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Yousefi-Fatmesari G, Chegene Lorestani R, Rostamian M, Khodamoradi S, Sedighi M, Daryoushi H, Norouzi M, Hoseini J, Ghadiri K. Comparison of the Effect of Two Therapeutic Interventions for the Treatment of Chronic Constipation in Children With Cerebral Palsy: A Randomized Clinical Trial. Glob Pediatr Health 2024; 11:2333794X241274287. [PMID: 39281353 PMCID: PMC11402094 DOI: 10.1177/2333794x241274287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 07/04/2024] [Accepted: 07/10/2023] [Indexed: 09/18/2024] Open
Abstract
Objectives. Constipation is one of the most common gastrointestinal symptoms in children with neurological disorders. This study was performed to compare the therapeutic effect of polyethylene glycol (PEG) plus domperidone with PEG plus placebo in the treatment of chronic constipation in children with cerebral palsy. Methods. In this a double-blind clinical trial study was done on the children with cerebral palsy who had chronic constipation and was referred to Mohammad Kermanshahi hospital of Kermanshah city in the west of Iran. The participants were randomly divided into 2 groups with 2 therapies of PEG combined with domperidone (case group, n = 21) and PEG with placebo (control group, n = 21). The information was extracted from patients based on the checklist before and after treatment and the response to treatment in the 2 groups were determined and compared. The data were analyzed by T-test or Mann-Whitney U test to compare quantitative variables and Chi-square and Fisher's exact tests for comparing qualitative variables. Results. In both case and control groups, all Rome IV criteria for a diagnosis of chronic constipation except incontinence were significantly reduced after treatment. However, the successful response rate in the case group (PEG + domperidone) was 90.5%, while this rate was 61.9% in the control group. Conclusion. Based on the results of the present study, it seems that PEG plus domperidone had a positive effect on the treatment of children with cerebral palsy and chronic constipation.
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Affiliation(s)
| | - Roya Chegene Lorestani
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepideh Khodamoradi
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Sedighi
- Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Daryoushi
- Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Norouzi
- Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jamal Hoseini
- Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Darma A, Fardah Atthiyah A, Rizky Sumitro K, Ferlina Lasmono S, Gunadi Ranuh R, Indra Gunawan P, Saharso D, Marto Sudarmo S. Polyethylene Glycol 4000 for Fecal Disimpaction in Cerebral Palsy Children. IRANIAN JOURNAL OF CHILD NEUROLOGY 2024; 18:61-69. [PMID: 38375128 PMCID: PMC10874514 DOI: 10.22037/ijcn.v17i2.37876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/22/2022] [Indexed: 02/21/2024]
Abstract
Objectives This study evaluated the efficacy of Polyethylene glycol 4000 for fecal disimpaction in children with cerebral palsy. Materials & Methods A randomized control trial study was conducted on children with cerebral palsy between February - March 2017 in the pediatric neurology outpatient clinic Dr. Soetomo Hospital. Children aged 2-16 years with fecal impaction randomly assigned into polyethylene glycol 4000 (PEG 4000) and saline enema group. Polyethylene glycol 4000 was given at a dosage of 0.7 g/kg and enema using normal saline 15ml/kg twelve hourly. Constipation was diagnosed using ROME IV criteria, and abdominal palpation identified fecal impaction. Efficacy was evaluated by clinical observation and adverse symptom monitoring. Data were analyzed by statistical software using an independent t-test (p<0,05). Results Thirty-two children were randomized into the study. Muscle relaxant was discovered in 17/32 patients. Sex, age, and body weight were not statistically different between groups. The resolution of fecal impaction was significantly different between PEG 4000 and saline enema (21.69 hours and 39 hours respectively; p=0.001). Application of muscle relaxant and severity of the disease did not involve treatment efficacy. There was no adverse symptom reported during treatment. Conclusion Polyethylene glycol 4000 results in fecal disimpaction faster than enema in constipated children with cerebral palsy.
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Affiliation(s)
- Andy Darma
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Alpha Fardah Atthiyah
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Khadijah Rizky Sumitro
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Shirley Ferlina Lasmono
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Reza Gunadi Ranuh
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Prastiya Indra Gunawan
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Darto Saharso
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Subijanto Marto Sudarmo
- Department of Child Health, Faculty of Medicine Universitas Airlangga/ Dr. Soetomo General Hospital Surabaya, Indonesia
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López J, Barba MG, Fernández SN, Solana MJ, Urbano J, Sánchez C, López-Herce J. Protocol for treatment of constipation with polyethylene glycol 3350 plus electrolytes in critically ill children. An Pediatr (Barc) 2023; 99:176-184. [PMID: 37640660 DOI: 10.1016/j.anpede.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. METHODS We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). RESULTS The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events. CONCLUSIONS The PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.
