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Gordon M, Hathagoda W, Rajindrajith S, Sinopoulou V, Abdulshafea M, Velasco C, Tabbers M, Benninga MA. Towards a definition of refractory/therapy-resistant/intractable constipation in children: a cross-sectional, questionnaire-based, online survey. BMJ Paediatr Open 2024; 8:e003063. [PMID: 39667952 DOI: 10.1136/bmjpo-2024-003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 11/27/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND The Rome criteria define childhood functional constipation but do not address refractory constipation. Attempts to define refractory constipation lack consensus. The interchangeable use of 'refractory' and 'intractable' or 'therapy-resistant' constipation and lack of understanding of the therapeutic ceilings before this diagnosis complicates the definition. AIM To conduct an online cross-sectional study among medical professionals and researchers across a range of countries, to propose a consensus definition, terminology and duration of medically unresponsive constipation. METHOD An expert-designed questionnaire was disseminated via Google Forms in a two-stage study over 2 months targeting paediatric gastroenterology professionals globally and Latin American clinicians with a translated version. The questionnaire had seven critical questions containing details needed to define medically unresponsive constipation. The study protocol was approved by the ethics review panel. RESULTS The survey involved 1079 participants: 87 from various countries in the first phase and 992 from Latin America in the second. There were 619 (57.3%) general paediatricians and 462 (43 %) paediatric gastroenterologists. The preferred term to indicate poorly responding constipation was 'therapy-resistant constipation' (47.8%), followed by 'refractory constipation' (43.6%). The majority of respondents (92.9%) agreed on considering a time frame for defining refractory constipation, with 37.7% suggesting 2-3 months. 467 (43.2%) recommended including failure despite maximum laxative therapy with two agents should be considered as previous therapy failure. Compliance with therapy was deemed essential for successful treatment by 91.1%, assessed through detailed history-taking (47.4%) or medical/pharmacy records (29.4%). CONCLUSION Based on the professional views collected in this study, we propose the term 'therapy-resistant constipation' and it can be defined as constipation that is not responding to a maximum dose of at least two laxatives of different classes for a minimum of 3 months with good compliance in a secondary or tertiary care facility.
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Affiliation(s)
| | - Wathsala Hathagoda
- Pediatrics, University of Colombo Faculty of Medicine, Colombo, Sri Lanka
| | | | | | | | | | - Merit Tabbers
- Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Marc A Benninga
- Pediatrics, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
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Kildegaard H, Bliddal M, Ernst MT, Sander SD, Wesselhoeft R, Gingrich JA, Pottegård A, Margolis KG, Talati A. Prenatal exposure to selective serotonin reuptake inhibitors and risk of disorders of gut-brain interaction in children. Mol Psychiatry 2024:10.1038/s41380-024-02848-3. [PMID: 39658704 DOI: 10.1038/s41380-024-02848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 12/12/2024]
Abstract
Preclinical data suggest that gestational exposure to selective serotonin reuptake inhibitors (SSRI) alter gut innervation, and delays colonic motility. In this study we investigated associations between gestational SSRI exposure and offspring disorders of gut-brain interaction (DGBI). Using population-based registries, we included all single-birth Danish children born 1997-2015 with follow-up until outcome occurrence, age 15 years, death, emigration, or December 2018. Children to mothers who continued SSRIs during pregnancy and children to mothers who discontinued SSRI use before pregnancy were compared using Cox regression. Main outcomes were the first diagnosis of a childhood DGBI (functional nausea and vomiting, functional abdominal pain disorders, functional diarrhea, and functional constipation), or a physician-prescribed laxative. Among 1,158,560 children, 21,969 children (1.9%) were exposed to SSRIs prenatally and 30,174 children (2.6%) were born to mothers who discontinued SSRIs before pregnancy. Overall, the estimated 15-year cumulative incidence of any DGBI was 15.5% (95% CI, 14.9-16.2) in the SSRI-exposed group and 14.7% (14.0-15.3) in the unexposed group. SSRI-exposed children had an overall increased risk of DGBIs (HR 1.08, [1.02-1.14]), which was driven by functional constipation (HR 1.19, [1.10-1.28]) rather than functional nausea and vomiting (HR 0.97, [0.83-1.13]) or functional abdominal pain disorders (HR 0.90, [0.81-1.00]). These data suggest that prenatal SSRI exposure is associated with an increased risk of developing functional constipation. These findings are also consistent with extensive preclinical data supporting key roles for serotonin in gut development and function. Together findings support the need for further investigation of the long-term impact of maternal depression and SSRI exposure on development of common gastrointestinal disorders.
