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Influence of constipation on enuresis. An Pediatr (Barc) 2021; 95:108-115. [PMID: 34373073 DOI: 10.1016/j.anpede.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Constipation has classically been considered as a risk factor of enuresis, although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics. OBJECTIVE To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis, and to find out the prevalence of the three disorders, as well as the lower urinary tract dysfunction and bladder-bowel dysfunction in the population. MATERIAL AND METHOD A cross-sectional observational prevalence study on a representative population sample of 5-9 year-old school boys and girls of Galicia, Spain. A questionnaire was completed in the schools on urinary and bowel habits, which included questions from the Paediatric Lower Urinary Tract Scoring System (PLUTSS) diagnostic questionnaire and grading of the lower urinary tract dysfunctions. The enuresis was diagnosed using the International Children's Continence Society (ICSS), and if it was also associated with diurnal symptoms, it was also classified as non-monosymptomatic enuresis. The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale. RESULTS A total of 772 questionnaires were included in the study. The prevalence of constipation was 20% and that of enuresis was 9.1% (62.9% monosymptomatic enuresis and 37.1% non-monosymptomatic), with the prevalence of bladder-bowel dysfunction being 5.2%. It was observed that constipation had no influence on the presence of monosymptomatic enuresis, but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions, where it was a significant risk factor. CONCLUSIONS The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis, since the therapeutic management and the characteristics of both disorders are different, with constipation only being a risk factor in cases of non-monosymptomatic enuresis.
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Popescu M, Mutalib M. Bowel transit studies in children: evidence base, role and practicalities. Frontline Gastroenterol 2021; 13:152-159. [PMID: 35300467 PMCID: PMC8862445 DOI: 10.1136/flgastro-2020-101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 02/04/2023] Open
Abstract
Constipation is common in children and adults with varied worldwide prevalence. The majority of children have functional constipation as defined by Rome clinical criteria and respond favourably to standard medical therapy; up to one-third can develop difficult-to-treat constipation requiring investigation and specialist treatment. Colon function tests aim to assess the neuromuscular integrity, the movement of faeces across the colon and evaluate/predict response to the therapy. The 'ideal' test should be practical, non-invasive, widely available and cost-effective. None of the available diagnostic tools is designed to provide a comprehensive assessment of colon function and clinicians often have to combine more than one test to answer different questions. In this review, we aim to assess the strengths and limitations of the commonly available diagnostic investigations (radiopaque marker studies, scintigraphy, wireless motility capsule and colonic manometry) used to assess colon transit in children and to provide guidance on the most appropriate test for particular clinical settings.
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Affiliation(s)
- Mara Popescu
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohamed Mutalib
- Faculty of Life Sciences and Medicine, King's College London, London, UK,Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
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103
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Veeraraghavan G, Therrien A, Degroote M, McKeown A, Mitchell PD, Silvester JA, Leffler DA, Leichtner AM, Kelly CP, Weir DC. Non-responsive celiac disease in children on a gluten free diet. World J Gastroenterol 2021; 27:1311-1320. [PMID: 33833484 PMCID: PMC8015304 DOI: 10.3748/wjg.v27.i13.1311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-responsive celiac disease (NRCD) is defined as the persistence of symptoms in individuals with celiac disease (CeD) despite being on a gluten-free diet (GFD). There is scant literature about NRCD in the pediatric population.
AIM To determine the incidence, clinical characteristics and underlying causes of NRCD in children.
METHODS Retrospective cohort study performed at Boston Children’s Hospital (BCH). Children < 18 years diagnosed with CeD by positive serology and duodenal biopsies compatible with Marsh III histology between 2008 and 2012 were identified in the BCH’s Celiac Disease Program database. Medical records were longitudinally reviewed from the time of diagnosis through September 2015. NRCD was defined as persistent symptoms at 6 mo after the initiation of a GFD and causes of NRCD as well as symptom evolution were detailed. The children without symptoms at 6 mo (responders) were compared with the NRCD group. Additionally, presenting signs and symptoms at the time of diagnosis of CeD among the responders and NRCD patients were collected and compared to identify any potential predictors for NRCD at 6 mo of GFD therapy.
RESULTS Six hundred and sixteen children were included. Ninety-one (15%) met criteria for NRCD. Most were female (77%). Abdominal pain [odds ratio (OR) 1.8 95% confidence interval (CI) 1.1-2.9], constipation (OR 3.1 95%CI 1.9-4.9) and absence of abdominal distension (OR for abdominal distension 0.4 95%CI 0.1-0.98) at diagnosis were associated with NRCD. NRCD was attributed to a wide variety of diagnoses with gluten exposure (30%) and constipation (20%) being the most common causes. Other causes for NRCD included lactose intolerance (9%), gastroesophageal reflux (8%), functional abdominal pain (7%), irritable bowel syndrome (3%), depression/anxiety (3%), eosinophilic esophagitis (2%), food allergy (1%), eating disorder (1%), gastric ulcer with Helicobacter pylori (1%), lymphocytic colitis (1%), aerophagia (1%) and undetermined (13%). 64% of children with NRCD improved on follow-up.
CONCLUSION NRCD after ≥ 6 mo GFD is frequent among children, especially females, and is associated with initial presenting symptoms of constipation and/or abdominal pain. Gluten exposure is the most frequent cause.
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Affiliation(s)
- Gopal Veeraraghavan
- Division of Gastro-enterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
- The Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
| | - Amelie Therrien
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
- The Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
| | - Maya Degroote
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
| | - Allison McKeown
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA 02115, United States
| | - Jocelyn A Silvester
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
- The Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
| | - Daniel A Leffler
- The Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
- Gastrointestinal Therapeutics, Takeda Pharmaceutical International Co, Cambridge, MA 02139, United States
| | - Alan M Leichtner
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
| | - Ciaran P Kelly
- The Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
| | - Dascha C Weir
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, United States
- Celiac Research Program, Harvard Medical School, Boston, MA 02115, United States
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Chouliaras GL, Krepis P, Bouzios I, Zellos A, Chrousos G, Roma-Giannikou E. Dietary habits in Greek children with functional constipation based on Rome III criteria: a school-based, cross-sectional multivariate analysis. Ann Gastroenterol 2021; 34:528-534. [PMID: 34276192 PMCID: PMC8276364 DOI: 10.20524/aog.2021.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Functional constipation (FC) is the most common gastrointestinal disorder of childhood and has a multifactorial etiology. We aimed to assess dietary habits in Greek children with FC compared to the general population (control group, CG). Methods This was a subgroup analysis of a school-based, cross-sectional study carried out in children 6-18 years of age, between January and June 2014, using the Rome III criteria for the diagnosis of FC. Dietary parameters, as well as socioeconomic and demographic data and their association with the likelihood of FC, were analyzed through multivariate logistic regression analysis and expressed as odds ratios (OR). Results A total of 1439 children (1218 CG, 221 FC) were included in the analysis. The final model showed that consumption of was the only dietary parameter significantly related to FC; higher frequency of consumption was inversely related to the likelihood of FC (OR: 0.98, 95% CI: 0.96, 0.99, P=0.048). Significant socioeconomic confounders with a positive association with FC were: parental educational level, victimization, physical activity and number of adults at home. Conclusions Increased frequency of fiber consumption is significantly associated with higher odds of FC irrespective of socioeconomic background and lifestyle parameters. Interventional studies are required to validate these cross-sectional observations.
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Affiliation(s)
- Giorgos L Chouliaras
- 2nd Department of Pediatrics, University of Athens, "P & Ag. Kyriakou" Children's Hospital (Giorgos L. Chouliaras, Panagiotis Krepis)
| | - Panagiotis Krepis
- 2nd Department of Pediatrics, University of Athens, "P & Ag. Kyriakou" Children's Hospital (Giorgos L. Chouliaras, Panagiotis Krepis)
| | - Ilias Bouzios
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - Aglaia Zellos
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - George Chrousos
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - Eleftheria Roma-Giannikou
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
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105
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Leung AK, Hon KL. Paediatrics: how to manage functional constipation. Drugs Context 2021; 10:dic-2020-11-2. [PMID: 33828605 PMCID: PMC8007206 DOI: 10.7573/dic.2020-11-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. Methods A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. Results A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. Conclusion Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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106
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Huang Y, Tan SY, Parikh P, Buthmanaban V, Rajindrajith S, Benninga MA. Prevalence of functional gastrointestinal disorders in infants and young children in China. BMC Pediatr 2021; 21:131. [PMID: 33731059 PMCID: PMC7968152 DOI: 10.1186/s12887-021-02610-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China. METHODS A prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0-4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria. RESULTS According to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0-6 months old while functional constipation (7.0%) was the most common among the 1-4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally. CONCLUSIONS Infantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children. TRIAL REGISTRATION Netherlands Trial Registry Identifier: NL6973/NTR7161 .
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Affiliation(s)
- Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Serene Yaling Tan
- FrieslandCampina, Amersfoort, The Netherlands.
- FrieslandCampina Development Centre AMEA, 89 Science Park Drive, #02-05/06/08 The Rutherford B, Science Park 1, Singapore, 118261, Singapore.
| | | | | | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, 1105, AZ, The Netherlands
- Academic Medical Center, Amsterdam, 1105, AZ, The Netherlands
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107
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Thompson AP, Wine E, MacDonald SE, Campbell A, Scott SD. Parents' Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review. Clin Pediatr (Phila) 2021; 60:154-169. [PMID: 33026251 DOI: 10.1177/0009922820964457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents' needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.
