Efficacy of Antidepressants in Treating Functional Abdominal Pain Disorders in Children: A Meta-Analysis of Randomized Controlled Trials

Pediatr Gastroenterol Hepatol Nutr. 2026 Jul;29(4):340-348. doi: 10.5223/pghn.2026.29.4.340. Epub 2026 Jul 7.

ABSTRACT

PURPOSE: Functional abdominal pain disorders (FAPDs) affect 13.5% of children and are challenging to treat owing to their poor quality of life and chronicity. Although antidepressants are potential interventions, the evidence of their efficacy remains inconclusive. This study evaluated the effectiveness of antidepressants in pediatric patients with FAPDs and explored the differences in antidepressant type and treatment duration.

METHODS: A systematic review of antidepressant efficacy in pediatric FAPDs was conducted using PubMed, EMBASE, Web of Science, and Cochrane Central databases. Randomized controlled trials (RCTs) comparing antidepressants were included. Subgroup analyses assessed the differences according to the antidepressant type (amitriptyline vs. citalopram) and treatment duration (4 weeks vs. 12 weeks).

RESULTS: Three RCTs with 287 participants met the inclusion criteria. The pooled odds ratio (OR) for clinical response (symptom improvement) was 3.18 (95% confidence interval [CI], 0.67-15.00), which was not statistically significant (p=0.144). Individual ORs were 1.59 (95% CI, 0.76-3.32) for citalopram, 15.55 (95% CI, 7.07-34.20) for amitriptyline, and 1.30 (95% CI, 0.56-2.99) for amitriptyline. Subgroup analysis suggested a numerically higher effect estimate for longer treatment duration; however, the 12-week finding (OR, 15.55; 95% CI, 7.07-34.20), which was derived from a single study, should be interpreted cautiously.

CONCLUSION: Although antidepressants did not demonstrate statistically significant overall efficacy in pediatric FAPDs, the observed effect estimates suggest a possible therapeutic benefit. Exploratory subgroup analyses indicated that treatment duration might influence symptom improvement; however, these findings were limited by substantial heterogeneity and the small number of trials available. Additional randomized controlled trials are warranted.

PMID:42487989 | PMC:PMC13388024 | DOI:10.5223/pghn.2026.29.4.340