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Affiliation(s)
- Helene Kildegaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Bliddal
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stine D Sander
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Southern Denmark, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Jay A Gingrich
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kara G Margolis
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, USA
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
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Kruger Howard A, Morgan JA. Evaluation of Polyethylene Glycol Dosing for Functional Constipation in Children. Hosp Pharm 2024; 59:645-649. [PMID: 39449859 PMCID: PMC11497520 DOI: 10.1177/00185787241257390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
Objective: The goal of this study was to evaluate the current use of polyethylene glycol (PEG) in a pediatric gastroenterology outpatient clinic. The primary endpoint was to determine the current weight-based PEG dosing schedules used for home cleanouts and maintenance treatment for functional constipation. The secondary endpoint was to assess the dosing efficacy for home cleanouts. Methods: This study was a retrospective cohort analysis of electronic medical records documenting new patient visits at our pediatric gastroenterology clinic between September 2017 and October 2018. Patients included in the study were 13 months to 18 years of age and prescribed PEG for an at-home cleanout and/or maintenance therapy for functional or slow transit constipation. Study participants given a clean-out regimen were divided into those who received treatment for less than 2 days or more. Cleanouts were considered successful if documented as such by the prescriber in the follow-up note or if there was documentation of clear flow. Results: Of the 201 new patients included, 112 (55.7%) received a recommendation for a home cleanout. Of these, 111 patients (99%) underwent PEG-based therapy with or without additional agents. The median weight-based PEG dose was 5.3 ± 2.4 and 4.6 ± 1.9 g/kg/day for 1- and 2-day cleanouts, respectively (P = 0.124). Of the 38 patients with documented outcomes, 28 (73.7%) were successful. We observed no statistically significant differences in the number of successful versus unsuccessful outcomes based on PEG dosing (P = 0.3) or cumulative dose exposures (P = 0.388). Similarly, we observed no significant differences when comparing those on 1-day versus 2-or-more-day cleanouts, (P = 0.17). The median weight-based maintenance PEG dose was 0.74 g/kg/day (interquartile range [IQR], 0.55, 0.96). Conclusions: While the PEG doses used by this clinic for 1-day bowel cleanouts align with the NASPGHAN best practices for colonoscopy report, patients who underwent a 2-day cleanout were provided more than double the weight-based doses. The doses were nearly 3-fold higher than the recommended doses for functional constipation home cleanouts. More information will be needed to determine if these higher doses for home cleanouts are needed for the successful management of patients with functional constipation.
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Affiliation(s)
| | - Jill A Morgan
- University of Maryland School of Pharmacy, Baltimore, MD, USA
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4
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Vos JMBW, Bloem MN, de Geus A, Leeflang MMG, Spijker R, Koppen IJN, Baaleman DF, Benninga MA. Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis. Pediatr Radiol 2024; 54:2227-2242. [PMID: 39545958 PMCID: PMC11638420 DOI: 10.1007/s00247-024-06083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Functional constipation is common in children and accurate diagnostic methods are essential for early diagnosis and effective management. The diagnostic accuracy of transabdominal ultrasound to diagnose functional constipation is unclear. OBJECTIVE To evaluate the diagnostic accuracy of transverse rectal diameter measurement via transabdominal ultrasound in diagnosing children with functional constipation and in identifying fecal impaction. MATERIALS AND METHODS Electronic databases were searched from inception to March 2023. Original studies investigating the diagnostic accuracy of measuring transverse rectal diameter via transabdominal ultrasound, including children with and without functional constipation, or with and without fecal impaction were included. Data extraction and quality assessment were performed independently by two reviewers. RESULTS Sixteen studies were included (n = 1,801 children, 0-17 years). Thirteen studies investigated the diagnostic accuracy for functional constipation, and five for fecal impaction. High risk of bias was found across the majority of studies mainly due to un-blinded case-control designs. Cut-off transverse rectal diameter values to diagnose functional constipation ranged from 2.4 cm to 3.8 cm. Meta-analysis (seven studies, n = 509 children) estimated mean sensitivity and specificity to diagnose functional constipation were 0.68 (95% confidence interval (CI) 0.55-0.78) and 0.81 (95% CI 0.71-0.88), respectively. Meta-analysis of diagnostic accuracy of identifying fecal impaction was not feasible. Studies reported a sensitivity and specificity ranging between 68-100% and 83-100%, respectively. CONCLUSION Transabdominal ultrasound may be a valuable non-invasive diagnostic tool to diagnose functional constipation by measuring transverse rectal diameter and identifying fecal impaction in children. Heterogeneous study methods and lack of age-dependent normal values impair current clinical recommendations. Future research should focus on separating age groups and developing a standardized protocol.
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Affiliation(s)
- Johanna M B W Vos
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Michelle N Bloem
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Anna de Geus
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Amsterdam Public Health, Medical Library, 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, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Desiree F Baaleman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
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Yu G, Gao J, Gu J, Li H, Wang X, Bian H. Efficacy of honey suppositories in treating paediatric functional constipation: A comparative study. J Paediatr Child Health 2024. [PMID: 39543451 DOI: 10.1111/jpc.16722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 10/23/2024] [Accepted: 11/03/2024] [Indexed: 11/17/2024]
Abstract
AIM This study sought to assess the clinical efficacy of honey suppositories in managing functional constipation in pre-school children, with a focus on those exhibiting Yin deficiency and intestinal dryness according to traditional Chinese medicine principles. The investigation aimed to determine whether honey suppositories could serve as a safer and more efficacious alternative to standard treatments. METHODS A randomised controlled trial was conducted involving pre-school children diagnosed with functional constipation. They were allocated to either a control group or a treatment group. While both groups received standard care, the treatment group also received honey suppositories. The efficacy of the treatment was evaluated based on the 'Guiding Principles for Clinical Research of New Chinese Medicines', and statistical analysis was performed using SPSS 25.0. RESULTS Following treatment, the treatment group demonstrated significantly lower constipation scoring system scores and higher bowel movement frequencies compared with the control group (P < 0.05). The clinical efficacy of the treatment group was notably superior, with a higher rate of complete recovery and effectiveness observed (P < 0.05). Additionally, no significant differences in baseline characteristics were found between the groups, confirming the comparability of the study cohorts. CONCLUSIONS Honey suppositories offer a promising therapeutic intervention for paediatric functional constipation, with significant clinical benefits over standard care.
