Pendahuluan

Childhood functional gastrointestinal disorders (FGIDs) are an umbrella term for multiple disorders.
They include a variable combination of often age-dependent, chronic or recurrent symptoms,
including colic, regurgitation, abdominal pain, and defecation-related disorders. Importantly these
symptoms cannot be attributed to another medical condition. after appropriate medical evaluation.
The recently published and revised Rome IV criteria describe different FGIDs including functional
abdominal pain disorders (FAPD): (1) functional dyspepsia (FD), (2) irritable bowel syndrome (IBS), (3)
abdominal migraine (AM), and (4) functional abdominal pain—not otherwise specified, and functional
constipation (FC) (Fig. 1). FAPD are one of the most common clinical entities encountered in pediatric
practice with a prevalence ranging from 0.2% to 23%, whereas the prevalence of FC vary from 0.7% to
29.6%. The etiology underlying abdominal pain and constipation is not well understood but many risk
factors are associated with the onset of both disorders.

In the last decade it has been suggested that the gut microbiota may play an essential role in the
development of these functional disorders. The human gut is colonized by a complex microbial
community. This complex ecosystem, the gut microbiome, is an integral part of the gastrointestinal
(GI) tract and changes are associated with a wide variety of diseases and disorders. Aberrations in the
gut microbiota composition has not only been correlated to GI complaints, but also to diseases like
obesity, diabetes, and autism. Because of the use of culture-independent techniques to study the gut
microbiota, our understanding of the role of the gut microbiota in health and disease has increased.
Not only the characterization is of great interest, but also how we might influence our gut microbiota
to correct for aberrations. One way to do so is by probiotics, this term was originally introduced as
opposite of antibiotics. Many definitions exist for probiotics, but all include that it should contain living
microorganisms which, upon ingestion of adequate amounts, exert health benefits for the host The
working mechanism of probiotics is based on the fact that they can interfere with pathogens, can
improve barrier function, and have a role in immunomodulation and neurotransmitter production.
Important in the context of FAPD and FC, probiotics such as Bifidobacterium and Lactobacillus species
produce short-chain fatty acids (SCFAs) that lower the intestinal pH, thereby enhancing peristalsis of
the colon Moreover, the gut microbiota can also modulate intestinal pain by the same mechanisms of
influencing neural, immune and endocrine activity of the host, and secretion of bacterial metabolites
that can influence the neural pathway. Because of these properties probiotics have been suggested
as potential treatment for children with FAPD and FC. Conventional treatment such as the use of
antispasmodics or amitriptyline in FAPD and laxatives for FC turns out to be insufficient in a substantial
amount of children, and many parents look for alternatives. This review provides an update on current
literature of the efficacy of probiotics in the treatment of FAPD and FC in children.