The Role of the Gut-Brain Axis in the Pathogenesis and Treatment of Irritable Bowel Syndrome in Children and Adolescents: A Review of Current Research with Focus on Dietary and Psychoneurogastroenterological Interventions

Abstract

Background. Irritable bowel syndrome (IBS) is a prevalent disorder of gut-brain interaction (DGBI) affecting 5-20% of children worldwide, with the microbiota-gut-brain axis (MGBA) playing a central pathophysiological role [7, 8, 21].   Aim. This narrative review evaluates MGBA-targeted therapeutic interventions in pediatric IBS.   Materials and methods. A systematic search of PubMed/MEDLINE (2021-2025) following PRISMA guidelines identified 31 eligible studies from 45 initially screened articles.   Results. Pediatric IBS pathophysiology involves intestinal dysmotility, visceral hypersensitivity, dysbiosis, and altered central processing of visceral signals [14, 15, 26]. The low-FODMAP diet has demonstrated efficacy in adults; however, pediatric evidence remains limited to five randomized trials with inconsistent results [25]. Probiotic supplementation with Lactobacillus rhamnosus GG and Limosilactobacillus reuteri DSM 17938 shows strain-specific efficacy [3, 4]. Cognitive-behavioral therapy and gut-directed hypnotherapy effectively target central signal processing [5, 21]. Pharmacological options, including neuromodulators, remain understudied in pediatric populations, with off-label use predominating [2, 12]. Psychological comorbidities, particularly anxiety and depression, significantly influence treatment response [1, 18].   Conclusions. The MGBA represents the primary therapeutic target in pediatric IBS, supporting multimodal approaches, but limitations in pediatric-specific evidence suggest the need for high-quality randomized controlled trials with standardized outcome measures and adequate long-term follow-up [6, 31].