children.

Russell began with a quick explanation of alternative, complementary, and integrative medicine. “While alternative medicine is used in place of standard treatments, and complementary medicine is therapy that is also not part of traditional Western medicine, integrative medicine combines both conventional and supplementary medicine practices that have been proven safe and effective,” she explained.

Why should pediatric health care providers consider complementary and alternative medicine (CAM) approaches when they have been trained to use a medical model? The numbers tell the story: At GI clinics, 40 to 75% of patients are being treated with CAM with positive results, with patients and families giving the top 3 reasons for doing so being a wish to feel better; advice from friends and family; and a preference for more natural therapies.

Melatonin
Poor sleep quality is a common symptom of increased acid exposure. Melatonin can regulate GI motility, modulate visceral sensation, and produce an anti-inflammatory response in vitro. Futhermore, Russell pointed out, melatonin levels are lower in patients with GERD, and sleep disturbances occur in nearly half of children with functional dyspepsia (FD). A pediatric pilot study in 2016 showed positive clinical response in 42% of patients on melatonin vs 50% on the placebo.

Licorice
A long-time childhood favorite candy can also have gastroprotective effect, by inhibiting prostaglandin synthesis and lipoxygenase. Deglycyrrhizinated licorice (DGL), in a chewable tablet before meals and bedtime, can be helpful. “I do 760 mg (2 chewables) per dose for kids,” says Russell.

Iberogast/STW 5
A commercial preparation of 9 herbal extracts (including lemon balm leaf and peppermint leaf) has been shown to decrease acid production, increase mucin production, increase release of prostaglandin E2, and decrease leukotrienes for IBS and FD, “similar in effect to antacids, but does not appear to induce acid rebound,” said Russell. For Iberogast, Russell recommends a 3 times a day dosage for children (10-20 drops, depending on age of child).

FD Gard
This duodenal-release formulation of caraway oil and I-menthol may possess gastroprotective, analgesic, and anti-inflammatory properties, and has shown efficacy within first hour of treatment.

Peppermint oil
A favorite, aromatic oil brought impressive results in alleviating IBS-associated symptoms in children; 42 children with IBS were given enteric-coated peppermint oil capsules or placebo. After 2 weeks, 75% of those receiving peppermint oil had reduced severity of IBS-associated pain (30-45 kg).

Other alternatives Russell discussed for relief of a variety of IBS and other GI disorders included fiber supplements (glucomannan, green banana, cocoa husk and fiber mixtures), Senna (from the fruit or leaf of the Senna alexandrina or Cassia augustifolia plant), and the natural curcuminoid found in turmeric (with curcumin being favored for use in children with ulcerative colitis when given as an adjunctive therapy with mesalamine or sulfasalazine.

Finally, concluded Russell,, “There are several safe, likely effective treatment options when used in conjunction with allopathic medicine approaches. Being knowledgeable and open to holistic approaches can bolster the doctor-patient-family relationship.”

Reference
Russell A. Integrative approaches to common pediatric GI conditions. PAS 2022. April 23, 2022. Denver, Colorado.