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Affiliation(s)
- Guili Yu
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
| | - Jing Gao
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
| | - Jinglian Gu
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
| | - Huazhen Li
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
| | - Xiaoying Wang
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
| | - Hui Bian
- Department of traditional Chinese medicine, Pujiang Community Health Service Center, Shanghai, China
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Halladay A, Croffie J, Dallman J, Grabenstatter H, Holingue C, Madgett K, Margolis KG, Motil KJ, Jimenez-Gomez A, Ferguson BJ, Moshiree B, Still K, Williams K, Upp GR, Bennett W. Conference proceedings: Inaugural meeting of the consortium for autism, genetic neurodevelopmental disorders, and digestive diseases. J Pediatr Gastroenterol Nutr 2024; 79:1062-1070. [PMID: 39257288 PMCID: PMC11531374 DOI: 10.1002/jpn3.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), often experience a higher prevalence of gastrointestinal (GI) symptoms but have complex medical and behavioral comorbidities that make diagnosis and treatment difficult. A multi-stakeholder conference was convened to (a) determine patient and family experiences related to GI symptoms in NDDs, (b) review the clinicians' and researchers' perspectives, and (c) determine actionable steps for future research. METHODS The Consortium for Autism, Neurodevelopmental Disorders and Digestive Diseases (CANDID; www.candidgi.com) virtually over 2 days in 2022 and consisted of four key activities: (1) an electronic family survey to assess underlying NDDs and GI symptoms, (2) a session focused on family perspectives, (3) review current clinical care and research, and (4) discussion to identify key next steps. Survey results were obtained electronically via the REDCap platform, and descriptive statistics were generated. The sessions were recorded, and themes were identified. RESULTS The pre-conference survey ran for ~2 months and 739 families provided responses, with 634 completing all items. 83% had a child with an NDD under age 18, and most patients were White (85%) and non-Hispanic (87%). Constipation (80%), GI reflux disease (51%), and bloating (49%) were the most frequently reported symptoms. Families gave unstructured feedback that the measures used in the surveys were often difficult to answer for patients with NDDs or who were nonspeaking. Family and clinical/scientific sessions identified several common themes, including (1) the need for less invasive diagnostic modalities, (2) the need to validate or adapt existing diagnostic measures (e.g., the Rome IV criteria) and outcome assessments, and (3) the need for enhanced attention to parent and caregiver input in treatment plans. CONCLUSIONS Those providing care to children with NDDs, especially those with communication and cognitive challenges, should be aware of the differing needs in this community and consider family perspectives in managing, treating, and measuring GI issues. Future research should focus on adapting or creating diagnostic and research measures for those with NDDs, developing new diagnostic methods to account for diversity in neurodevelopment and communication, and improving methods for family and caregiver engagement in the care of GI disorders.
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Affiliation(s)
- Alycia Halladay
- Autism Science Foundation
- Rutgers University
- Alliance for Genetic Etiologies in Neurodevelopmental Disorders
| | - Joseph Croffie
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children
| | | | - Heidi Grabenstatter
- Alliance for Genetic Etiologies in Neurodevelopmental Disorders
- International Foundation for CDKL5 Research
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Kara G Margolis
- NYU Pain Research Center
- NYU College of Dentistry
- NYU Grossman School of Medicine
| | - Kathleen J Motil
- USDA/ARS Children’s Nutrition Research Center
- Department of Pediatrics, Baylor College of Medicine
| | - Andres Jimenez-Gomez
- Neuroscience Center, Joe DiMaggio Children’s Hospital
- Stiles-Nicholson Brain Institute, Florida Atlantic University
| | - Bradley J Ferguson
- Departments of Health Psychology and Radiology, University of Missouri
- Thompson Center for Autism and Neurodevelopment
| | | | - Kate Still
- Alliance for Genetic Etiologies in Neurodevelopmental Disorders
- Phelan-McDermid Syndrome Foundation
| | | | | | - William Bennett
- Alliance for Genetic Etiologies in Neurodevelopmental Disorders
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children
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7
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van der Zande JMJ, Srinivas S, Koppen IJN, Benninga MA, Wood RJ, Sanchez RE, Puri NB, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Anorectal physiology and colonic motility in children with a history of tethered cord syndrome. J Pediatr Gastroenterol Nutr 2024; 79:976-982. [PMID: 39206742 DOI: 10.1002/jpn3.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/02/2024] [Accepted: 07/14/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES The understanding of the impact of tethered cord syndrome (TCS) on the physiology of the colorectal area is limited. Our aim was to describe anorectal and colonic motility in children with TCS and compare the findings to those of children with functional constipation (FC). METHODS We conducted a retrospective review of children with TCS who had an anorectal manometry (ARM) performed at our institution from January 2011 to September 2023. We recorded demographics, medical and surgical history, clinical symptoms, and treatment at time of ARM, ARM findings (resting pressure, push maneuver, rectal sensation, rectoanal inhibitory reflex [RAIR], and RAIR duration), and the final interpretation of colonic manometry (CM) if performed. We identified age and sex-matched control groups of children with FC. RESULTS We included 24 children with TCS (50% female) who had ARM testing (median age at ARM 6.0 years, interquartile range 4.0-11.8 years). All children had constipation at time of ARM. Nineteen children had detethering surgery before ARM was performed. No significant differences in ARM parameters were found between children who had detethering surgery before ARM and children with FC. Among the 24 children, 14 also had a CM performed (13/14 after detethering surgery). No significant differences in colonic motility were found between children with a history of TCS and children with FC. CONCLUSIONS Anorectal physiology and colonic motility are similar between children with a history of TCS and children with FC, suggesting that the underlying pathophysiology of defecatory disorders in children with and without history of TCS is similar.
