You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Online psychological treatment for pediatric recurrent pain: a randomized evaluation.
Abstract 1:
OBJECTIVE To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain . METHODS Forty-seven participants ( 9 - 16 years of age ) were r and omly assigned to either an Internet-based treatment or a st and ard medical care waitlist . Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail . At 1- and 3-month follow-ups , participants were assessed on the outcome variables of pain and quality of life . A 50 % reduction in diary pain scores was considered clinical ly significant . RESULTS Significant between-group differences were found : 71 and 72 % of the treatment group achieved clinical ly significant improvement at the 1- and 3-month follow-ups , respectively , whereas only 19 and 14 % of the control group achieved the criterion . No significant differences were found on the quality of life variable . CONCLUSIONS Distance methods have considerable potential for making effective treatments more accessible with lower associated costs


Title 2:
The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial.
Abstract 2:
Recurrent abdominal pain ( RAP ) affects 10 % to 18 % of school-age children and is caused by obvious organic pathology in fewer than 10 % of cases . Two recent studies do not support previous beliefs that most RAP is psychogenic . Studies have shown disorders of bowel motility in children with RAP similar to those of adult irritable bowel syndrome ( IBS ) ; controlled trials of additional dietary fiber in adult IBS have shown beneficial results . We did a r and omized , double-blind , placebo-controlled study in 52 children with RAP and demonstrated a clinical ly and statistically significant decrease in pain attacks ( at least 50 % fewer ) in almost twice as many children who were given additional fiber as placebo .  Compliance was excellent in both groups and side effects were few . Although the cause of RAP is poorly understood , it is hypothesized that the beneficial effect of added fiber is due to its effect on shortening transit time , as in IBS


Title 3:
Recurrent Abdominal Pain: Symptom Subtypes Based on the Rome II Criteria for Pediatric Functional Gastrointestinal Disorders
Abstract 3:
Objectives Recurrent abdominal pain ( RAP ) is a common childhood complaint rarely associated with organic disease . Recently , the Pediatric Rome Criteria were developed to st and ardize the classification of pediatric functional gastrointestinal disorders ( FGIDs ) using a symptom-based approach . The authors tested the hypothesis that most patients with childhood RAP could be classified into one or more of the symptom subtypes defined by the Pediatric Rome Criteria . Methods Using a prospect i ve longitudinal design , new patients with RAP ( n = 114 ) were studied at a tertiary care children 's medical center . Before the medical evaluation , parents completed a question naire about their child , assessing symptoms defined by the Pediatric Rome Criteria . Results Of the 107 children for whom medical evaluation revealed no organic etiology for pain , 73 % had symptom profiles consistent with the Pediatric Rome Criteria for one of the FGIDs associated with abdominal pain ( irritable bowel syndrome , 44.9 % ; functional dyspepsia,15.9 % ; functional abdominal pain , 7.5 % ; abdominal migraine , 4.7 % ) Conclusions This study provides the first systematic empirical evidence that RAP , originally defined by Apley , includes children whose symptoms are consistent with the symptom criteria for several FGIDs defined by the Rome criteria . The pediatric Rome criteria may be useful in clinical research to ( 1 ) describe the symptom characteristics of research participants who meet Apley 's broad criteria for RAP , and ( 2 ) select patients with particular symptom profiles for investigation of potential biologic and psychosocial mechanisms associated with pediatric FGIDs


Title 4:
Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study.
Abstract 4:
OBJECTIVE To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with  recurrent abdominal pain ( RAP ) in children at age 6(3/4 ) years . METHOD A longitudinal cohort study ( the Avon Longitudinal Study of Parents and Children ) , followed 8,272 children from pregnancy to age 6(3/4 ) years . Parental reports of child and parent functioning were gathered . Associations between parental and child functioning assessed at 6 to 8 months postpartum , and RAP measured at age 6(3/4 ) years were investigated . RESULTS The prevalence of RAP in this sample was 11.8 % . Both maternal anxiety ( adjusted odds ratio = 1.53 ; 95 % confidence interval 1.24 - 1.89 ) and paternal anxiety ( adjusted odds ratio = 1.38 ; 95 % confidence interval 1.12 - 1.71 ) in the first year of a child 's life were associated with later childhood RAP . Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP . CONCLUSIONS This is the first evidence from a prospect i ve study that anxiety in both mothers and fathers and child temperament features pre date the occurrence of RAP in children . These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP , although some caution should be exercised in their interpretation because of possible reporting bias


Title 5:
Double-blind, placebo-controlled trial of famotidine in children with abdominal pain and dyspepsia: global and quantitative assessment.
Abstract 5:
To determine the benefit of using an H2-receptor antagonist in children with abdominal pain and dyspepsia , 25 such children were enrolled in a double-blind , placebo-controlled trial of famotidine . Global and quantitative pain assessment s were done before and after each treatment period . The quantitative assessment was calculated based on the abdominal pain score that was the sum of three components . Based on the global evaluation , there was a clear benefit of famotidine over placebo ( 68 % vs 12 % ) . Using the quantitative assessment , however , the mean improvement of the score using famotidine versus placebo was not statistically significant ( 3.37+/-3.53 vs 1.66+/-2.7 ) . There was a significant improvement in this score during the first treatment period regardless of medication used ( period effect : P = 0.05 ) . A subset of patients with peptic symptoms demonstrated a significant drug effect that outweighed the period effect ( drug effect : P = 0.01 ; period effect : P = 0.02 ) . We conclude that famotidine subjectively improves the symptoms of children with recurrent abdominal pain  but not objective ly using the derived score . However , famotidine is significantly more effective than placebo among children with peptic symptoms . The use of this simple scoring scale may facilitate selecting those children who will benefit from H2-receptor antagonist therapy


