Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood: Meta-analysis: Lactobacillus GG and abdominal pain-related functional disorders
Open accessAbstract
BACKGROUND: A lack of reliable treatments for abdominal pain-related functional gastrointestinal disorders prompts interest in new therapies. AIM: To evaluate systematically the effect of Lactobacillus rhamnosus GG (LGG) for treating abdominal pain-related functional gastrointestinal disorders in children. METHODS: MEDLINE, EMBASE, CINAHL, the Cochrane Library, trial registries and proceedings of major meetings were searched for randomised controlled trials (RCTs) evaluating LGG supplementation in children with abdominal pain-related functional gastrointestinal disorders based on the Rome II or Rome III criteria. Risk of bias was assessed for generation of the allocation sequence, allocation concealment, blinding and follow-up. RESULTS: Compared with placebo, LGG supplementation was associated with a significantly higher rate of treatment responders (defined as no pain or a decrease in pain intensity) in the overall population with abdominal pain-related functional gastrointestinal disorders (three RCTs, n = 290; risk ratio, RR 1.31, 95% CI 1.08-1.59, number needed to treat, NNT 7, 95% CI 4-22) and in the irritable bowel syndrome (IBS) subgroup (three RCTs, n = 167; RR 1.70, 95% CI 1.27-2.27, NNT 4, 95% CI 3-8). However, no difference was found in the rate of treatment responders between children with functional abdominal pain or functional dyspepsia who received placebo or LGG. The intensity of pain was significantly reduced in the overall study population and in the IBS subgroup. The frequency of pain was significantly reduced in the IBS subgroup only. CONCLUSION: The use of Lactobacillus rhamnosus GG moderately increases treatment success in children with abdominal pain-related functional gastrointestinal disorders, particularly among children with IBS.
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Lactobacillus rhamnosus GG was found in a meta-analysis of three randomized placebo-controlled trials to confer a modest but significantly increased rate of treatment response versus placebo in pediatric IBS.
“Among the most studied probiotics in pediatric IBS is Lactobacillus rhamnosus GG, which was found in a meta-analysis of three randomized, placebo-controlled trials (RCTs) to confer a modest but significantly increased rate of treatment response versus placebo133.”
From The gut Microbiome in adult and pediatric functional gastrointestinal disorders (2019) · cites this paper as [133]
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“Considering the high prevalence of IBS and the safety of this treatment strategy, even a slight improvement in the symptoms could be significant (16-20).”
BackgroundJadrešin, O., Sila, S., Trivić, I., Mišak, Z., Kolaček, S., & Hojsak, I. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.04.019 · Cited by 39 · see citing works
Probiotics and Prebiotics in Infants and Children
Vandenplas, Y., Greef, E. D., Devreker, T., Veereman-Wauters, G., & Hauser, B. (2013) · Current Infectious Disease Reports · doi:10.1007/s11908-013-0334-4 · Cited by 38 · see citing works
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Abbott, R. A., Martin, A. E., Newlove‐Delgado, T. V., Bethel, A., Whear, R. S., Thompson Coon, J., & Logan, S. (2018) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001922 · Cited by 36 · see citing works
“Horvath et al (81), and more recently Rutten et al (82), reported that L rhamnosus GG and VSL#3 were associated with significantly more treatment responders than placebo in their systematic review of nonpharmacological treatments; the same authors found inconclusive data regarding the effects of fibre-based supplement…”
BackgroundIvashkin, V. T., Maev, I. V., Abdulganieva, D. I., Alekseenko, S. A., Gorelov, A. V., Zakharova, I. N., Zolnikova, O. Y., Ivashkina, N. Y., Korochanskaya, N. V., Mammayev, S. N., et al. (2021) · Russian Journal of Gastroenterology, Hepatology, Coloproctology · doi:10.22416/1382-4376-2021-31-2-65-91 · Cited by 35 · see citing works
Takahashi, K., Khwaja, I., Schreyer, J. R., Bulmer, D. C., Peiris, M., Terai, S., & Aziz, Q. (2021) · Crohn s & Colitis 360 · doi:10.1093/crocol/otab073 · Cited by 33 · see citing works
