Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in <12 Months Old Infants

Yvan Vandenplas 1, Muath Abdurrahman Alturaiki 2, Wafaa Al-Qabandi 3, Fawaz AlRefaee 4, Ziad Bassil 5, Bassam Eid 6, Ahmed El Beleidy 7, Ali Ibrahim Almehaidib 8, Pierre Mouawad 9, Maroun Sokhn 10

Affiliations

01 September 2016

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doi: 10.5223/pghn.2016.19.3.153

Abstract

This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.

Keywords: Breast feeding; Colic; Constipation; Diarrhea; Formula feeding; Gastrointestinal diseases; Regurgitation.

Figures

Fig. 1. Algorithm for regurgitation. BF: breastfed, CMPA: cow's milk protein allergy, AR-formula: anti-regurgitation formula, FF: fomula fed, eHF: extensively hydrolyzed formula, GERD: gastro-esophageal reflux disease.

Fig. 1. Algorithm for regurgitation. BF: breastfed, CMPA: cow's milk protein allergy, AR-formula: anti-regurgitation formula, FF: fomula fed, eHF: extensively hydrolyzed formula, GERD: gastro-esophageal reflux disease.

Fig. 2. Algorithm for functional constipation. FF: formula fed, BF: breastfed, pHF: partially hydrolyzed formula, GOS: galacto-oligosaccharides, FOS: fructo-oligosaccharides, L: Lactobacillus, B: Bifidobacterium, Mg: magnesium, PEG: polyethylene glycol, eHF: extensively hydrolyzed formula, CMPA: cow's milk protein allergy.

Fig. 2. Algorithm for functional constipation. FF: formula fed, BF: breastfed, pHF: partially hydrolyzed formula, GOS: galacto-oligosaccharides, FOS: fructo-oligosaccharides, L: Lactobacillus, B: Bifidobacterium, Mg: magnesium, PEG: polyethylene glycol, eHF: extensively hydrolyzed formula, CMPA: cow's milk protein allergy.

Fig. 3. Algorithm for infantile colic. GI: gastrointestinal, CM-free: cow's milk-free, BF: breastfed, eHF: extensively hydrolyzed formula, FF: formula fed, CMPA: cow's milk protein allergy, L: Lactobacillus, pHF: partially hydrolyzed formula, GOS: galacto-oligosaccharides, FOS: fructo-oligosaccharides.

Fig. 3. Algorithm for infantile colic. GI: gastrointestinal, CM-free: cow's milk-free, BF: breastfed, eHF: extensively hydrolyzed formula, FF: formula fed, CMPA: cow's milk protein allergy, L: Lactobacillus, pHF: partially hydrolyzed formula, GOS: galacto-oligosaccharides, FOS: fructo-oligosaccharides.

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