Pharmacotherapy of Irritable Bowel Syndrome with Constipation in Children: An Update on Clinical Progress and Successes.

Irritable bowel syndrome with constipation is a prevalent disorder of gut-brain interaction in children and adolescents, associated with chronic abdominal pain, altered bowel habits, reduced quality of life, and a significant healthcare burden. Despite a wide range of therapeutic approaches, treatment responses remain suboptimal, highlighting the need for effective, evidence-based pharmacological options. This review summarizes current and emerging pharmacological therapies for pediatric irritable bowel syndrome with constipation, with a focus on their mechanisms of action, efficacy, and safety. Traditional treatments such as dietary fiber, probiotics, antispasmodics, laxatives, prokinetics, antidepressants, antibiotics, and antihistamines are reviewed, emphasizing the limited and often inconsistent evidence supporting their use for pain relief and overall symptom improvement. Particular attention is given to newer agents approved for adults with irritable bowel syndrome with constipation, including secretagogues (linaclotide, plecanatide, and lubiprostone) and the retainagogue tenapanor, with a detailed discussion of their pharmacological properties and clinical trial data. Linaclotide is currently the only medication approved by the U.S. Food and Drug Administration for the treatment of irritable bowel syndrome with constipation in children aged 7 years or older. While other novel agents have shown promise in adults, pediatric data remain limited or unavailable. Overall, although pharmacological treatment options for pediatric irritable bowel syndrome with constipation are expanding, high-quality, pediatric specific clinical trials are still needed to guide safe and effective management.