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Affiliation(s)
- Julia M J van der Zande
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Shruthi Srinivas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ilan J N Koppen
- 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
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Raul E Sanchez
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Neetu B Puri
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karla Vaz
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Desale Yacob
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter L Lu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
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Sila S, Niseteo T, Hojsak I. Importance of dietary fiber in children. Minerva Pediatr (Torino) 2024; 76:679-689. [PMID: 37310770 DOI: 10.23736/s2724-5276.23.07211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dietary fibers (DFs) are essential components of human nutrition and are principally defined as non-digestible carbohydrates (oligosaccharides and polysaccharides) usually classified by their physicochemical and physiological characteristics (water solubility, viscosity, fermentability, and bulking effect). Unfortunately, there is limited information on dietary fiber recommendations for children, and the evidence on their effect on health and symptom control is mainly available for the adult population. Therefore, this review aims to give a comprehensive overview of the characteristics and dietary sources of dietary fiber and their potential health benefits in healthy children but also their potential use in the treatment of sick children.
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Affiliation(s)
- Sara Sila
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Tena Niseteo
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia -
- University of Zagreb, School of Medicine, Zagreb, Croatia
- School of Medicine, University J.J. Strossmayer, Osijek, Croatia
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9
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Ahmad H, Smith C, Witte A, Lewis K, Reeder RW, Garza J, Zobell S, Hoff K, Durham M, Calkins C, Rollins MD, Ambartsumyan L, Rentea RM, Yacob D, Lorenzo CD, Levitt MA, Wood RJ. Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study. Eur J Pediatr Surg 2024; 34:410-417. [PMID: 37940124 DOI: 10.1055/a-2206-6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility. METHODS A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p-Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States). RESULTS A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection. CONCLUSION In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.
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Affiliation(s)
- Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Children's Hospital of Orange County, Orange, California, United States
| | - Caitlin Smith
- Department of Pediatric and Thoracic General Surgery, Seattle Children's Hospital, Seattle, Washington, United States
| | - Amanda Witte
- Department of Pediatric Surgery, Children's Hospital of Wisconsin Inc, Milwaukee, Wisconsin, United States
| | - Katelyn Lewis
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Ron William Reeder
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Jose Garza
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Sarah Zobell
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Kathleen Hoff
- Department of Pediatric Surgery, Children's Healthcare of Atlanta Inc, Atlanta, Georgia, United States
| | - Megan Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Casey Calkins
- Department of Pediatric Surgery, Children's Hospital of Wisconsin Inc, Milwaukee, Wisconsin, United States
| | - Michael D Rollins
- Department of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, United States
| | - Lusine Ambartsumyan
- Department of Pediatric Surgery, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington, United States
| | - Rebecca Maria Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Marc A Levitt
- Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
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10
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Lin AE, Scimone ER, Thom RP, Balaguru D, Kinane TB, Moschovis PP, Cohen MS, Tan W, Hague CD, Dannheim K, Levitsky LL, Lilly E, DiGiacomo DV, Masse KM, Kadzielski SM, Zar-Kessler CA, Ginns LC, Neumeyer AM, Colvin MK, Elder JS, Learn CP, Mou H, Weagle KM, Buch KA, Butler WE, Alhadid K, Musolino PL, Sultana S, Bandyopadhyay D, Rapalino O, Peacock ZS, Chou EL, Heidary G, Dorfman AT, Morris SA, Bergin JD, Rayment JH, Schimmenti LA, Lindsay ME. Emergence of the natural history of Myhre syndrome: 47 patients evaluated in the Massachusetts General Hospital Myhre Syndrome Clinic (2016-2023). Am J Med Genet A 2024; 194:e63638. [PMID: 38779990 PMCID: PMC11586855 DOI: 10.1002/ajmg.a.63638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
Myhre syndrome is an increasingly diagnosed ultrarare condition caused by recurrent germline autosomal dominant de novo variants in SMAD4. Detailed multispecialty evaluations performed at the Massachusetts General Hospital (MGH) Myhre Syndrome Clinic (2016-2023) and by collaborating specialists have facilitated deep phenotyping, genotyping and natural history analysis. Of 47 patients (four previously reported), most (81%) patients returned to MGH at least once. For patients followed for at least 5 years, symptom progression was observed in all. 55% were female and 9% were older than 18 years at diagnosis. Pathogenic variants in SMAD4 involved protein residues p.Ile500Val (49%), p.Ile500Thr (11%), p.Ile500Leu (2%), and p.Arg496Cys (38%). Individuals with the SMAD4 variant p.Arg496Cys were less likely to have hearing loss, growth restriction, and aortic hypoplasia than the other variant groups. Those with the p.Ile500Thr variant had moderate/severe aortic hypoplasia in three patients (60%), however, the small number (n = 5) prevented statistical comparison with the other variants. Two deaths reported in this cohort involved complex cardiovascular disease and airway stenosis, respectively. We provide a foundation for ongoing natural history studies and emphasize the need for evidence-based guidelines in anticipation of disease-specific therapies.