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Affiliation(s)
| | - Eytan Wine
- University of Alberta, Edmonton, Alberta, Canada
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108
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Vriesman MH, de Jonge CS, Kuizenga-Wessel S, Adler B, Menys A, Nederveen AJ, Stoker J, Benninga MA, Di Lorenzo C. Simultaneous assessment of colon motility in children with functional constipation by cine-MRI and colonic manometry: a feasibility study. Eur Radiol Exp 2021; 5:8. [PMID: 33565002 PMCID: PMC7873179 DOI: 10.1186/s41747-021-00205-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/19/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI. METHODS After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon. RESULTS Data regarding six patients (three males) were analysed (median age 14 years, range 12-17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI. CONCLUSIONS Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.
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Affiliation(s)
- M H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - C S de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - S Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Adler
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
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Avelar Rodriguez D, Popov J, Ratcliffe EM, Toro Monjaraz EM. Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence. Front Pediatr 2021; 8:595531. [PMID: 33553067 PMCID: PMC7856458 DOI: 10.3389/fped.2020.595531] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
Functional constipation is a common condition in childhood with significant impact on patients' quality of life and on health care resources. Functional constipation is characterized by decreased bowel movements and/or hard stools, which cause significant distress for children and their caregivers. While the term "functional" may imply the absence of organic causes with a focus on behavioral aspects, 40% of children continue to have symptoms beyond conventional management with one in four children continuing to experience constipation into adulthood. The refractory and chronic nature of constipation highlights the importance of considering a range of pathophysiological mechanisms, including the potential role of the gut microbiome. In this review, we provide an overview of preclinical and clinical studies that focus on the potential mechanisms through which the gut microbiome might contribute to the clinical presentation of functional constipation in pediatrics.
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Affiliation(s)
- David Avelar Rodriguez
- Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría, Mexico City, Mexico
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jelena Popov
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Elyanne M. Ratcliffe
- Division of Gastroenterology and Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Erick Manuel Toro Monjaraz
- Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría, Mexico City, Mexico
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Thompson AP, MacDonald SE, Wine E, Scott SD. Understanding Parents' Experiences When Caring for a Child With Functional Constipation: Interpretive Description Study. JMIR Pediatr Parent 2021; 4:e24851. [PMID: 33470939 PMCID: PMC7857943 DOI: 10.2196/24851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pediatric functional constipation (FC) is a common but serious medical condition. Despite significant effects on children, families, and the health care system, the condition is typically undertreated. Parents carry the primary responsibility for complex treatment programs; therefore, understanding their experiences and needs may offer a critical perspective toward improving clinical care. OBJECTIVE The aim of this study is to understand and give voice to parents' experiences and information needs when caring for a child with FC. The ultimate objective is to build an evidence base suitable for creating a digital knowledge translation tool to better support parents caring for a child with FC. METHODS This qualitative design used an interpretive description methodology to generate findings aimed at improving clinical care. One-on-one, in-depth interviews were completed either in person or through web-based teleconferencing to explore parents' perspectives. Data collection and analysis occurred concurrently. RESULTS Analysis of 16 interviews generated 4 major themes: living in the shadows; not taken seriously, with a subtheme of persevering and advocating; missing information and misinformation; and self-doubt and strained relationships. One minor theme of affirmative influences that foster resilience and hope was identified. CONCLUSIONS Parents have unmet needs for support and information related to pediatric FC. To address gaps in current care provision, decision makers may consider interventions for clinicians, resources for parents, and shifting care models to better meet parents' needs.
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Affiliation(s)
| | | | - Eytan Wine
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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111
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Yamada M, Sekine M, Tatsuse T, Fujimura Y. Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study. BMC Public Health 2021; 21:47. [PMID: 33407297 PMCID: PMC7789557 DOI: 10.1186/s12889-020-10044-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background We aimed to clarify the predisposing factors for adolescent constipation in a longitudinal study, because while factors associated with childhood constipation have been reported, prospective studies on the incidence of constipation are lacking. Methods We enrolled 5540 adolescents aged 12 to 13 years from the Toyama Birth Cohort Study—a community-based prospective study examining children’s health. The incidence of constipation, defined as bowel movement frequency of less than once every 2 days, was surveyed during the three-year period from baseline (grade 4) to follow-up (grade 7). Multivariate logistic regression analyses were performed to explore the association between the incidence of adolescent constipation and their lifestyle variables. Results A total of 261 adolescents (4.7%) developed constipation during the three-year period. Female sex (odds ratio [OR] = 2.62,) overweight (OR = 0.60), and infrequent intake of fruits (OR = 1.50) at baseline were associated with the incidence of constipation. Furthermore, factors related to lifestyle changes and psychological status such as skipping breakfast (OR = 1.73), becoming physically inactive (OR = 1.55), and being persistently irritated (OR = 1.80) were significantly associated with the incidence of constipation. Conclusion Our prospective study demonstrated that female sex, insufficient fruit intake, and deteriorating lifestyles such as skipping breakfast and becoming inactive during the 3-year period were associated with the incidence of adolescent constipation. Beyond anecdotal, maintaining a healthy lifestyle is recommended to reduce the incidence of adolescent constipation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10044-5.
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Affiliation(s)
- Masaaki Yamada
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuko Fujimura
- Department of Community Medicine and Health Promotion, University of Toyama, Toyama, Japan. 2630 Sugitani, Toyama, 930-0194, Japan
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Baaleman DF, Gupta S, Benninga MA, Bali N, Vaz KH, Yacob D, Di Lorenzo C, Lu PL. The Use of Linaclotide in Children with Functional Constipation or Irritable Bowel Syndrome: A Retrospective Chart Review. Paediatr Drugs 2021; 23:307-314. [PMID: 33876403 PMCID: PMC8119400 DOI: 10.1007/s40272-021-00444-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Linaclotide is a well-tolerated and effective agent for adults with functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C). However, data in children are lacking. The aim of this study is to examine the efficacy and safety of linaclotide in children. METHODS We performed a retrospective review of children < 18 years old who started linaclotide at our institution (Nationwide Children's Hospital, Columbus, Ohio). We excluded children already using linaclotide or whom had an organic cause of constipation or abdominal pain. We recorded information on patient characteristics, medical and surgical history, symptoms, clinical response, course of treatment, and adverse events at baseline, first follow-up, and after 1 year of linaclotide use. A positive clinical response was based on the physician's global assessment of symptoms at the time of the visit as documented. RESULTS We included 93 children treated with linaclotide for FC (n = 60) or IBS-C (n = 33); 60% were female; median age was 14.7 years (IQR 13.2-16.6). Forty-five percent of patients with FC and 42% with IBS-C had a positive clinical response at first follow-up a median of 2.5 and 2.4 months after starting linaclotide, respectively. Approximately a third of patients experienced adverse events and eventually 27% stopped using linaclotide due to adverse events. The most common adverse events were diarrhea, abdominal pain, nausea, and bloating. CONCLUSION Nearly half of children with FC or IBS-C benefited from linaclotide, but adverse events were relatively common. Further prospective, controlled studies are needed to confirm these findings and to identify which patients are most likely to benefit from linaclotide.
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Affiliation(s)
- Desiree F. Baaleman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Shivani Gupta
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
| | - Marc A. Benninga
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Neetu Bali
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
| | - Karla H. Vaz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
| | - Peter L. Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH USA
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Strisciuglio C, Coppola V, Russo M, Tolone C, Marseglia GL, Verrotti A, Caimmi S, Caloisi C, D'Argenio V, Sacchetti L, Staiano A. Promelaxin Microenemas Are Non-inferior to Oral Polyethylene Glycol for the Treatment of Functional Constipation in Young Children: A Randomized Clinical Trial. Front Pediatr 2021; 9:753938. [PMID: 34778144 PMCID: PMC8586088 DOI: 10.3389/fped.2021.753938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Polyethylene glycol (PEG) is recommended as first-line treatment of pediatric functional constipation. However, the oral route of administration is often poorly feasible in children mostly due to poor palatability. Promelaxin microenemas exert a topical evacuative action and may offer a valuable option in pediatric FC. Aim: To assess whether Promelaxin microenemas would be non-inferior to PEG 4000 in young children with FC. Methods: This is a randomized, open-label, multi-centric, non-inferiority trial enrolling infants and young children aged 6-48 months, with FC according to Rome III criteria. After 1 week of run in, children were randomized to 2 weeks of Promelaxin or PEG, followed by a 6-week on-demand treatment period. Primary endpoint was response rate to randomized treatment, with "response" defined as at least 3 evacuations per week and an average increase of at least one evacuation per week as compared to baseline. Safety, stool consistency and the analysis of fecal microbiota were secondary endpoints. Results: Out of the 158 patients who entered the trial, 153 patients were treated (77 and 76, PEG and Promelaxin arm, respectively). In the primary analysis, the 95% confidence interval (CI) for the treatment's effect lay entirely above the non-inferiority margin in both Full Set (FAS) and Per Protocol (PP) analyses, providing evidence of the non-inferiority of Promelaxin vs. PEG 4000 [response rate difference: 16.5% (CI 1.55-31.49%) and 11.03% (CI -5.58 to 27.64%), FAS and PP analyses, respectively]. Mean compliance to the randomized treatment was >80% in both arms. Secondary endpoints did not significantly differ between the two arms, except for the average number of total days of on-demand treatment that was significantly lower in the Promelaxin arm [14.6 (12.7) vs. 9.8 (9.1), mean (SD); primary endpoint responders in PEG and Promelaxin arm, respectively; p = 0.027]. Microbiota evenness significantly increased in the PEG 4000 arm at V4 as compared to the Promelaxin arm (p < 0.05). In addition, at V5, patients treated with PEG showed a significantly decreased microbiota density as compared to patients treated with Promelaxin (p = 0.036). Conclusions: Promelaxin microenemas are non-inferior to oral PEG in children with FC. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02751411.