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Affiliation(s)
- Jorge López
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain.
| | - María G Barba
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Montepríncipe, Madrid, Spain
| | - Sarah N Fernández
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - María J Solana
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Urbano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - César Sánchez
- Unidad de Gastroenterología Infantil, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, RICORS (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús López-Herce
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
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Tran DL, Sintusek P. Functional constipation in children: What physicians should know. World J Gastroenterol 2023; 29:1261-1288. [PMID: 36925458 PMCID: PMC10011959 DOI: 10.3748/wjg.v29.i8.1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 02/16/2023] [Indexed: 02/28/2023] Open
Abstract
Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.
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Affiliation(s)
- Duc Long Tran
- Thailand and Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Bangkok, Thailand
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 9000, Viet Nam
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Thai Red Cross, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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Belsky JA, Stanek JR, Rose MJ. Investigating the safety and feasibility of osteopathic medicine in the pediatric oncology outpatient setting. J Osteopath Med 2022; 122:423-429. [PMID: 35421288 DOI: 10.1515/jom-2021-0246] [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: 10/07/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Pediatric patients receiving chemotherapy experience unwanted therapy-induced side effects, commonly constipation and pain that diminish quality of life. To date, few studies have investigated the safety and feasibility of osteopathic manipulative treatment (OMT) in pediatric oncology. OBJECTIVES The primary objective of this study is to investigate the safety and feasibility of OMT in pediatric oncology outpatient clinics. METHODS This is a single institutional pilot study evaluating children aged ≥2-21 years receiving chemotherapy for an oncological diagnosis at Nationwide Children's Hospital (NCH). Permission was obtained from the NCH Institutional Review Board. Participants were enrolled for 8 weeks and received weekly OMT. OMT was deemed feasible by participating in six out of eight weekly treatments, and safety was assessed through adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE). During the clinic visit, patients answered validated surveys on constipation (Bristol Stool Scale) and pain (FACES Scale) pre/post-OMT. Feasibility was analyzed utilizing a one-sided exact binomial test while validated tools and adverse events were summarized descriptively. RESULTS A total of 23 patients were enrolled, with 21 included in feasibility analyses. The majority of the patients were female (n=13, 61.9%), with a median age of 12 years at enrollment (range, 2.7-20.8 years). There were no serious adverse events attributed to OMT intervention, and among the patients assessed for feasibility, 100% of them participated in at least two-thirds of their weekly OMT treatments, meeting our defined feasibility criteria. The intervention lasted an average of 14.2 min (range, 7.2-19.2 min). There were no FACES or Bristol Stool Scale scores that correlated with worsening pain on constipation post-OMT intervention. CONCLUSIONS Pediatric oncology patients were feasibly and safely able to receive OMT during a regularly scheduled chemotherapy visit. The limitations include the small sample size. These findings support the need to further investigate the safety and feasibility, as well as efficacy, of OMT in the pediatric oncology clinical setting.
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Affiliation(s)
- Jennifer A Belsky
- Division of Pediatric Hematology/Oncology/BMT, Riley Hospital for Children, Indianapolis, IN, USA.,Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Joseph R Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa J Rose
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Leung AKC, Hon KL. Paediatrics: how to manage functional constipation. Drugs Context 2021; 10:2020-11-2. [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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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: 5] [Impact Index Per Article: 1.3] [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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Hossain MJ, Rahman MM, Amin MR, Ali MA, Rana S, Kumar D, Hoque MA, Khan JM, Ahamed M. Clouding phenomena and thermodynamics of TX-100 + polyethylene glycol mixture: influence of several electrolytes. CHEMICAL PAPERS 2020. [DOI: 10.1007/s11696-020-01385-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Abstract
PURPOSE OF REVIEW Chronic constipation is a common problem that substantially impacts the quality of life of patients and families, healthcare professionals, and resources. The purpose of this review is to discuss the medications that are available for management of chronic constipation, including medications that have been approved by the FDA for adults, other been studied in pediatrics now, and might become available within the upcoming years. RECENT FINDINGS Recent developments in the evaluation of childhood constipation are providing a better understanding into defecation disorders in children and not only new therapies are becoming available, including medications, but also other therapies, such as biofeedback for treatment of functional defecation disorders, electrical stimulation, and surgeries. The aim of this article is to provide an update on the medications that are available for management of chronic constipation, especially with the development and study of newer medications, such as Linaclotide and Lubiprostone with promising results in both adult and pediatric patients. SUMMARY This review will help us identify and have a better understanding regarding what medications are available for use and the indications, so that we can better manage patients with chronic constipation. VIDEO ABSTRACT.