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Affiliation(s)
- Angela E. Lin
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor R. Scimone
- Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robyn P. Thom
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Duraisamy Balaguru
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - T. Bernard Kinane
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter P. Moschovis
- Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S. Cohen
- Pediatric Otorhinolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Weizhen Tan
- Pediatric Nephrology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cole D. Hague
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katelyn Dannheim
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lynne L. Levitsky
- Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel V. DiGiacomo
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara M. Masse
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M. Kadzielski
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire A. Zar-Kessler
- Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leo C. Ginns
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann M. Neumeyer
- Lurie Center for Autism, Mass General for Children, Boston, Massachusetts, USA
- Pediatric Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mary K. Colvin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jack S. Elder
- Division of Pediatric Urology, Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher P. Learn
- Division of Cardiology, Department of Medicine, Corrigan Minehan Heart Center, Adult Congenital Heart Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hongmei Mou
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn M. Weagle
- Department of Child Life, Pediatric Imaging Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen A. Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William E. Butler
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenda Alhadid
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L. Musolino
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sadia Sultana
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary S. Peacock
- Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Elizabeth L. Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Aaron T. Dorfman
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shaine A. Morris
- Division of Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James D. Bergin
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan H. Rayment
- Respiratory Medicine, Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A. Schimmenti
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E. Lindsay
- Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatric Cardiology, Department of Pediatrics, Cardiovascular Genetics Program, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Encisco EM, Garza R, McNinch NL, Davis C, Rosen NG, Rymeski B, Frischer JS, Garrison AP, Huntington JT. What Happens Post-Malone? An Investigation of Long-Term Postoperative Management of Antegrade Continence Enemas. J Pediatr Surg 2024:161958. [PMID: 39358084 DOI: 10.1016/j.jpedsurg.2024.161958] [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: 09/07/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND An option for medically refractory fecal incontinence and/or constipation is the antegrade continence enema (ACE). We investigated ACE usage and its perceptions, including whether patients were able to discontinue use of the appendicostomy/cecostomy tube. METHODS Patients who underwent appendicostomy creation or cecostomy tube placement at two institutions between 2012 and 2021 were reviewed. Patients or parents/guardians were contacted for completion of a survey. Summary statistics for clinical data were tabulated and associations were evaluated with chi-square analysis. RESULTS A total of 165 patients were included, including 92 (55.8%) males. Eighty-two (49.7%) surveys were completed. Most patients (51.5%) presented with fecal incontinence; 38 (23.3%) presented with constipation. More patients had a primary underlying diagnosis of anorectal malformation (39.4%), followed by functional constipation (21.2%), Hirschsprung disease (18.8%), and spinal malformation (17.6%). Thirty-six (21.8%) patients discontinued flushes by time of contact, with switch to laxatives being the most common reason (19%), followed by appendicostomy stricture/obstruction/closure (17%), switch to ileostomy/colostomy (17%), and patient preference (14%). There was no difference in patients' ability to stop using flushes based on underlying diagnosis (p = 0.31). The majority (84.1%) of respondents were "very likely" to recommend antegrade enemas to other children with similar diagnosis and 76.8% reported being "very satisfied" that the operation was done. CONCLUSIONS There remains a high degree of satisfaction with antegrade continence enemas for children with constipation and fecal incontinence; some children may be able to stop using antegrade enemas with varied mechanisms including patient/family weaning versus with assistance and laxative trials. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ellen M Encisco
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA; Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Neil L McNinch
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Carolyn Davis
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
| | - Nelson G Rosen
- Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Rymeski
- Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason S Frischer
- Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron P Garrison
- Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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Jonker CAL, van der Zande JMJ, Benninga MA, de Jong JR, Di Lorenzo C, Lu PL, Tabbers MM, de Vries R, Koppen IJN, Gorter RR. Antegrade Continence Enemas for Pediatric Functional Constipation: A Systematic Review. J Pediatr Surg 2024; 60:161952. [PMID: 39389879 DOI: 10.1016/j.jpedsurg.2024.161952] [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: 08/02/2024] [Revised: 09/09/2024] [Accepted: 09/17/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Despite optimal conservative and medical treatment, some children with functional constipation (FC) continue to experience symptoms. Antegrade continence enema (ACE) surgery has been suggested as the primary surgical option after less invasive pharmacological and non-pharmacological interventions have not been effective. The purpose of this systematic review was to assess the outcomes of ACE for children with FC. METHODS Electronic databases were searched (inception-March 2024) for studies evaluating ACE surgery performed in children with FC. The primary outcome was treatment success (as defined in the original manuscript), including at least defecation frequency and/or fecal incontinence frequency. Secondary outcomes were cessation of ACE, complications, health-related quality of life (HRQoL) and patient/parent satisfaction. Quality of evidence was evaluated based on tools from the New-Ottawa Scale and Joanna Bridge Institute. RESULTS Thirteen studies were included, representing 477 children with FC treated with either an appendicostomy or a cecostomy. Reported treatment success rates varied widely, ranging from 32% to 100%. ACE treatment was stopped in 15% due to treatment success and in 8% due to treatment failure, leading to more invasive surgery. Complication rates ranged from 6% to 100%, requiring surgical intervention in 0% to 34%. An improvement in HRQoL following ACE treatment was reported in all three studies that assessed HRQoL. The two studies assessing patient/parent satisfaction, reported high satisfaction rates. CONCLUSION Reported treatment success and complication rates following ACE surgery for children with FC vary widely. This systematic review highlights the necessity for uniform definitions and treatment guidelines for ACE surgery in children with FC. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Charlotte A L Jonker