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Affiliation(s)
- Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Coppola
- Department of Translational Medical Sciences, Section of Pediatric, University of Naples Federico II, Naples, Italy
| | - Marina Russo
- Department of Translational Medical Sciences, Section of Pediatric, University of Naples Federico II, Naples, Italy
| | - Carlo Tolone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gian Luigi Marseglia
- Maternal and Child Department, IRCCS Foundation Policlinico "S. Matteo" di Pavia, Pavia, Italy
| | | | - Silvia Caimmi
- Maternal and Child Department, IRCCS Foundation Policlinico "S. Matteo" di Pavia, Pavia, Italy
| | - Claudia Caloisi
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Valeria D'Argenio
- CEINGE Biotecnologie Avanzate S. C. A R. L., Naples, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
| | | | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatric, University of Naples Federico II, Naples, Italy
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Muhardi L, Aw MM, Hasosah M, Ng RT, Chong SY, Hegar B, Toro-Monjaraz E, Darma A, Cetinkaya M, Chow CM, Kudla U, Vandenplas Y. A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria. Front Pediatr 2021; 9:778747. [PMID: 35071132 PMCID: PMC8767117 DOI: 10.3389/fped.2021.778747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/24/2021] [Indexed: 12/27/2022] Open
Abstract
Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0-5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0-6 months, the reported prevalence of colic ranged between 10-15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0-12 months, the reported prevalence of regurgitation and constipation were 3.4-25.9% and 1.3-17.7%, respectively. The reported prevalence of constipation was 1.3-26% among children aged 13-48 months and 13% among children aged 4-18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.
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Affiliation(s)
| | - Marion M Aw
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mohammed Hasosah
- Department of Pediatric, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Ruey Terng Ng
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Yee Chong
- Department of Pediatrics, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Badriul Hegar
- Department of Pediatrics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erick Toro-Monjaraz
- Unit of Physiology and Gastrointestinal Motility, Department of Gastroenterology and Nutrition, National Institute of Pediatrics, Mexico City, Mexico
| | - Andy Darma
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Merih Cetinkaya
- Department of Neonatology, Health Sciences University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Chung Mo Chow
- Virtus Medical Group, Hong Kong, Hong Kong SAR, China
| | | | - Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Timmerman ME, Trzpis M, Broens PM. Prevalence of Defecation Disorders and their Symptoms is Comparable in Children and Young Adults: Cross-Sectional Study. Pediatr Gastroenterol Hepatol Nutr 2021; 24:45-53. [PMID: 33505893 PMCID: PMC7813573 DOI: 10.5223/pghn.2021.24.1.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We aimed to compare the prevalence rates and associated symptoms of constipation and fecal incontinence in children and young adults and evaluate how these patient groups cope with these disorders. METHODS A cross-sectional study was performed in which 212 children (8-17 years) and 149 young adults (18-29 years) from the general Dutch population completed a questionnaire about defecation disorders. RESULTS Constipation occurred in 15.6% of children and 22.8% of young adults (p=0.55), while the prevalence of fecal incontinence was comparable between groups (7%, p=0.91). The symptoms associated with constipation occurred as often in children as in young adults, while most fecal incontinence symptoms occurred more often in young adults. Approximately 43% of children had constipation for more than 5 years, while 26% of young adults experienced constipation since childhood. Only 27% of constipated children and 21% of constipated young adults received treatment (mostly laxatives). For fecal incontinence, 13% of children and 36% of young adults received treatment (mostly antidiarrheal medications or incontinence pads). CONCLUSION In contrast to the general belief, the prevalence of defecation disorders and associated symptoms seem to be comparable in children and young adults. Only a few people with defecation disorders receive adequate treatment.
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Affiliation(s)
- Marjolijn E.W. Timmerman
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Fifi AC, Velasco-Benitez C, Saps M. Celiac Disease in Children with Functional Constipation: A School-Based Multicity Study. J Pediatr 2020; 227:77-80. [PMID: 32698030 DOI: 10.1016/j.jpeds.2020.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/19/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether children in the community with functional constipation have increased prevalence of celiac disease. STUDY DESIGN Between April 4, 2015, and April 25, 2017, we enrolled 1809 children from 5 schools in Colombia and screened them for functional gastrointestinal disorders (FGIDs), including functional constipation, using questionnaires recommended in the Rome III/IV criteria. We matched children with functional constipation with healthy controls without a FGID and tested them for celiac disease with tissue transglutaminase (tTG)-Immunoglobulin A (IgA) and total IgA screening. In those who tested positive for tTG-IgA, we performed HLA genotyping and endoscopy to obtain 4 duodenal biopsy specimens for classification of celiac disease using the Marsh criteria. Analysis of statistical significance between groups of children with and without functional constipation was done using a 2-tailed Fisher exact test. RESULTS Patients diagnosed with functional constipation (n = 203) were matched with 419 healthy controls without FGIDs. The overall prevalence of celiac disease in the entire cohort was 0.6%. Of those with functional constipation, 1 (0.5%) was diagnosed with celiac disease, and 3 (0.7%) of the control patients without FGIDs had celiac disease (P = .743). CONCLUSIONS The prevalence of celiac disease in our cohort was similar to worldwide estimates. The prevalence of celiac disease in schoolchildren with functional constipation in Colombia is similar to those without FGIDs. Thus, routine testing of schoolchildren with functional constipation for celiac disease is not indicated.
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Affiliation(s)
- Amanda C Fifi
- Department of Pediatrics, University of Miami, Miami, FL.
| | - Carlos Velasco-Benitez
- Department of Pediatrics, Universidad del Valle, Cali, Colombia; Program in Clinical Medicine and Public Health, University of Granada, Grenada, Spain
| | - Miguel Saps
- Department of Pediatrics, University of Miami, Miami, FL
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Zhang Q, Zhong D, Sun R, Zhang Y, Pegg RB, Zhong G. Prevention of loperamide induced constipation in mice by KGM and the mechanisms of different gastrointestinal tract microbiota regulation. Carbohydr Polym 2020; 256:117418. [PMID: 33483010 DOI: 10.1016/j.carbpol.2020.117418] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Constipation is one of the most prevalent gastrointestinal tract diseases. Konjac glucomannan (KGM) dietotherapy can effectively relieve the clinical symptoms of patients with constipation. However, the causal relationship among KGM, constipation and different gastrointestinal microbiome (i.e., the stomach {St}, small intestine {S}, and large intestine {L}) remains poorly understood. In this study, constipated mice were treated with KGM (75, 150, 300 mg/kg bw). Results showed that KGM treatment improved the general physiological state, fecal character, small intestinal propulsive rate, gastric emptying rate, MTL and AchE activities, ET-1, 5-HT, and NO levels, and SCFA concentrations. KGM in the diets of constipated mice reduced the diversity of St and S microbiota, while increased those in the L. The KGM intervention regulated the microbiota profile, which afterwards was closer to the normal mouse group: confirmation was provided by different changes of bacteria like Lactobacillus, Bifidobacterium and Allobaculum spp et al.
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Affiliation(s)
- Qi Zhang
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Dian Zhong
- Department of Food Science and Technology, University of Georgia, Athens, 30602, United States
| | - Rui Sun
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Yang Zhang
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Ronald B Pegg
- Department of Food Science and Technology, University of Georgia, Athens, 30602, United States.
| | - Geng Zhong
- College of Food Science, Southwest University, Chongqing, 400715, China.
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118
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Kohyama J. Lifestyle Habits Associated with Poor Defecation Habit among Pupils in Japan. Pediatr Gastroenterol Hepatol Nutr 2020; 23:567-576. [PMID: 33215028 PMCID: PMC7667229 DOI: 10.5223/pghn.2020.23.6.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Not enough attention has been paid to defecation habits in Japan. This study aimed to emphasize the importance of defecation habits on health and function in Japanese pupils. METHODS Using multiple regression analysis, 2,722 questionnaires obtained from pupils in grades 5 to 12 were analyzed to determine lifestyle habits associated with defecation frequency. RESULTS Significant regression formulae for defecation scores were obtained for all school types: elementary school (ES) (adjusted R2=0.08, p<0.001), junior high school (JHS) (0.09, p<0.001), and senior high school (SHS) (0.15, p<0.001). The following factors were associated with poorer defecation scores, according to school type: female gender (all 3 school types), breakfast skipping (elementary and JHSs), lower physical activity (JHSs and SHSs), and longer school-day screen time (elementary and SHSs). In addition, poorer self-reported academic performance scores in ES, less standardized body mass index (BMI) in JHS, and shorter non-school- day screen time scores in SHS, were associated with poorer defecation scores. CONCLUSION Poor defecation frequency showed significant associations with various lifestyle habits, such as breakfast skipping, physical activity, and screen time, among pupils. Academic performance and standardized BMI were also associated with defecation frequency. More attention should be paid to defecation frequency to sustain health and function in pupils.