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Evaluating the effects of probiotics in pediatrics with recurrent abdominal pain
Rahmani, P., Ghouran-orimi, A., Motamed, F., & Moradzadeh, A. (2020) · Korean Journal of Pediatrics · doi:10.3345/cep.2019.01613 · Cited by 31 · see citing works
Paul, S. P., & Basude, D. (2016) · World Journal of Pediatrics · doi:10.1007/s12519-016-0044-8 · Cited by 31 · see citing works
Mandarino, F. V., Sinagra, E., Barchi, A., Verga, M. C., Brinch, D., Raimondo, D., & Danese, S. (2023) · Microorganisms · doi:10.3390/microorganisms11051122 · Cited by 29 · see citing works
Atsushi, G. O. M. I., Iino, T., Nonaka, C., Miyazaki, K., & Ishikawa, F. (2015) · Journal of Dairy Science · doi:10.3168/jds.2014-9158 · Cited by 28 · see citing works
Vázquez-Frías, R., Consuelo‐Sánchez, A., Acosta-Rodríguez-Bueno, C. P., Blanco-Montero, A., Robles, D. C., Cohen, V., Márquez, D., & Perez, M. I. (2022) · Pediatric Drugs · doi:10.1007/s40272-022-00536-9 · Cited by 32 · see citing works
Barnes, D. M., & Yeh, A. M. (2015) · Nutrition in Clinical Practice · doi:10.1177/0884533615610081 · Cited by 27 · see citing works
Consenso mexicano sobre probióticos en gastroenterología
Valdovinos, M. A., Montijo, E., y Abreu, A. T. A., Heller, S., Garay, A. G. G., Nogales, D. B., Bielsa-Fernández, M. V., Bojórquez-Ramos, M. D. C., Bosques‐Padilla, F., Burguete-García, A. I., et al. (2017) · Revista de Gastroenterología de México · doi:10.1016/j.rgmx.2016.08.004 · Cited by 27 · see citing works
Pediatric IBS: An Overview on Pathophysiology, Diagnosis and Treatment
Chogle, A. S., Mintjens, S., & Saps, M. (2014) · Pediatric Annals · doi:10.3928/00904481-20140325-08 · Cited by 26 · see citing works
Gwee, K., Lee, W. W., Ling, K. L., Ooi, C. J., Quak, S. H., Dan, Y. Y., Siah, K. T. H., Huang, J. G., Chua, A. S. B., Hilmi, I. N., et al. (2018) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.14268 · Cited by 26 · see citing works
Șchiopu, C. G., Ștefănescu, C., Boloș, A., Diaconescu, S., Gîlcă-Blanariu, G.-E., & Ștefănescu, G. (2022) · Microorganisms · doi:10.3390/microorganisms10112199 · Cited by 24 · see citing works
“In addition, microflora functions were altered in the FD group showing that the ureolysis and fumaric acid respiratory function of duodenal bacteria was significantly different than in the healthy group [107].”
BackgroundGu, Q., Zhang, J., & Feng, Y. (2015) · Artificial Cells Nanomedicine and Biotechnology · doi:10.3109/21691401.2015.1111238 · Cited by 24 · see citing works
“Probiotics work for a part of IBS patients by effectively reliving related symptoms and by improving the quality of life (Horvath et al. 2011; O’Mahony et al. 2005).”
Backgroundvan Tilburg, M. A. L., & Carter, C. A. (2018) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2018.07.010 · Cited by 24 · see citing works
Probiotics and Functional Gastrointestinal Disorders in Pediatric Age: A Narrative Review
Capozza, M., Laforgia, N., Rizzo, V., Salvatore, S., Guandalini, S., & Baldassarre, M. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.805466 · Cited by 24 · see citing works
Italian guidelines for the management of irritable bowel syndrome in children and adolescents
Nardo, G. D., Barbara, G., Borrelli, O., Cremon, C., Giorgio, V., Greco, L., Pietra, M. L., Marasco, G., Pensabene, L., Piccirillo, M., et al. (2024) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-024-01607-y · Cited by 23 · see citing works
“…GG for the treatment of abdominal pain-related functional gastrointestinal disorders in childhood found that LGG treatment significantly reduced intensity and frequency of pain in the IBS subgroup (3 RCTs, n = 167; RR = 1.70, 95% CI 1.27–2.27, number needed to treat [NNT] 4, 95% CI 3–8) [145].”
BackgroundInfluentialThe Mexican consensus on probiotics in gastroenterology
Valdovinos, M. A., Montijo, E., y Abreu, A. T. A., Heller, S., Garay, A. G. G., Nogales, D. B., Bielsa-Fernández, M. V., Bojórquez-Ramos, M. D. C., Bosques‐Padilla, F., Burguete-García, A. I., et al. (2017) · Revista de Gastroenterología de México (English Edition) · doi:10.1016/j.rgmxen.2017.03.003 · Cited by 22 · see citing works
“In a meta-analysis, Horvath et al.(64) evaluated 3 CCTs conducted on a total of 290 children with functional gastrointestinal disorders (IBS, FAP, and FD) according to the Rome II criteria.”