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Julia M J van der Zande
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - 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
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ralph de Vries
- Medical Library, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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13
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Lindert J, Day H, de Andres Crespo M, Amerstorfer E, Alexander S, Backes M, de Filippo C, Golebiewski A, Midrio P, Mohideen M, Modrzyk A, Lemli A, Rassouli-Kirchmeier R, Pfaff-Jongman M, Staszkiewicz K, Telborn L, Stenström P, Holström K, Kohl M, Curry J, Loukogeorgakis S, Davidson JR. Influence of Diet on Bowel Function and Abdominal Symptoms in Children and Adolescents with Hirschsprung Disease-A Multinational Patient-Reported Outcome Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1118. [PMID: 39334650 PMCID: PMC11429589 DOI: 10.3390/children11091118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/21/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024]
Abstract
Introduction: This study aimed to understand the influence of diet and nutrition items on gastrointestinal symptoms in patients with Hirschsprung Disease (HD). Method: An online questionnaire was created to obtain patient-reported outcomes using the multinational Holistic Care in Hirschsprung Disease Network. This was distributed in Dutch, English, German, Italian, Polish, and Swedish via patient associations. Information on demographics, the extension of disease, current diet, and the influence of food ingredients on bowel function were obtained. Results: In total, 563 questionnaires were answered by parents or patients themselves. The length of the aganglionic segment was short in 33%, long in 45%, total colonic aganglionosis (TCA) in 11%, and involved the small intestine in 10%. Overall, 90% reported following a mixed diet, and 31% reported taking probiotics, with twice as many patients taking probiotics in the TCA group compared to standard HD. Mealtimes and behaviours around eating were affected by 61%, while 77% had established food items that worsened symptoms, and of these, 80% stated that they had worked these items out themselves. A high-fibre diet was followed by 24% and 18% a low-fibre diet. Symptoms were reported, particularly from dairy in 30%, fruits in 39%, pulses in 54%, and sugar in 48%. Conclusions: This first multinational survey on diet and bowel function in HD reports an association between certain dietary items with gastrointestinal symptoms. This study can support an improved understanding of the interaction between food items and bowel function in children with HD. We suggest a multidisciplinary approach to balance dietary exclusions and support adequate growth, preventing nutrition deficiencies and enhancing quality of life.
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Affiliation(s)
- Judith Lindert
- Department of Paediatric Surgery, University Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany;
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London WC1N 3JH, UK; (H.D.); (J.C.); (S.L.); (J.R.D.)
| | - Hannah Day
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London WC1N 3JH, UK; (H.D.); (J.C.); (S.L.); (J.R.D.)
| | - Marta de Andres Crespo
- Department of Paediatric Surgery, University Rostock, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany;
- UCL GOSH Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Eva Amerstorfer
- Department of Paediatric Surgery, University Hospital Graz, Auenbruggerplatz 34, 8036 Graz, Austria;
| | - Sabine Alexander
- SoMA e.V.—Selbsthilfeorganisation für Betroffene von Morbus Hirschsprung und Anorektale Fehlbildungen Patient Organization, Munich, Blombergstr. 9, 81825 München, Germany; (S.A.); (A.L.)
| | - Manouk Backes
- Department of Paediatric Surgery, Radboudumc Njjmegen, Geert Grooteplein Zuid 32, 6525 Nijmege, The Netherlands; (M.B.); (R.R.-K.)
| | - Carlotta de Filippo
- Italian Association of Hirschsprung’s Disease A.Mor.Hi, Via dei Castani 116, 00172 Rome, Italy;
- Institute of Agricultural Biology and Biotechnology, National Research Council (CNR), Via Moruzzi, 1, 56124 Pisa, Italy
| | - Andrzej Golebiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Paola Midrio
- Pediatric Surgery Unit, Ca’Foncello Hospital, Piazzale dell´Ospedale 1, 31100 Treviso, Italy;
| | - Mazeena Mohideen
- SoMA Austria—Selbsthilfeorganisation für Betroffene von Morbus Hirschsprung und Anorektale Fehlbildungen, Am-Ostrom-Park 11/7, 1220 Wien, Austria;
| | - Anna Modrzyk
- Department of Children’s Developmental Defects Surgery and Traumatology, Medical University of Silesia, 41-800 Zabrze, Poland;
| | - Anette Lemli
- SoMA e.V.—Selbsthilfeorganisation für Betroffene von Morbus Hirschsprung und Anorektale Fehlbildungen Patient Organization, Munich, Blombergstr. 9, 81825 München, Germany; (S.A.); (A.L.)
| | - Roxana Rassouli-Kirchmeier
- Department of Paediatric Surgery, Radboudumc Njjmegen, Geert Grooteplein Zuid 32, 6525 Nijmege, The Netherlands; (M.B.); (R.R.-K.)
| | - Marijke Pfaff-Jongman
- Dutch Patient Association, Vereniging Ziekte van Hirschsprung, Hambakenwetering 15, 5231 ‘S-Hertogenbosch, The Netherlands;
| | | | - Lovisa Telborn
- Department of Pediatric Surgery, Lund University, Skåne University Hospital, 22100 Lund, Sweden; (L.T.); (P.S.)
| | - Pernilla Stenström
- Department of Pediatric Surgery, Lund University, Skåne University Hospital, 22100 Lund, Sweden; (L.T.); (P.S.)
| | - Karolin Holström
- Swedish Patient Association-Hirschsprungs Sjukdom Patientförening, Sockervägen 25, 23253 Akarp, Sweden
| | - Martina Kohl
- Paediatric Gastroenterology, Paediatric Department, University Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany;
| | - Joe Curry
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London WC1N 3JH, UK; (H.D.); (J.C.); (S.L.); (J.R.D.)
| | - Stavros Loukogeorgakis
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London WC1N 3JH, UK; (H.D.); (J.C.); (S.L.); (J.R.D.)