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Affiliation(s)
- Jun Kohyama
- Department of Pediatrics, Tokyo Bay Urayasu Ichikawa Medical Centre, Urayasu, Japan
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119
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Bolia R, Safe M, Southwell BR, King SK, Oliver MR. Paediatric constipation for general paediatricians: Review using a case-based and evidence-based approach. J Paediatr Child Health 2020; 56:1708-1718. [PMID: 33197982 DOI: 10.1111/jpc.14720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
Constipation is a common problem in childhood. The most common type of constipation is functional, accounting for 90-95% of all cases. The aim of this review is to provide clinical scenarios with treatment using evidence-based information, and management strategies and a clinical algorithm to guide the management of constipation in children. Recent guidelines and online information sites are detailed. Clinical red flags and organic causes of constipation are included. Four clinical scenarios are presented: case (1) 4-month-old child with constipation since birth and likely Hirschsprung disease; case (2) 6-month-old infant with infant dyschezia; case (3) 4-year old with functional constipation; and; case (4) 9-year old with treatment resistant constipation. Children with functional constipation need a thorough history and physical exam to rule out the presence of any 'red flags' but do not require laboratory investigations. Management includes education and demystification, disimpaction followed by maintenance therapy with oral laxatives, dietary counselling and toilet training. Treatment options differ between infants and children. Disimpaction and maintenance regimens for common laxatives are presented. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. The radionuclide intestinal transit study (scintigraphy) is a useful modality for evaluation and planning of management in treatment-resistant children. Treatment options for treatment-resistant patients are presented. High-level evidence (meta-analyses) for pharmalogical and non-pharmalogical treatment modalities are reviewed and an algorithm for assessment and treatment are presented.
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Affiliation(s)
- Rishi Bolia
- Division of Paediatric Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Mark Safe
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Bridget R Southwell
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark R Oliver
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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120
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Flankegård G, Mörelius E, Duchen K, Rytterström P. Experiences of parents who give pharmacological treatment to children with functional constipation at home. J Adv Nurs 2020; 76:3519-3527. [PMID: 33043491 PMCID: PMC7702076 DOI: 10.1111/jan.14539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Aim The aim was to explore the lived experiences of parents who give oral and rectal pharmacological treatment to their children with functional constipation at home. Design A phenomenological design with a reflective lifeworld research approach that describes phenomena as they are experienced by individuals. Methods From January–May 2019, 15 interviews were conducted with parents of children with functional constipation with home‐based oral and rectal treatment. Parents were recruited from three different healthcare levels. Open‐ended questions were used starting from the description of a normal day with constipation treatment. Analyses were made with an open and reflective ‘bridling’ attitude. Findings Constipation treatment causes parents to question their parental identity and what it means to be a good parent. Forced treatment makes them feel abusive and acting against their will as parents. There is a conflict between doubt and second thoughts about the treatment, the urge to treat based on the child's needs and encouragement from healthcare professionals to give treatment. Conclusion As pharmacological constipation treatment can be experienced as challenging, it is important to help parents make an informed decision about how such treatment should be carried out at home. The findings reveal a medical treatment situation where parents hesitate and children resist, resulting in insecure parents who question their parental identity. Impact The findings point to the importance of supporting parents in treatment situations. Healthcare providers need to treat children with constipation with greater focus and more prompt management to prevent these families from lingering longer than necessary in the healthcare system.
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Affiliation(s)
- Gunilla Flankegård
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Karel Duchen
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Rytterström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
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Rajindrajith S, Ranathunga N, Jayawickrama N, van Dijk M, Benninga MA, Devanarayana NM. Behavioral and emotional problems in adolescents with constipation and their association with quality of life. PLoS One 2020; 15:e0239092. [PMID: 33044960 PMCID: PMC7549826 DOI: 10.1371/journal.pone.0239092] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/29/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess behavioral and emotional problems in children and adolescents with functional constipation and their relationship with psychological maladjustment and health-related quality of life (HRQoL). Design A school-based cross-sectional survey conducted in 8 randomly selected schools from 4 randomly selected districts in Sri Lanka. A previously validated questionnaire was used for data collection. Behavioral and emotional problems were assessed using the Sinhala version of the Child Behavior Check List (CBCL-S/4-18). Constipation was diagnosed by applying the Rome III criteria. Results A total of 1000 questionnaires were distributed, and 913 completed questionnaires were included in the analysis. Sixty adolescents (6.5%) had functional constipation. Scores obtained for isolated psychological problems such as withdrawal (3.1 [3.1] vs. 1.9 [2.4], p<0.001), somatic complaints (3.2 [2.8] vs. 2.3 [2.5], p<0.05) anxiety/depression (5.8 [2.5] vs. 3.9 [3.6], p<0.001), social problems (3.0 [2.7] vs. 2.2 [1.9] p<0.001) and attention problems (5.4 [4.1] vs. 3.9 [3.4], p<0.001), and broadband scale of internalization (12.1 [8.4] vs. 8.3 [7.2], p<0.05) and mean total CBCL-S/4-18 score (29.4 [19.5] vs. 23.2 [17.0], p<0.001) were higher in adolescents with functional constipation. Clinical characteristics, socio-demographic and family factors and psychological maladjustment had no relationship with externalization, internalization and total CBCL-S/4-18 score. Internalization (-0.49, p<0.0001), externalization (-0.30, p<0.05), and total CBCL-S/4-18 (-0.44, p<0.001) scores had a negative impact on HRQoL of adolescents with functional constipation. Conclusions Adolescents with functional constipation are suffering from significant behavioral and emotional problems. These problems negatively affect their HRQoL.
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Affiliation(s)
- Shaman Rajindrajith
- Faculty of Medicine, Department of Pediatrics, University of Colombo, Colombo, Western Province, Sri Lanka
- The Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Nayomi Ranathunga
- Faculty of Medicine, Department of Physiology, Wyamba University of Sri Lanka, Kuliyapitiya, North Central Province, Sri Lanka
| | | | - Marieke van Dijk
- Psychological Department, Emma Children Hospital, Amsterdam University Medical Center, Meibergdreef, Amsterdam, The Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Meibergdreef, AZ, Amsterdam, The Netherlands
| | - Niranga Manjuri Devanarayana
- Faculty of Medicine, Department of Physiology, University of Kelaniya, Ragama, Western Province, Sri Lanka
- * E-mail:
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Yaqi H, Nan J, Ying C, Xiaojun Z, Lijuan Z, Yulu W, Siqi W, Shixiang C, Yue Z. Foot reflexology in the management of functional constipation: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 40:101198. [PMID: 32891277 DOI: 10.1016/j.ctcp.2020.101198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Foot reflexology has been considered an important complementary therapy for many health-related symptoms, especially for some chronic conditions such as anxiety, stress, pain and fatigue. Some studies also showed that foot reflexology had a significant effect on functional constipation, whereas some studies did not. The effect of foot reflexology on functional constipation remains controversial. Therefore, an evidence-based systematic review and meta-analysis of randomised controlled trials were conducted to investigate the effect of foot reflexology on functional constipation. METHODS Randomised controlled trials were identified by searching five electronic databases and hand-searching eligible reference lists. Studies that reported the effect of foot reflexology on functional constipation were included. Two reviewers performed the study screening, quality assessment and data extraction. Any discrepancy was discussed with a third reviewer. Quantitative synthesis was conducted for the same outcome measurements by calculating weighted risk ratios. RESULTS A total of 203 records were identified, of which seven were eligible. Overall, foot reflexology significantly increased the curative ratio, with a pooled risk ratio of 1.27 (95% CI: 1.16, 1.40, p < 0.00001). Three trials compared the improvement of constipation-related symptoms after intervention in both the experimental and control groups by evaluating the constipation-related symptom scores. The results all showed that foot reflexology can effectively improve constipation-related symptoms. However, one trial reported that foot reflexology had no significant effect on stool frequency and stool consistency. Two studies indicated that foot reflexology significantly reduced the recurrence rate of functional constipation. One study reported the effect of foot reflexology on compliance with the toilet training, diet and motivation. Nevertheless, no significant improvement was detected. CONCLUSION Foot reflexology is an effective complementary therapy for treating functional constipation. However, because of the small number of included studies and their small sample sizes, the current evidence was insufficient to support the effectiveness of foot reflexology in reducing the recurrence rate, improving the constipation-related symptom, and compliance with toilet training, diet and motivation. Randomised controlled trials with long-term follow-up are needed for further investigation.
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Affiliation(s)
- Huang Yaqi
- School of Nursing, Tianjin Medical University, China.
| | - Jiang Nan
- School of Nursing, Tianjin Medical University, China.
| | - Chen Ying
- School of Nursing, Tianjin Medical University, China.
| | - Zhang Xiaojun
- School of Nursing, Tianjin Medical University, China.
| | - Zhang Lijuan
- School of Nursing, Liaoning University of Traditional Chinese Medicine, China.
| | - Wang Yulu
- School of Nursing, Tianjin Medical University, China.
| | - Wei Siqi
- School of Nursing, Tianjin Medical University, China.
| | - Chen Shixiang
- School of Nursing, Tianjin Medical University, China.
| | - Zhao Yue
- School of Nursing, Tianjin Medical University, China.