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11
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Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.742937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yue C, Liu Y, Zhang X, Xu B, Sheng H. Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty. J Clin Nurs 2020; 29:2863-2871. [PMID: 32320100 DOI: 10.1111/jocn.15299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Chen Yue
- Department of Orthopedic Surgery Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province Luoyang China
- Zhejiang Chinese medical university Hangzhou China
| | - Youwen Liu
- Department of Orthopedic Surgery Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province Luoyang China
| | - Xue Zhang
- Department of Orthopedic Surgery Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province Luoyang China
| | - Bin Xu
- Department of Orthopedics Tongde Hospital of ZheJiang Province Hangzhou China
| | - Hongfeng Sheng
- Department of Orthopedics Tongde Hospital of ZheJiang Province Hangzhou China
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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: 8] [Impact Index Per Article: 2.0] [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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14
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Dehghani SM, Bahroloolomifard MS, Yousefi G, Pasdaran A, Hamedi A. A randomized controlled double blinded trial to evaluate efficacy of oral administration of black strap molasses (sugarcane extract) in comparison with polyethylene glycol on pediatric functional constipation. JOURNAL OF ETHNOPHARMACOLOGY 2019; 238:111845. [PMID: 30946967 DOI: 10.1016/j.jep.2019.111845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/18/2019] [Accepted: 03/29/2019] [Indexed: 02/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE As a significant health issue, Functional Constipation (FC) has a high prevalence of 0.7%-29% worldwide. In Persian ethnomedicine, several formulations of sugarcane extracts including faniz, shekar-e- sorkh and black strap molasses have been used to treat pediatric constipation. AIM OF THE STUDY To evaluate efficacy and safety of oral intake of black strap molasses syrup (BSM) on FC in children. MATERIALS AND METHODS A randomized controlled double blinded trial was performed on children aged 4-12 years diagnosed with FC according to ROMIII Constipation Measurement Questionnaire. Ninety-two patients were randomly divided in two groups of BSM or PEG syrups (40%) with a dose of 1 mL/kg body weight/day for 1 month. Symptoms were evaluated every two weeks. Possible serological side-effects and changes in children's body weight were investigated. BSM syrup constituents were determined by pharmacognostic methods. RESULTS Treatment was successful with both interventions with no significant difference between the groups. Defecation per week was significantly improved in both groups. Symptoms including volitional stool retention, large diameter stool, painful or hard stool and large fecal mass in the rectum decreased significantly two and four weeks after intervention (P < 0.05). There was no significant difference between groups except for the rate of large diameter stool. No side -effects were observed. The BSM naturally contained polyphenols (960 μg/mL), potassium (12430 μg/mL), iron (80 μg/mL) and calcium (3320 μg/mL). CONCLUSION BSM and PEG syrups had similar efficacy on FC. Compared with PEG, BSM syrup contained different natural micronutrients.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Department of Pediatric Gastroentrology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Gholamhossein Yousefi
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ardalan Pasdaran
- Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Hamedi
- Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmacognosy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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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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Yachha SK, Srivastava A, Mohan N, Bharadia L, Sarma MS. Management of Childhood Functional Constipation: Consensus Practice Guidelines of Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1402-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Mínguez M, López Higueras A, Júdez J. Use of polyethylene glycol in functional constipation and fecal impaction. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:790-806. [PMID: 27871178 DOI: 10.17235/reed.2016.4571/2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate in an analytical and descriptive manner the evidence published so far on the use of polyethylene glycol (PEG), with or without electrolytes, in the management of functional constipation and the treatment of fecal impaction. METHODOLOGY Search on MEDLINE, EMBASE and Cochrane databases until May 2016 of all publications adjusted to the following terms: constipation AND/OR fecal impaction AND (PEG OR polyethylene glycol OR macrogol OR movicol OR idralax OR miralax OR transipeg OR forlax OR golytely OR isocolan OR mulytely) NOT colonoscopy. Critical reading of selected articles (English or Spanish), sorting their description according to group age (adult/pediatric age) and within those, in accordance with study features (efficacy evaluation versus placebo, doses query, safety, comparison with other laxatives, observational studies and monographic review articles of polyethylene glycol or meta-analysis). RESULTS Fifty-eight publications have been chosen for descriptive analysis; of them, 41 are clinical trials, eight are observational studies and nine are systematic reviews or meta-analysis. Twelve clinical trials evaluate PEG efficacy versus placebo, eight versus lactulose, six are dose studies, five compare polyethylene glycol with and without electrolytes, two compare its efficacy with respect to milk of magnesia, and the rest of the trials evaluate polyethylene glycol with enemas (two), psyllium (one), tegaserod (one), prucalopride (one), paraffin oil (one), fiber combinations (one) and Descurainia sophia (one). CONCLUSIONS Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability. These preparations constitute the most efficacious osmotic laxatives (more than lactulose) and are the first-line treatment for functional constipation in the short and long-term. They are as efficacious as enemas in fecal impaction, avoid the need for hospital admission and are well tolerated by patients (mainly when administered without electrolytes).