- UCL GOSH Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Joseph R Davidson
- Department of Specialist Neonatal and Paediatric Surgery Great, Ormond Street Hospital NHS Trust, London WC1N 3JH, UK; (H.D.); (J.C.); (S.L.); (J.R.D.)
- UCL GOSH Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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14
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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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15
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Reeves PT, Meyers T, Howard B, Rogers PL, Jack B, Kolasinski NT, Burklow CS, Min S, Nylund CM. Potty Stools, a Pilot Study to Step Up the Management of Functional Constipation in Children. Clin Pediatr (Phila) 2024:99228241278900. [PMID: 39225493 DOI: 10.1177/00099228241278900] [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] [Indexed: 09/04/2024]
Abstract
Functional constipation (FC) comprises 30% of pediatric gastroenterology clinic visits. FC results from withholding behaviors that can be worsened by poor toileting posture. The use of a defecation posture modification device (DPMD)-a potty stool-has demonstrated benefit in adults. The aim of this study was to assess the risks and benefits of incorporating a DPMD as an adjunct to the FC treatment plan for children. Toilet-trained children aged ≥4 years meeting the Rome IV criteria for FC were enrolled and offered a DPMD at no cost and were followed for 4 months. There were no injuries or treatment-related adverse events reported by the 43 subjects who completed the study. Notably, 98% (n = 42) of respondents would recommend the DPMD to assist other children with FC. DPMD users showed a 33% reduction in fecal incontinence compared with 60% non-users. The DPMD represents a safe adjunct to incorporate into the FC management plan of children.
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Affiliation(s)
- Patrick T Reeves
- Pediatric Colorectal Center, Brooke Army Medical Center, San Antonio, TX, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Taylor Meyers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Bailey Howard
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Philip L Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Benjamin Jack
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nathan T Kolasinski
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steve Min
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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16
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Jackman L, Arpe L, Thapar N, Rybak A, Borrelli O. Nutritional Management of Pediatric Gastrointestinal Motility Disorders. Nutrients 2024; 16:2955. [PMID: 39275271 PMCID: PMC11397404 DOI: 10.3390/nu16172955] [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: 06/21/2024] [Revised: 08/07/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Normal and optimal functioning of the gastrointestinal tract is paramount to ensure optimal nutrition through digestion, absorption and motility function. Disruptions in these functions can lead to adverse physiological symptoms, reduced quality of life and increased nutritional risk. When disruption or dysfunction of neuromuscular function occurs, motility disorders can be classified depending on whether coordination or strength/velocity of peristalsis are predominantly impacted. However, due to their nonspecific presenting symptoms and overlap with sensory disruption, they are frequently misdiagnosed as disorders of the gut-brain interaction. Motility disorders are a prevalent issue in the pediatric population, with management varying from medical therapy to psychological therapy, dietary manipulation, surgical intervention or a multimodal approach. This narrative review aims to discuss the dietary management of common pediatric motility disorders including gastroesophageal reflux, esophageal atresia, achalasia, gastroparesis, constipation, and the less common but most severe motility disorder, pediatric intestinal pseudo-obstruction.
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Affiliation(s)
- Lucy Jackman
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Lauren Arpe
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Nikhil Thapar
- Department of Paediatric Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, School of Medicine, University of Queensland, Centre of Children Nutrition Research, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Anna Rybak
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Osvaldo Borrelli
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
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17
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Park CK, Wang L, Koppen IJK, Alpert SA, Diefenbach KA, Wood RJ, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Sacral nerve stimulation leads to long-term improvement in fecal incontinence and quality of life for children with functional and organic defecation disorders. Neurogastroenterol Motil 2024; 36:e14865. [PMID: 39005152 DOI: 10.1111/nmo.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Our objective was to evaluate long-term outcomes of sacral nerve stimulation (SNS) for children with functional and organic defecation disorders. METHODS We performed a prospective study of children <21 years of age who started SNS treatment between 2012 and 2018. We recorded demographics, medical history, and diagnostic testing. We obtained measures of symptom severity and quality of life at baseline and follow up at 1, 6, 12, 24, 36, 48, and ≥60 months. Successful response was defined as bowel movements >2 times/week and fecal incontinence (FI) <1 time/week. Families were contacted to administer the Glasgow Children's Benefit Inventory and to evaluate patient satisfaction. KEY RESULTS We included 65 patients (59% female, median age at SNS 14 years, range 9-21) with median follow-up of 32 months. Thirty patients had functional constipation (FC), 15 had non-retentive FI (NRFI), and 16 had an anorectal malformation (ARM). The percentage with FI <1 time/week improved from 30% at baseline to 64% at 1 year (p < 0.001) and 77% at most recent follow-up (p < 0.001). Patients with FC, NRFI, and ARM had sustained improvement in FI (p = 0.02, p < 0.001, p = 0.02). Patients also reported fewer hard stools (p = 0.001). Bowel movement frequency did not improve after SNS. At most recent follow-up, 77% of patients with a functional disorder and 50% with an organic disorder had responded (p = 0.03). Nearly all families reported benefit. CONCLUSIONS AND INFERENCES SNS led to sustained improvement in FI regardless of underlying etiology, but children with functional disorders were more likely to respond than those with organic disorders.