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Thompson AP, MacDonald SE, Wine E, Scott SD. An Evaluation of Parents' Experiences of Patient Engagement in Research to Develop a Digital Knowledge Translation Tool: Protocol for a Multi-Method Study. JMIR Res Protoc 2020; 9:e19108. [PMID: 32663147 PMCID: PMC7435679 DOI: 10.2196/19108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background The last decade has seen increasing calls for patient and public involvement in health-related research due to an ideological shift toward more equitable methods of knowledge development and an effort to increase the usability and relevance of knowledge by improving outcomes in clinical practice. Patient engagement includes simply informing patients to offering complete decision-making autonomy to individuals, groups, communities, caregivers, friends, and families who have personal experience and knowledge of a health issue. Despite the use of patient engagement methods in research, evaluation has lagged, resulting in a knowledge gap that makes it difficult to foster capacity and sustainability for patients and researchers alike since little is known about how effective patient collaborations in research are built, maintained, or improved. This study centers on pediatric functional constipation, a common condition that affects children and families. Since parents play a pivotal role in treatment, they are an optimal group to engage in improving the resources and support available to them. Objective This study aims to use patient-engagement methods to establish a research collaboration with parents to cocreate a digital knowledge translation tool for parents caring for a child with functional constipation and formally evaluate the patient engagement processes within this project to build the science of patient engagement in research. Methods Members of the parent collaborator group will be recruited from previous participants who expressed interest in the development of a digital knowledge translation tool. The group will collaborate with the research team to create a tool to address patients’ support and information needs when caring for a child with functional constipation. The parent collaborator group will then be evaluated in a multimethod study design. Data will be digitally and anonymously collected from all members of the parent collaborator group, using the validated Public and Patient Engagement Evaluation Tool (PPEET) patient questionnaire. Descriptive statistics will be used to report group characteristics and question responses. Qualitative analysis will be used to understand open-ended question responses. Specifically, directed content analysis will be used to assess themes of the Patient Engagement in Research (PEIR) Framework with a combination of deductive and inductive analyses. Findings will be integrated into the discussion if there are sufficient commonalities and inter-relationships. The final manuscript will include reporting of each element as described by the Good Reporting of a Mixed Methods Study criteria. Results Recruitment is planned for June 2020. Data collection for the evaluation of patient engagement processes will occur upon completion of the digital knowledge translation tool. The results of this study are expected to be published by the end of 2020. Conclusions This study will provide valuable information about parents’ experiences participating in child-health research and is a fundamental step in building the science of patient engagement in research. International Registered Report Identifier (IRRID) PRR1-10.2196/19108
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Affiliation(s)
| | | | - Eytan Wine
- Department of Pediatrics, Division of Pediatric Gastroenterology & Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Vriesman MH, Wang L, Park C, Diefenbach KA, Levitt MA, Wood RJ, Alpert SA, Benninga MA, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence. Neurogastroenterol Motil 2020; 32:e13809. [PMID: 32017325 PMCID: PMC7507175 DOI: 10.1111/nmo.13809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND To compare antegrade continence enema (ACE) treatment and sacral nerve stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI). METHODS We performed a retrospective review of children 6-18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory. KEY RESULTS We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow-up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS). CONCLUSIONS AND INFERENCES Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.
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Affiliation(s)
- Mana H. Vriesman
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA,Department of Pediatric Gastroenterology and NutritionEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Lyon Wang
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA,The Ohio State University College of MedicineColumbusOHUSA
| | - Candice Park
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA,The Ohio State University College of MedicineColumbusOHUSA
| | | | - Marc A. Levitt
- Department of SurgeryNationwide Children's HospitalColumbusOHUSA
| | - Richard J. Wood
- Department of SurgeryNationwide Children's HospitalColumbusOHUSA
| | - Seth A. Alpert
- Department of UrologyNationwide Children's HospitalColumbusOHUSA
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and NutritionEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Karla Vaz
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA
| | - Peter L. Lu
- Division of Gastroenterology, Hepatology and NutritionDepartment of PediatricsNationwide Children's HospitalColumbusOHUSA
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Aydın G, van Engelenburg-van Lonkhuyzen ML, Baktır S, Kaya Mutlu E, Mutlu C, de Bie RA. The Turkish version of the childhood bladder and bowel dysfunction questionnaire (CBBDQ): Cross-cultural adaptation, reliability and construct validity. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:482-488. [PMID: 32721920 DOI: 10.5152/tjg.2020.19348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Bladder and bowel dysfunction (BBD) are both prevalent health problems in pediatric population. The CBBDQ is a parent-reported tool to evaluate and quantitatively assess bladder and bowel dysfunction symptoms in pediatric patients. This study was designed for the translation the CBBDQ into Turkish and the cultural adaptation of CBBDQ for the use among 5-12-year-old children. Moreover, another aim of this study was that the determination of the reliability and construct validity of the Turkish version. The main hypothesis of our study was that the translation and cultural adaptation of the CBBDQ into Turkish language, so that Turkish parents could understand it. Additionally, we estimated that the Turkish version would have eventual internal consistency and test-retest reliability and admissible construct validity. MATERIALS AND METHODS The CBBDQ was guideline driven translated into Turkish language and administered two times to the parents of children with one week interval to assess test-retest reliability. The internal consistency was determined by using Cronbach's α value and the test-retest reliability was calculated by using the inter-rater correlation coefficient. For the estimation of construct validity, the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and Pediatric Quality of Life Inventory (PedsQL) in 5-7, 8-12 years old children were used as the external criterias. RESULTS The participants were parents of 5-12-year-old children. The internal consistency was 0.83 that was the Cronbach's α value which reflects a good result. The Turkish-CBBDQ5-12y and the DVISS showed a satisfactory level correlation (r=0.64 P<0.001). There was not any correlation between the Turkish-CBBDQ5-12y and the PedsQL-General Health and PedsQL-Psychological Health (r=-0.17, P=0.1 and r:0.12 P=0.25, respectively). CONCLUSION The Turkish-CBBDQ5-12y version is a reliable and valid instrument in terms of the content and construction and can be confidently used in clinical practice.
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Affiliation(s)
- Gamze Aydın
- Division of Physiotherapy and Rehabilitation, İstanbul Okan University School of Health Sciences, Istanbul, Turkey;Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Institute of Graduate Education, Istanbul, Turkey
| | - Marieke L van Engelenburg-van Lonkhuyzen
- Deparment of Epidemiology, Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Seda Baktır
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Institute of Graduate Education, Istanbul, Turkey
| | - Ebru Kaya Mutlu
- Division of Physiotherapy and Rehabilitation, İstanbul University-Cerrahpasa School of Health Sciences, İstanbul, Turkey
| | - Caner Mutlu
- Department of Child and Adolescent Psychiatry, Bakirkoy Mazhar Osman Training and Research Hospital, İstanbul, Turkey
| | - Rob A de Bie
- Deparment of Epidemiology, Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
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126
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Blanco Díaz M, Bousoño García C, Segura Ramírez DK, Rodríguez Rodriguez ÁM. Manual Physical Therapy in the Treatment of Functional Constipation in Children: A Pilot Randomized Controlled Trial. J Altern Complement Med 2020; 26:620-627. [DOI: 10.1089/acm.2020.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- María Blanco Díaz
- Surgery and Medical Surgical Specialities Department, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, Spain
| | - Carlos Bousoño García
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Diana Katherine Segura Ramírez
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
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Steutel NF, Zeevenhooven J, Scarpato E, Vandenplas Y, Tabbers MM, Staiano A, Benninga MA. Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers. J Pediatr 2020; 221:107-114. [PMID: 32446468 DOI: 10.1016/j.jpeds.2020.02.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands. STUDY DESIGN Children were enrolled if they were age 0-48 months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12 months and for toddlers age 13-48 months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria. RESULTS In total 2751 children were included: 1698 infants age 0-12 months and 1053 children age 13-48 months. The prevalence of any FGID in infants age 0-12 months and 13-48 months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P = .030) and formula feeding (P = .045) were associated with the prevalence of any FGID among infants. Country (Italy) (P = .033) and parents subjected to domestic violence (P = .035) were associated with the prevalence of any FGID in toddlers age 13-48 months. CONCLUSIONS FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.
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Affiliation(s)
- Nina F Steutel
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Clinical Epidemiology, Bioinformatics and Biostatistics, Amsterdam, The Netherlands
| | - Judith Zeevenhooven
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - Elena Scarpato
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
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Athanasakos E, Cleeve S, Thapar N, Lindley K, Perring S, Cronin H, Borrelli O, Mutalib M. Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement. Neurogastroenterol Motil 2020; 32:e13797. [PMID: 31989766 DOI: 10.1111/nmo.13797] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) and high-resolution anorectal manometry (HRAM) are relatively novel tools for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. Although it is the gold standard tool in adults, it has yet to be formally accepted as a standardized diagnostic tool in the pediatric age, with limited knowledge regarding indications, protocol, and normal values. ARM/HRAM is slowly becoming recognized among pediatricians, but given that there are currently no agreed guidelines there is a risk that will lead to diversity in practice. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)-Motility Working Group (MWG) therefore has taken the opportunity to provide guidance on the use of ARM/HRAM in children with CC and/or FI.
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Affiliation(s)
| | | | - Nikhil Thapar
- Gastroenterology, Great Ormond Street Hospital, London, UK.,UCL Great Ormond Street Institute of Child Health Library, London, UK
| | - Keith Lindley
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Steve Perring
- Medical Physics, Poole Hospital NHS Trust, Poole, UK
| | - Hannah Cronin
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Osvaldo Borrelli
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Mohamed Mutalib
- Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
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Tosto M, D’Andrea P, Salamone I, Pellegrino S, Costa S, Lucanto MC, Pallio S, Magazzu’ G, Guandalini S. Functional constipation masked as irritable bowel syndrome. BMC Gastroenterol 2020; 20:86. [PMID: 32252644 PMCID: PMC7132980 DOI: 10.1186/s12876-020-01244-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/27/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rome IV criteria for functional gastrointestinal disorders state that children suspected of having Irritable Bowel Syndrome (IBS) with Constipation (IBS-C) should be preliminarily treated for constipation. We aimed at verifying if functional constipation may indeed lead to an erroneous diagnosis of IBS with diarrhea (IBS-D) or IBS with mixed pattern of diarrhea and constipation (IBS-M). METHODS We prospectively enrolled in an unblinded fashion 10 and 16 consecutive children referred to our center who met Rome IV criteria for a diagnosis of IBS-D and IBS-M, respectively. Patients who fulfilled criteria for suspect "occult constipation" were then given a bowel cleaning regimen with Polyethylene glycol 3350, re-evaluated at 2 months and followed up for at least 6 months. Sixteen additional patients with IBS with Constipation (IBS-C) referred in the same period served as control. The endpoints were: 1) a decrease of more than 50% in abdominal pain intensity and frequency scores; and 2) for patients with IBS-D and IBS-M: resolution of diarrhea. RESULTS The endpoints were met by 8 (80%) and 14 (87%) of the patients with IBS-D and IBS-M, respectively, with decrease of abdominal pain and resolution of "diarrhea". The response was not significantly different from that observed in 15 (93%) of the IBS-C control group. CONCLUSION Acknowledging the limitations of the small number of patients and of the uncontrolled nature of the study, we suggest that a possibly large number of patients labeled as IBS-D or IBS-M may actually simply present functional constipation and should be managed as such.
