Comparative efficacy of probiotic, prebiotic, and synbiotic interventions in children with functional abdominal pain disorders: a systematic review and network meta-analysis.

BACKGROUND: Functional abdominal pain disorders (FAPDs) are common pediatric gut-brain interaction disorders that substantially impair quality of life and lack effective pharmacologic or behavioral treatments. Given their biological plausibility, probiotics have emerged as a promising therapy, yet evidence remains inconsistent due to strain-specific effects and heterogeneous study designs. METHODS: Eight databases (PubMed, Embase, Web of Science, CENTRAL, CNKI, VIP, Wanfang, and CBM) were searched up to October 2025 for randomized controlled trials (RCTs) evaluating probiotic interventions in children (4-18 years) with FAPDs. Eligible comparators included placebo, no treatment, or other probiotics. Primary outcomes were global improvement, complete pain resolution, pain severity, and pain frequency. Data were synthesized using a frequentist random-effects network meta-analysis (Stata 17.0, mvmeta command), and treatment efficacy was ranked by SUCRA. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and evidence certainty with CINeMA. Sensitivity and meta-regression analyses evaluated the robustness of findings and the influence of dosage, duration, strain composition, age, and country. RESULTS: 21 RCTs ( CONCLUSION: This network meta-analysis shows that probiotics significantly improve symptoms in children with functional abdominal pain disorders. Specific strains- SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251218779, identifier CRD420251218779.