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Affiliation(s)
- Miguel Mínguez
- Servicio de Medicina Digestiva, Hospital Clínico de Valencia
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Librizzi J, Flores S, Morse K, Kelleher K, Carter J, Bode R. Hospital-Level Variation in Practice Patterns and Patient Outcomes for Pediatric Patients Hospitalized With Functional Constipation. Hosp Pediatr 2017; 7:320-327. [PMID: 28522604 DOI: 10.1542/hpeds.2016-0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. METHODS We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision. Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. RESULTS A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P < .0001). The percentage of patients receiving the following treatment during their hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P < .0001). Mean 90-day readmission rate was 3.78% (range: 0.95%-7.53%, P < .0001). CONCLUSIONS There is significant variation in practice patterns and clinical outcomes for pediatric patients hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric functional constipation.
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Affiliation(s)
- Jamie Librizzi
- Department of Pediatric Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Samuel Flores
- Department of Pediatric Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Keith Morse
- Department of Pediatric Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Kelly Kelleher
- Department of Pediatric Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Jodi Carter
- Department of Pediatric Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Ryan Bode
- Department of Pediatric Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Jordan-Ely J, Hutson JM, Southwell BR. Disimpaction of children with severe constipation in 3-4 days in a suburban clinic using polyethylene glycol with electrolytes and sodium picosulphate. J Paediatr Child Health 2015; 51:1195-8. [PMID: 26059611 DOI: 10.1111/jpc.12939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
AIM Constipation is a common cause of admission to hospital for disimpaction, as oral laxatives are often inadequate. High-dose oral laxative protocols are used for complete bowel clearance prior to colonoscopy, but have not been reported for treating faecal impaction. The aim of this study was to assess the effectiveness of a high-dose oral protocol using polyethylene glycol with electrolytes (PEG + E) (Movicol Rx) combined with sodium picosulphate (SP) (Dulcolax SP Rx) in faecal impaction in children presenting to a suburban clinic. METHODS Forty-four children presented with acute/chronic faecal impaction were given six to eight sachets of PEG + E were given on day 1, with decreasing doses on subsequent 3 days, while 15-20 SP drops were given on days 2 and 3. Compliance with medication was achieved using a simple method of motivation, with the child drinking the laxatives in a race. On day 4, PEG + E was reduced to one sachet and SP to 10 drops as an ongoing maintenance dose. Defecation, soiling, diet and water intake was monitored daily for 7 days in a diary. RESULTS Forty-four children (aged 2-17 years) seen over 8 months were reviewed retrospectively. Children began defecating within 10-12 h reaching a maximum volume of stool/day (four cups) on day 2. All patients were disimpacted successfully and in the week following disimpaction there was no reported faecal soiling or complications. CONCLUSIONS A high-dose oral protocol combining PEG + E sachets and SP drops successfully and safely disimpacted a cohort of children with acute/chronic constipation presenting to a suburban continence clinic. This protocol appears to be useful to control faecal disimpaction in an outpatient setting, thereby avoiding hospital admission.
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Affiliation(s)
- Julie Jordan-Ely
- Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - John M Hutson
- Urology Department, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Bridget R Southwell
- Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
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Abstract
Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Functional constipation is a clinical diagnosis; the evaluation primarily consists of a thorough medical history and a complete physical examination. Additional investigations are not necessary in most cases. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. This review discusses the evaluation and management of functional constipation in the pediatric population and provides a summary of drug treatment options.
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Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, Room C2-312, 1105 AZ, Amsterdam, The Netherlands.
| | - Laureen A Lammers
- Department of Hospital Pharmacy, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, Room C2-312, 1105 AZ, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, Room C2-312, 1105 AZ, Amsterdam, The Netherlands.
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