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Affiliation(s)
- Monica Tosto
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | | | - Ignazio Salamone
- Oncological Radiology Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino Hospital, University of Messina, Messina, Italy
| | - Salvatore Pellegrino
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Stefano Costa
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Maria Cristina Lucanto
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Socrate Pallio
- Digestive Diseases Endoscopy Unit, Policlinico G. Martino Hospital, University of Messina, Messina, Italy
| | - Giuseppe Magazzu’
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Adult and Pediatric Pathology Department G. Barresi, University of Messina, Messina, Italy
| | - Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, USA
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Noviello C, Nobile S, Romano M, Mazzarini A, Papparella A, Cobellis G. Functional constipation or redundancy of the colon? Indian J Gastroenterol 2020; 39:147-152. [PMID: 32406008 DOI: 10.1007/s12664-020-01034-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/26/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon. METHODS All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation. RESULTS Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59. CONCLUSIONS Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.
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Affiliation(s)
- Carmine Noviello
- Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy.
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, University Cattolica del Sacro Cuore, Rome, Italy
| | - Mercedes Romano
- Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy
| | - Alessandra Mazzarini
- Department of Radiological Sciences, Azienda Ospedaliero-Universitaria, Ancona, Italy
| | - Alfonso Papparella
- Pediatric Surgery Unit, Università degli Studi della Campania, Luigi Vanvitelli, Naples, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy
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Epidemiology of Functional Abdominal Pain Disorders and Functional Defecation Disorders in Adolescents in Curacao. J Pediatr Gastroenterol Nutr 2020; 70:e71-e76. [PMID: 32213782 DOI: 10.1097/mpg.0000000000002623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Functional abdominal pain disorders (FAPDs) and functional defecation disorders (FDDs) are common in children and adolescents, but prevalence rates from the Caribbean are lacking. Therefore, our aim was to determine the prevalence of FAPDs and FDDs in adolescents in Curacao and to assess the influence of psychosocial factors on the prevalence of FAPDs and FDDs. METHODS The prevalence of FAPDs and FDDs in children and adolescents living in Curacao, ages 11 to 18 years, was assessed using the Rome IV Questionnaire on Pediatric Gastrointestinal Disorders (RIV-QPGD). FAPDs and FDDs were diagnosed according to the Rome IV criteria. Sociodemographic characteristics, somatic symptoms, early adverse life events, stressful life events, and physical and emotional abuse were evaluated as associated factors. RESULTS Out of 946 questionnaires distributed, 783 were included for further analysis. The mean age of adolescents was 14.7 years (±1.6) with 61.7% being girls. A total of 266 adolescents (34%, 95% confidence interval [CI] 30.7-37.5) met Rome IV criteria for at least 1 FAPD or FDD. Twenty-nine adolescents (3.7%) qualified for 2 functional gastrointestinal disorders. Functional constipation (18.6%) and irritable bowel syndrome (12.3%) were the most prevalent disorders. After multivariate logistic regression analyses, dizziness (odds ratio [OR] 1.84, 95% CI 1.28-2.64) was significantly associated with having a FAPD or FDD. CONCLUSIONS FAPDs and FDDs are common in adolescents in Curacao. Dizziness is associated with the presence of a FAPD or FDD.
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Southwell BR. Treatment of childhood constipation: a synthesis of systematic reviews and meta-analyses. Expert Rev Gastroenterol Hepatol 2020; 14:163-174. [PMID: 32098515 DOI: 10.1080/17474124.2020.1733974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Constipation occurs in many children and can become chronic. Many grow out of it but for one third, it continues into adulthood. For most patients, there is no identifiable organic disorder and it is classified as functional constipation.Areas covered: In 2016, treatment of childhood constipation was extensively reviewed by Rome IV. This review covers meta-analyses and evidence for treatment of paediatric constipation since 2016 and new emerging treatments.Expert opinion: Since 2016, meta-analyses conclude 1) fibre should be included in a normal diet, but further supplementation does not improve constipation; 2) probiotics may increase stool frequency in children, but evidence from larger RCTs is needed; 3) comparing laxatives, polyethylene glycol (PEG) is superior to placebo, lactulose and milk of magnesia, and 4) appendix stomas are effective and should be considered before surgery. Emerging areas of study include food intolerance, electrical stimulation and faecal microbiota transplant. For research, outcome measures need standardising to allow comparison between studies and allow meta-analyses. To assist this, validated GI instruments have been developed by Rome IV and PedsQl.
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Affiliation(s)
- Bridget R Southwell
- Murdoch Children's Research Institute, Urology Department, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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133
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Trajanovska M, Liew A, Gibb S, Goldfeld S, King SK. Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling. J Paediatr Child Health 2020; 56:298-303. [PMID: 31436004 DOI: 10.1111/jpc.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
AIM This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). METHODS We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. RESULTS Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12-month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). CONCLUSION Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community-based primary care, need to be explored to improve timely management.
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Affiliation(s)
- Misel Trajanovska
- Centre for Community and Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Policy and Equity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amos Liew
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community and Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Policy and Equity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
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134
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van Summeren JJGT, Holtman GA, Kollen BJ, Lisman-van Leeuwen Y, van Ulsen-Rust AHC, Tabbers MM, Dekker JH, Berger MY. Physiotherapy for Children with Functional Constipation: A Pragmatic Randomized Controlled Trial in Primary Care. J Pediatr 2020; 216:25-31.e2. [PMID: 31732133 DOI: 10.1016/j.jpeds.2019.09.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the effectiveness of physiotherapy plus conventional treatment compared with conventional treatment alone for the treatment of functional constipation in children age 4-17 years in primary care. STUDY DESIGN Pragmatic randomized controlled trial with 8 months follow-up. Primary care physicians recruited children diagnosed with functional constipation (n = 234), and pediatricians recruited newly referred children with a diagnosis of functional constipation (n = 11). Conventional treatment comprised toilet training, nutritional advice, and laxative prescribing, whereas physiotherapy focused on resolving dyssynergic defecation. The primary outcome was treatment success over 8 months, defined as the absence of functional constipation (Rome III criteria) without laxative use. Secondary outcomes included the absence of functional constipation irrespective of continuation of laxative use and global perceived treatment effect. RESULTS Children were allocated to conventional treatment plus physiotherapy or conventional treatment alone (67 per group), mean (SD) age was 7.6 (3.5) years. Results of longitudinal analyses in the intention-to-treat population showed that the treatment success percentage was not statistically improved by adding physiotherapy to conventional treatment (adjusted relative risk [aRR] 0.80, 95% CI 0.44-1.30). At 4 months, fewer children receiving physiotherapy had treatment success (17%) than children receiving conventional treatment alone (28%), but this had equalized by 8 months (42% and 41%, respectively). The percentage of children without functional constipation, irrespective of continuation of laxative use, was not statistically different between groups over 8 months (aRR 1.12, 95% CI 0.82-1.34). Notably, parents reported significantly more global symptom improvement after physiotherapy than after conventional treatment (aRR 1.40; 95% CI 1.00-1.73). CONCLUSIONS We find no evidence to recommend physiotherapy for all children with functional constipation in primary care. TRIAL REGISTRATION Netherlands Trial Registry: NTR4797.
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Affiliation(s)
- Jojanneke J G T van Summeren
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands.
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Boudewijn J Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Yvonne Lisman-van Leeuwen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | | | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC-Location AMC, Amsterdam, the Netherlands
| | - Janny H Dekker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
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135
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Meena J, Mathew G, Hari P, Sinha A, Bagga A. Prevalence of Bladder and Bowel Dysfunction in Toilet-Trained Children With Urinary Tract Infection and/or Primary Vesicoureteral Reflux: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:84. [PMID: 32300575 PMCID: PMC7145391 DOI: 10.3389/fped.2020.00084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Urinary tract infection (UTI) in children leads to renal scarring in 10-15% of patients. Urinary tract anomalies and bladder and bowel dysfunction (BBD) are documented risk factors for recurrent UTIs. Estimates of baseline prevalence of BBD in children with UTI will help the clinician in the management strategy. Hence, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of BBD. Methods: MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched for articles related to UTI, primary vesicoureteral reflux (VUR), and BBD. We included studies that provided prevalence of BBD in toilet-trained patients aged 1-18 years with UTI and/or VUR. BBD was defined based on clinical history or questionnaire or urodynamic studies. Two authors independently reviewed, assessed, and abstracted data from studies. Pooled prevalence was calculated based on a random effects model. Results: Forty-three studies fulfilling the eligibility criteria were selected from a total of 1,731 studies. Among patients presenting with UTI without primary VUR, pooled prevalence of BBD was 41% (95% CI: 26-55; nine studies, 920 patients, I 2 = 96.0%), whereas its prevalence in patients with primary VUR was 49% (43-56; 30 studies, 5,060 patients, I 2 = 96.0%). Weighting by the study design and quality did not affect the prevalence. In patients with primary VUR, prevalence of BBD was higher in females (53%; 42-65) than in males (44%; 15-73). In studies where urodynamic study was used for the diagnosis of BBD, prevalence was 63%. The presence of BBD in patients with primary VUR increased risk of recurrent UTIs [relative risk (RR): 2.1; 1.7-2.5]. In five studies that reported separate data on constipation, pooled prevalence of constipation was 27% (16-37). Conclusion: Almost half of the patients with primary VUR have BBD, and its presence increases the risk of recurrent UTIs. Trends of high BBD prevalence were also observed in patients presenting with UTI without VUR. These prevalence estimates suggest that all toilet-trained children presenting with UTI with or without VUR should be assessed for BBD, which will help in their further management.
