According to the studies, the prevalence of IBS ranges from 6-14% in children and 22.0-35.5% in adolescents in Western countries.2-4
A recent Chinese survey of students determined that the prevalence of IBS in children and adolescents was 20.7% according to the Rome III criteria.8
In our study, the prevalence of IBS in children 4 to 18 years old was 22.6%, which is higher than that detected using the Rome I and II criteria. The main difference between the pediatric Rome III and II criteria is that the duration of abdominal pain was reduced from 3 to 2 months. In a study conducted in Sri Lanka, the Rome II and III criteria were used to diagnose functional gastrointestinal system disorders; 60% and 71% of children were diagnosed with functional gastrointestinal system disorders using the respective criteria.9
Therefore, the Rome III criteria are considered more effective for diagnosis of functional gastrointestinal system disorders.
Our study was patient based and done in a tertiary hospital. Also children and adolescents in Turkey are devoted to their studies, and many attend private cramming schools on weekends to increase their probability of passing the entrance examinations for prestigious senior high schools and colleges. This, and the changing lifestyle due to urbanization, put them under stress. These factors might explain the high prevalence we report here.
In a Sri Lanken study using Rome III criteria, 27.1% of IBS patients were constipation predominant, 28% diarrhea predominant and 27.1% were mixed type.10
A recent study using the Rome III criteria classified IBS patients as 20.1% constipation predominant, 18.5% diarrhea predominant, 10.3% alternating diarrhea and constipation, and 51.1% undetermined.8
In our study, constipation was also the most common subtype (42.3%), with diarrhea predominant in 33.3%, alternating attacks of both in 12.8%, and 11.5% unclassified.
In one study, the prevalence of IBS in the parents of children with IBS was significantly higher than in those of children without IBS. There was an association between the types of gastrointestinal disorder found in children and their parents. Of the mothers of children with IBS, 41% were diagnosed with depression. This was significantly higher than in the control group.
Clinical overlap of FD and IBS according to the Rome III criteria is very common. One risk factor for FD-IBS overlap is the presence of postprandial fullness symptom.11
In a study of adults with IBS, 87% met the criteria for dyspepsia.12
Overlap between FD and IBS has been reported in pediatric studies.13
We found that the prevalence of FD in IBS patients was 80.8%, which was significantly higher than in the control group.
One meta-analysis of 4 controlled studies compared smooth muscle relaxants such as trimebutine maleate and placebo. The data suggested that trimebutine was significantly more effective than placebo for controlling pain and flatus. There was no difference in side effects between the trimebutine and placebo groups.14
In our study, the clinical recovery was significantly higher in the trimebutine maleate group. Although our study is not placebo controlled, and it seems like a limitation of our study, the significant difference between the treated and non-treated group may implicate the efficacy of trimebutine maleate in IBS children.
IBS is common in the pediatric population visiting general pediatrics clinics. IBS is closely associated with somatic and familial factors. Trimebutine maleate is effective for treating pediatric IBS patients.