Title 6:
Characterization of Symptoms in Children with Recurrent Abdominal Pain: Resemblance to Irritable Bowel Syndrome
Abstract 6:
We sought to prospect ively characterize and compare the symptoms of children ≥ 5 years of age with recurrent abdominal pain to previously established criteria for irritable bowel syndrome ( IBS ) in adults . For all eligible subjects , a detailed question naire concerning characteristics of abdominal pain and defecatory pattern was completed at presentation . In addition , a battery of screening tests was performed and additional evaluation was done at the discretion of their physician . In all , 227 subjects fulfilled the entrance criteria , but 56 were sub-sequently excluded because of diagnoses of inflammatory bowel disease ( nine cases ) , lactose malabsorption ( 46 cases ) , or celiac disease ( one case ) . Of the remaining 171 patients , 117 had IBS symptoms . In the IBS subjects , lower abdominal discomfort ( p < 0.001 ) , cramping pain ( p < 0.0009 ) , and increased flatus ( p < 0.0003 ) were more common , whereas dyspeptic symptoms such as epigastric discomfort ( p < 0.003 ) , pain radiating to the chest ( p < 0.009 ) , and regurgitation ( p < 0.02 ) were more common in the non-IBS subjects . Our study not only confirms the clinical heterogeneity of children with recurrent abdominal pain  but also concomitantly demonstrates that most children with this disorder have symptoms that fulfill the st and ardized criteria for IBS in adults . The identification of subgroups of children with recurrent abdominal pain can provide a framework for the diagnosis of functional bowel disease as well as establish the need for invasive and expensive tests


Title 7:
IS MIGRAINE FOOD ALLERGY?: A Double-blind Controlled Trial of Oligoantigenic Diet Treatment
Abstract 7:
93 % of 88 children with severe frequent migraine recovered on oligoantigenic diets ; the causative foods were identified by sequential re introduction , and the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children . Most patients responded to several foods . Many foods were involved , suggesting an allergic rather than an idiosyncratic ( metabolic ) pathogenesis . Associated symptoms which improved in addition to headache included abdominal pain , behaviour disorder , fits , asthma , and eczema . In most of the patients in whom migraine was provoked by non-specific factors , such as blows to the head , exercise , and flashing lights , this provocation no longer occurred while they were on the diet


Title 8:
Recurrent abdominal pain and lactose absorption in children.
Abstract 8:
The association of lactase deficiency with recurrent abdominal pain was investigated . One hundred three white children between the ages of 6 to 14 years with recurrent abdominal pain were evaluated . Sixty-nine underwent lactose tolerance tests and 26 had intestinal biopsies with lactase determinations ; 21 of 69 ( 30.4 % ) had abnormal lactose tolerance tests and eight of 26 ( 31 % ) were lactase deficient . However , 16 of 61 ( 26.4 % ) control subjects matched for age and ethnic background exhibited lactase deficiency . Thus , a similar prevalence of lactase deficiency was found in the control and the recurrent abdominal pain groups . Thirty-eight patients with recurrent abdominal pain completed three successive six-week diet trials conducted in a double-blind fashion . An increase above base line value in pain frequency was seen in ten of 21 ( 48 % ) lactose malabsorbers and four of 17 ( 24 % ) lactose absorbers . After a 12-month milk elimination diet , six of 15 ( 40 % ) malabsorbers and five of 13 ( 38 % ) absorbers had elimination of their pain . This result compared with improvement occurring in five of 12 ( 42 % ) absorbers with recurrent abdominal pain who received a regular diet for one year and suggests that the elimination of lactose will not affect the overall frequency of improvement in recurrent abdominal pain . In addition , the recovery rate from recurrent abdominal pain is similar in both lactose absorbers and nonabsorbers independent of dietary restrictions


Title 9:
Dietary lactose and the child with abdominal pain.
Abstract 9:
spread metastases and died two months later , having remained normocalcaemic and swallowed normally until death . Case 2-A 50 year old man developed lymphadenopathy in the left supraclavicular fossa due to squamous carcinoma secondary to a symptomless primary tumour of the left main bronchus . The nodes were treated with palliative radiotherapy , but two months later he developed total dysphagia for solids , anorexia , and nausea . Examination showed some residual lymphadenopathy but was otherwise unremarkable ; a chest x ray film , however , showed a primary carcinoma in the left hilar region and multiple bone metastases . Barium swallow showed free flow of barium with no mechanical hold up but some slight muscular incoordination in the pharynx . A biochemical profile showed calcium concentration 3 - 8 mmol/l ( 15 ng/100 ml ) , alkaline phosphatase activity 200 IU/1 , urea concentration 17 - 9 mmol/l ( 108 mg/100 ml ) ( normal 2 - 0 - 8 - 1 mmol/l ( 12 - 49 mg/100 ml ) ) , and glutamic oxaloacetic transaminase activity 315 IU/l ( normal 5 - 45 IU/1 ) . Treatment with intravenous fluids , high dose steroids , and mithramycin corrected the hypercalcaemia , and his dysphagia had gone completely after five days and he was discharged home . He had no further problems with dysphagia . but died a month later from generalised disease . Postmortem examination confirmed a squamous cell carcinoma of the left main bronchus with widespread metastases but with a normal oesophagus that was not obstructed
In spite of these method ological weaknesses and the clinical heterogeneity , the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children , particularly in primary care , will improve with reassurance and time