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Affiliation(s)
- Jitendra Meena
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Georgie Mathew
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Nephrology, All India Institute of Medical Sciences, New Delhi, India
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136
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Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020; 17:21-39. [PMID: 31690829 DOI: 10.1038/s41575-019-0222-y] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Michael Camilleri
- C.E.N.T.E.R. Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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137
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Probiotics for Childhood Functional Gastrointestinal Disorders: Do We Know What We Advise? PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2019.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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138
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Játiva‐Mariño E, Rivera‐Valenzuela MG, Velasco‐Benitez CA, Saps M. The prevalence of functional constipation in children was unchanged after the Rome IV criteria halved the diagnosis period in Rome III. Acta Paediatr 2019; 108:2274-2277. [PMID: 31140192 DOI: 10.1111/apa.14880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/26/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022]
Abstract
AIM The Rome IV criteria for the diagnosis of functional constipation are one month, compared with two months in the Rome III criteria. Our aim was to see whether this altered the prevalence in Ecuador by surveying school children and comparing the results to our previous study. METHODS A cross-sectional study was conducted in Quito, Ecuador, in 2013 two randomly selected schools: one private and one public. Children aged 8-15 completed the Spanish version of the Questionnaire of Paediatric Gastrointestinal Symptoms based on the Rome IV criteria. We compared our findings with our previous 2013 study based on the Rome III criteria. RESULTS A total of 951 children (61% male) completed the Rome IV questionnaire from June to July 2017 at a mean age of 11.2 ± 1.8 years, and 417 children (52% male) completed the Rome III questionnaire in June 2013 at a mean age of 12.0 ± 1.8 years. We found that 14.4% met the Rome IV criteria for functional constipation compared with 11.8% for the Rome III criteria (p = 0.11). CONCLUSION Modifying the time required for a diagnosis functional constipation from two months to one month did not result in a significant difference in the prevalence.
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Affiliation(s)
- Edgar Játiva‐Mariño
- Faculty of Medicine Universidad Central del Ecuador Quito Ecuador
- Medical Sciences PhD program Universidad de La Frontera Temuco Chile
| | | | | | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Miller School of Medicine University of Miami Miami FL USA
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139
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Rego RMP, Machado NC, Carvalho MDA, Graffunder JS, Ortolan EVP, Lourenção PLTDA. Transcutaneous posterior tibial nerve stimulation in children and adolescents with functional constipation: A protocol for an interventional study. Medicine (Baltimore) 2019; 98:e17755. [PMID: 31702626 PMCID: PMC6855522 DOI: 10.1097/md.0000000000017755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION A vast majority of children with functional constipation respond to the standard medical treatment. However, a subset of patients may present with an unsatisfactory response and only minor improvement of symptoms. Transcutaneous posterior tibial nerve stimulation (PTNS) involves electrical stimulation of the posterior tibial nerve at the level of the ankle, transcutaneously through electrodes fixated on the overlying skin. Stimulation of the tibial nerve can modulate urinary and defecatory function through the stimulation of sacral nerves. Thus, transcutaneous PTNS can be considered a very promising, noninvasive, and safe method to be used in the pediatric age group. However, there is still no published study that has investigated its use in children for the treatment of intestinal constipation. This is a single-center, prospective, longitudinal, and interventional study designed to assess the applicability and clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation. Children will be submitted to daily sessions of transcutaneous PTNS for a period of 4 weeks. All children will also be invited to participate in semistructured interviews, 1 in each of the 3 assessments: 1 week before the start of the intervention; immediately after the 4 weeks of intervention; and 4 weeks after the end of the intervention period. In these interviews, the aspects related to bowel habits and quality of life will be assessed. This project aims to evaluate the clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation and the applicability of this kind of treatment. CONCLUSIONS This protocol intended to demonstrate the efficacy of this promising method to increase the number of bowel movements and the stool consistency, to reduce the number of episodes of retentive fecal incontinence, and to indirectly improve the overall quality of life.
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Affiliation(s)
| | - Nilton Carlos Machado
- UNESP - São Paulo State University, Botucatu Medical School, Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Division, Botucatu
| | - Mary de Assis Carvalho
- UNESP - São Paulo State University, Botucatu Medical School, Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Division, Botucatu
| | | | - Erika Veruska Paiva Ortolan
- UNESP - São Paulo State University, Botucatu Medical School, Department of Surgery and Orthopedics, Pediatric Surgery Division, Botucatu, SP, Brazil
| | - Pedro Luiz Toledo de Arruda Lourenção
- UNESP - São Paulo State University, Botucatu Medical School, Department of Surgery and Orthopedics, Pediatric Surgery Division, Botucatu, SP, Brazil
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140
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Vriesman MH, Rajindrajith S, Koppen IJN, van Etten-Jamaludin FS, van Dijk M, Devanarayana NM, Tabbers MM, Benninga MA. Quality of Life in Children with Functional Constipation: A Systematic Review and Meta-Analysis. J Pediatr 2019; 214:141-150. [PMID: 31399248 DOI: 10.1016/j.jpeds.2019.06.059] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the literature on health-related quality of life (HRQoL) in children with functional constipation and to identify disease-related factors associated with HRQoL. STUDY DESIGN The Pubmed, Embase, and PsycINFO database were searched. Studies were included if they prospectively assessed HRQoL in children with functional constipation according to the Rome criteria. Articles were excluded if patients had organic causes of constipation and if HRQoL was only assessed after successful therapeutic interventions. A meta-analysis was performed calculating sample size-weighted pooled mean and SD of HRQoL scores. The quality of the studies was also assessed. RESULTS A total of 20 of 2658 studies were included, providing HRQoL data for 2344 children. Quality of evidence was considered to be poor in 9 of the 20 studies (45%); 13 of the 20 studies reported sufficient data to be included in the meta-analysis. Pooled total HRQoL scores of children with functional constipation were found to be lower compared with healthy reference samples (65.6 vs 86.1; P < .01). Similar HRQoL scores were found according to self-report and parent proxy report. Hospital-based studies reported lower HRQoL scores as compared with community-based studies. Two studies reported on HRQoL scores of children with and without fecal incontinence, but no significant difference was found. CONCLUSIONS HRQoL is compromised in children with functional constipation.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marieke van Dijk
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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141
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Abstract
PURPOSE OF REVIEW Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre- and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. RECENT FINDINGS Pre- and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.
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142
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Timmerman MEW, Trzpis M, Broens PMA. The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study. Eur J Pediatr 2019; 178:33-39. [PMID: 30264351 PMCID: PMC6311181 DOI: 10.1007/s00431-018-3243-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/28/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
Abstract
We aimed to study constipation and fecal incontinence in terms of prevalence, recognizing the disorders, help-seeking behavior, and associated symptoms. In this cross-sectional study, 240 children (8 to 18 years) from the general Dutch population completed a questionnaire about defecation disorders. After exclusions for anorectal/pelvic surgery or comorbidities, we analyzed 212 children. The prevalence of constipation was 15.6%; in a quarter of the cases, it co-occurred with fecal incontinence. We found 3% fecal incontinence without constipation. Even though children with a defecation disorder rated their bowel habits worse compared to children without defecation disorders (P < 0.001), 46% constipated children and 67% fecally incontinent children rated their bowel habits as good or very good. Moreover, 21 to 50% of children with a defecation disorder did not mention their symptoms to anybody. Interestingly, most constipated children had "normal" stool frequencies (64%) and consistencies (49%).Conclusion: The prevalence of constipation and fecal incontinence is quite high in children. Stool frequency and consistency is normal in half the constipated children, which may complicate the recognition of constipation. Finally, a considerable number of children does not recognize their disorders as constituting a problem and does not seek help, which leads to an underestimation of these disorders. What is Known: • Constipation and fecal incontinence are common in children, but their prevalence rates may be underestimated due to a variety of reasons. • Diagnosing these disorders remains challenging owing to the variety of symptoms and co-existence with other diseases. What is New: • The prevalence of constipation and fecal incontinence in children is high. • Many children do not recognize their defecation disorders as constituting a problem and do not seek help, which leads to an underestimation of the problem of these disorders.
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Affiliation(s)
- Marjolijn E. W. Timmerman
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M. A. Broens
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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143
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Froon-Torenstra D, Beket E, Khader AM, Hababeh M, Nasir A, Seita A, Benninga MA, van den Berg MM. Prevalence of functional constipation among Palestinian preschool children and the relation to stressful life events. PLoS One 2018; 13:e0208571. [PMID: 30521620 PMCID: PMC6283531 DOI: 10.1371/journal.pone.0208571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
AIM Increasing evidence exists with respect to the relation between stressful life events and functional constipation (FC). We aimed to investigate the prevalence of FC in Palestinian refugee preschool children and to determine if stress and trauma exposure are risk factors of FC in these children. METHODS From November 2013 until May 2014, a cross-sectional survey was conducted in West Bank, Gaza and Jordan. Mothers of 862 Palestinian refugee children aged 7-48 months were interviewed on defecation pattern, socio-economic factors and the child's exposure to traumatic events. RESULTS Twelve percent of the Palestinian refugee children fulfilled the criteria for FC. The prevalence of constipation was significantly lower in Gaza compared to Jordan (2% vs. 17%, p <0,001). Living in Gaza was associated with lower odds of FC (OR 0,08, 95% CI 0,03-0,20). Trauma exposure was associated with higher odds of FC (OR 1,19, 95% CI 1,06-1,35), however only a small number of children had been exposed to traumatic events. CONCLUSION The overall prevalence of FC in Palestinian preschool children is comparable to prevalence rates among older children worldwide. In this age group stressful life events and trauma exposure seem not to play an important role in the development of FC.