BackgroundMethodInfluentialStachelska, M. A., Karpiński, P., & Kruszewski, B. (2024) · Nutrients · doi:10.3390/nu17010009 · Cited by 22 · see citing works
“Among the potentially effective strains are Bifidobacterium infantis 35,624 and L. plantarum 299v, and in children, Lactobacillus GG [36–38].”
Molecular Mechanisms of Chronic Pain and Therapeutic Interventions
Li, Z., Li, X., Liu, J., Sun, R., Ye, Y., Xiang, H., Luo, F., Li, S., & Luo, A. (2025) · MedComm · doi:10.1002/mco2.70325 · Cited by 26 · see citing works
Lower and Biliary Disorders of Gut–Brain Interaction: Child and Adolescent
Lorenzo, C. D., Saps, M., Chumpitazi, B. P., Rajindrajith, S., Staiano, A., Thapar, N., van Tilburg, M. A. L., Benítez, C. A. V., & Vlieger, A. M. (2026) · Gastroenterology · doi:10.1053/j.gastro.2026.01.036 · Cited by 23 · see citing works
Probiotics, Prebiotics, and Dietary Fiber in the Management of Functional Gastrointestinal Disorders
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Self-citationProbiotics for paediatric functional abdominal pain disorders: A rapid review
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Intestinal Permeability in Children with Functional Gastrointestinal Disorders: The Effects of Diet
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“The most-studied probiotic in pediatric FGIDs is Lactobacillus rhamnosus GG [37].”
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“A metaanalysis of three randomized clinical trials on the efficacy of Lactobacillus GG for the treatment of functional abdominal pain disorders, found that the efficacy of Lactobacillus GG was limited to IBS and was mostly effective in those with the diarrhea-predominant type [38].”
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“Additionally, treatment with Lactobacillus rhamnosus GG was found to reduce abdominal pain in children with functional GI disorders [48], and a mixture of Bifidobacterium infantis with other bacterial strains was found to improve abdominal pain in children with IBS [49].”
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“, 2018), and alleviating abdominal pain (Horvath et al., 2011; Trivić et al., 2021).”
BackgroundA clinical primer of the role of gut microbiome in health and disease
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“Mixed preparations of probiotics have also led to decreased bowel movements, pain, and bloating.(69) Lastly, while data are still limited, initial evidence is quite strong for the use of Bifidobacterium infantis for a 4-”
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Regulation of Pain Perception by Microbiota in Parkinson Disease
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Probiotics and prebiotics in pediatric diarrheal disorders
Vandenplas, Y., Greef, E. D., Hauser, B., Devreker, T., & Veereman-Wauters, G. (2013) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2013.771632 · Cited by 15 · see citing works
“rhamnosus GG moderately increases treatment success in children with abdominal painrelated functional gastrointestinal disorders, particularly among children with IBS [93].”
BackgroundInfluentialChronic abdominal pain in children: help in spotting the organic diagnosis
Wright, N. J., Hammond, P., & Curry, J. (2012) · Archives of Disease in Childhood Education & Practice · doi:10.1136/archdischild-2012-302273 · Cited by 15 · see citing works
- Authors
- Horvath, A., Dziechciarz, P., & Szajewska, H.
- Affiliations
- Medical University of Warsaw (PL)
- Corresponding author
- Szajewska, H.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2011-04-20
- Volume
- 33
- Issue
- 12
- Pages
- 1302-1310
- ISSN
- 0269-2813 (ISSN-L)
- OpenAlex
- W1780023862
- Cited by
- 201
- References
- 21
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 13 · 2022: 18 · 2021: 12 · 2020: 14 · 2019: 15 · 2018: 15 · 2017: 17 · 2016: 21 · 2015: 17 · 2014: 13 · 2013: 11 · 2012: 16
- FWCI
- 13.76
- Type
- journal article
- Language
- en
- Open access
- green
- hal.science
- Licence
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- Funders
- Warszawski Uniwersytet Medyczny
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- Lactobacillus rhamnosus GG, probiotics, abdominal pain, functional gastrointestinal disorders, irritable bowel syndrome, functional abdominal pain, functional dyspepsia, children, pain intensity, pain frequency, Rome criteria
- MeSH terms
- Child, Female, Gastrointestinal Diseases, Humans, Male, Abdominal Pain, Treatment Outcome, Probiotics, Lacticaseibacillus rhamnosus
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