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Affiliation(s)
| | - Elise Beket
- Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Ali M. Khader
- United Nations Relief and Works Agency for Palestinian refugees in the Near East, Headquarters Amman, Jordan
| | - Majed Hababeh
- United Nations Relief and Works Agency for Palestinian refugees in the Near East, Headquarters Amman, Jordan
| | - Arwa Nasir
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Akihiro Seita
- United Nations Relief and Works Agency for Palestinian refugees in the Near East, Headquarters Amman, Jordan
| | - Marc A. Benninga
- Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
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Parent-child Agreement on Health-Related Quality of Life in Children With Functional Constipation in Primary Care. J Pediatr Gastroenterol Nutr 2018; 67:726-731. [PMID: 30095575 PMCID: PMC6282676 DOI: 10.1097/mpg.0000000000002124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Functional constipation (FC) has a major impact on the health-related quality of life (HRQoL) of children. The aim of this study was to evaluate parent-child agreement on HRQoL in children (8-17 years) with FC in primary care. METHODS Children diagnosed with FC by their clinician were eligible. HRQoL was measured with the Defecation Disorder List (DDL, score 0-100), and the EuroQol-5-Dimension-Youth Visual Analogue Scale (EQ-5D-Y-VAS, scale 0-100). Parent-child agreement was examined with discrepancy scores, intraclass correlation coefficients and Bland-Altman plots. RESULTS Fifty-six children, median age of 10 years (IQR 8-12) and their parents were included. Parent-child agreement at a group level was good, with an intraclass correlation coefficient of 0.80 (95% confidence interval 0.67 to 0.88) for the DDL, and 0.78 (95% confidence interval 0.65 to 0.87) for the EQ-5D-Y-VAS. Mean discrepancy scores for the DDL and EQ-5D-Y-VAS were small: -2.6 and -2.9, implying that parents were slightly more positive about the HRQoL than their children. Bland-Altman plots showed considerable discordance between individual parent-child pairs. Limits of agreement were -19.7 and 14.6 for the DDL and -27.6 and 21.8 for the EQ-5D-Y-VAS. CONCLUSIONS There is good parent-child agreement on HRQoL in children with FC at group level. However, a substantial number of parent-child pairs differed considerably on their rating of the HRQoL of the child. Therefore, we recommend clinicians, if they want to have an impression of the impact of the FC on the HRQoL of the child, to ask both the child and the parent(s).
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Lack of Benefit of Lactobacillus reuteri DSM 17938 as an Addition to the Treatment of Functional Constipation. J Pediatr Gastroenterol Nutr 2018; 67:763-766. [PMID: 30134331 DOI: 10.1097/mpg.0000000000002134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to investigate the role of Lactobacillus reuteri DSM 17983 in the treatment of functional constipation in children. The trial was a single-center randomized, double-blind, placebo-controlled study. Patients were allocated into the 2 groups; intervention group which received L reuteri DSM 17983 and lactulose and placebo group which received placebo and lactulose. Due to small recruitment rate study was terminated prematurely; therefore, only 33 children (12 girls, median age 4.5 years, range 2-16) were randomized. There was no difference between groups in the stool frequency, stool consistency, pain, soiling rate and dose of the lactulose. This study found that L reuteri DSM 17938 adds no benefit to the treatment of constipation in children. Due to small sample size, these results, however, should be interpreted with caution.
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146
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The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children. Nutrients 2018; 10:nu10111650. [PMID: 30400292 PMCID: PMC6267171 DOI: 10.3390/nu10111650] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 12/12/2022] Open
Abstract
We reviewed the available evidence on the role of fiber in the treatment of Functional Constipation (FC) and Irritable Bowel Syndrome (IBS) in children. The vast majority of toddlers and preschoolers do not consume enough fiber. Two of the most common reasons for consultation to a pediatric gastroenterology practice include FC and IBS. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines state that the evidence does not support the use of fiber supplements in the treatment of FC in children, and the Rome IV criteria do not recommend an increase in fiber consumption, in children with IBS. Despite this, in general practice, it is commonly recommended that children who experience constipation and IBS to increase their fiber intake. We conducted a systematic review of the available evidence on the role of fiber in the treatment of FC and IBS in children. Thirteen full-text articles with a total of seven hundred and twenty-three pediatric participants were included in this review. Three clinical trials found positive effects of dietary fiber for the management of IBS. Nine out of ten trials found fiber to be either more effective than placebo, or just as effective as laxative treatment. Most studies on the use of fiber for the treatment of FC and IBS have shown its benefit. However, due to the heterogeneity in study design, length of treatment, outcome measures, and amount and type of fiber, we were unable to make a definitive recommendation supporting the use of fiber for the treatment of FC and IBS in children.
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147
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Neuhaus E, Bernier RA, Tham SW, Webb SJ. Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents With Autism Spectrum Disorder. Front Psychiatry 2018; 9:515. [PMID: 30405456 PMCID: PMC6204460 DOI: 10.3389/fpsyt.2018.00515] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 12/18/2022] Open
Abstract
Individuals with autism spectrum disorder (ASD) are at heightened risk of psychiatric comorbidities across the lifespan, including elevated rates of internalizing, externalizing, and self-injurious behaviors. Identification of medical comorbidities that contribute to these concerns may elucidate mechanisms through which psychiatric concerns arise, as well as offer additional avenues for intervention. Gastrointestinal (GI) conditions are of particular interest, as they are prevalent among those with ASD, may share genetic or neurobiological etiologies with the core features of ASD, and are linked with psychiatric difficulties in the general population. In this paper, we draw on data from nearly 2,800 children and adolescents with ASD within the Simons Simplex Collection to characterize the unique contributions of (1) autism symptoms, (2) psychosocial factors (child's age, sex, verbal and nonverbal IQ, adaptive behavior, race, and household income), and (3) GI concerns with respect to multiple psychiatric outcomes. Multiple regression models revealed unique contributions of ASD symptoms and multiple psychosocial factors such as verbal IQ, adaptive behavior, and family income to internalizing, externalizing, and self-injurious behavior. In general, higher levels of psychiatric symptoms were associated with more ASD symptoms, higher verbal IQ, lower adaptive behavior skills, and lower family income. Furthermore, levels of GI symptoms accounted for unique variance in psychiatric outcomes over and above these other factors, linking increased GI problems with increased psychiatric symptoms in children with ASD. Taken together, results indicate that the presence and quantity of GI symptoms should be considered when evaluating psychiatric and behavioral concerns among children with ASD, and that treatment of GI conditions may be an important component in alleviating a broad array of mental health concerns in this group.
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Affiliation(s)
- Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
| | - Raphael A Bernier
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - See Wan Tham
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Rajindrajith S, Devanarayana NM, Benninga MA. Delayed or not delayed? That is the question in Indian children with constipation. Indian J Gastroenterol 2018; 37:385-387. [PMID: 30315493 DOI: 10.1007/s12664-018-0893-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Emma Children Hospital, Amsterdam, The Netherlands
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Lyseng-Williamson KA. Macrogol (polyethylene glycol) 4000 without electrolytes in the symptomatic treatment of chronic constipation: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2018; 34:300-310. [PMID: 30546252 PMCID: PMC6267542 DOI: 10.1007/s40267-018-0532-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Macrogol 4000, a biologically inert, non-absorbable osmotic laxative, is a highly effective and well-tolerated first-line option for the treatment of the symptoms of chronic idiopathic/functional constipation in children and adults. High-molecular-weight (HMW) macrogols ± electrolytes have generally similar efficacy profiles; however, the taste of macrogol 4000 is generally preferred over that of macrogol 3350 + electrolytes. Macrogol 4000 is more effective than lactulose in improving stool frequency and consistency, and is associated with less vomiting and flatulence. Comparisons with other osmotic and bulk-forming laxatives are limited, with macrogol 4000 being at least as, or more effective than, psyllium hydrocolloid and magnesium hydroxide in treating chronic constipation. Current clinical treatment guidelines recommend the use of HMW macrogols over the use of lactulose and bulk-forming laxative in the symptomatic treatment of constipation in children and adults.
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150
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Hojsak I. Probiotics in Functional Gastrointestinal Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1125:121-137. [PMID: 30578460 DOI: 10.1007/5584_2018_321] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Infantile colic, constipation, functional abdominal pain (FAP), and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders (FGID). This chapter will review current evidence on the role of probiotics in the treatment of these FGID. The etiology of FGID is considered multifactorial, but the importance of intestinal microbiota in their development has been repeatedly emphasized. As a consequence, the potential role of probiotics in their treatment is being increasingly scrutinized. Presently, the strongest evidence of efficacy is for the use of Lactobacillus reuteri (L reuteri) DSM 17938 at the dose of 108 CFU/day for the treatment of infantile colic in breastfed infants. Limited, yet encouraging, evidence exists for Lactobacillus rhamnosus GG (LGG) at the dose of 3 × 109 CFU and for a multi-strain preparation for the treatment of IBS. In the treatment of FAP, there is some evidence for the use of L reuteri DSM 17938 at the dose of at least 108 CFU/day.
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Affiliation(s)
- Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Zagreb, Croatia. .,School of Medicine Osijek, University J.J. Strossmayer, Osijek, Croatia.
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