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Affiliation(s)
- Candice K Park
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lyon Wang
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ilan J K Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Seth A Alpert
- Department of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Neetu Bali
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karla Vaz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Desale Yacob
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter L Lu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
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18
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Di Lorenzo C, Robert J, Rodriguez-Araujo G, Shakhnovich V, Xie W, Nurko S, Saps M. Safety and efficacy of linaclotide in children aged 2-5 years with functional constipation: Phase 2, randomized study. J Pediatr Gastroenterol Nutr 2024; 79:510-518. [PMID: 38962910 DOI: 10.1002/jpn3.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Linaclotide, a guanylate cyclase-C agonist, was recently approved in the United States for the treatment of children 6-17 years of age with functional constipation (FC). This study evaluated the dose-response, safety, and efficacy of 4 weeks of linaclotide compared with placebo in children 2-5 years of age with FC. METHODS In this phase 2, randomized, double-blind, placebo-controlled, multidose study, 35 children with FC (based on Rome III criteria) were randomized 3:1 to receive linaclotide (18, 36, or 72 μg, for groups 1, 2, and 3, respectively) and 5:1 to receive linaclotide 9, 18, 36, or 72 μg (group 4), or matching placebo. Key endpoints were the changes from baseline in overall spontaneous bowel movement (SBM) frequency (SBMs/week), stool consistency, and straining, as well as the proportion of days with fecal incontinence during the study intervention period. Adverse events (AEs) were recorded. RESULTS Of the randomized patients, 34 (97.1%) completed the treatment period and 33 (94.3%) completed the posttreatment period. Mean change from baseline over the treatment period for three of the four key efficacy endpoints showed greater improvement in the linaclotide 72 μg group versus placebo. A dose-response trend was seen for stool consistency in patients receiving linaclotide. Four patients randomized to linaclotide experienced treatment-emergent AEs, one of which was treatment-related (mild diarrhea). All AEs were mild or moderate and none were severe. CONCLUSIONS Linaclotide was well tolerated in this pediatric population and an efficacy trend was seen with linaclotide 72 μg versus placebo.
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Affiliation(s)
- Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jon Robert
- HealthStar Research, Hot Springs, Arkansas, USA
| | | | | | | | - Samuel Nurko
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Miguel Saps
- Pediatric Gastroenterology, University of Miami, Miami, Florida, USA
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19
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Soliman A, AboAli SEM, Abdel Karim AE, Elsamahy SA, Hasan J, Hassan BAA, Mohammed AH. Effect of adding telerehabilitation home program to pharmaceutical treatment on the symptoms and the quality of life in children with functional constipation: a randomized controlled trial. Eur J Pediatr 2024; 183:3943-3958. [PMID: 38922435 PMCID: PMC11322404 DOI: 10.1007/s00431-024-05639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4-18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference. CONCLUSION Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life. TRIAL REGISTRATION Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024. WHAT IS KNOWN • Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation. • Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces. WHAT IS NEW • Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life. • Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain.
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Affiliation(s)
- Amir Soliman
- Department of Public Health and Community Medicine, Faculty of Medicine, Delta University for Science and Technology, Gamasa, Egypt
| | - Safy Eldin M AboAli
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, October University for Modern Sciences and Arts, Giza, Egypt
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatrics, Misr University for Science and Technology, Giza, Egypt
| | - Sara A Elsamahy
- Basic Science Department, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Judy Hasan
- Dakahlia STEM School, Al-Mansoura, Egypt
| | - Badr Al-Amir Hassan
- Department of Physical Therapy for Internal Medicine and Geriatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Amira H Mohammed
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt.
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20
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Beaudry-Bellefeuille I, Ramos-Polo E. Improving Participation in Toileting Routines in a Child with Functional Constipation: A Case Study Using the Integrated Sensory Toileting® Approach. Occup Ther Health Care 2024:1-12. [PMID: 39177311 DOI: 10.1080/07380577.2024.2394947] [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: 05/19/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024]
Abstract
This article presents a case report of a three and half year-old boy with functional constipation and sensory hyperreactivity. The Integrated Sensory Toileting® approach was used to guide clinical reasoning and identify the sensory underlying factors that were impacting the child's ability to acquire age-appropriate toileting habits and gastrointestinal health. The six months of treatment in occupational therapy and gastroenterology, as well as six months of follow-up are described. Improvements in sensory reactivity are documented using the Sensory Processing Measure-2 and the Toileting Habit Profile Questionnaire-Revised and corroborate with improvements in the child's ability to participate in toileting routines and improved gastrointestinal health.
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21
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Goy B, Berkenou J, Rothenbuhler A, Audrain C, Linglart A, Dubern B. Characterization of Digestive Manifestations in Patients with Impaired PTH/PTHrP Signaling Disorder/Pseudohypoparathyroidism. Horm Res Paediatr 2024:1-8. [PMID: 39154638 DOI: 10.1159/000539995] [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: 01/09/2024] [Accepted: 06/19/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Pseudohypoparathyroidism, newly classified as inactivating PTH/PTHrP signaling disorder (iPPSD) type 2 or type 3, is a rare disease caused by defects in the GNAS imprinted gene that encodes Gsα. The most common phenotype comprises resistance to hormones binding to G protein-coupled receptors such as PTH, PTHrP, or TSH, subcutaneous ossifications, short stature, brachydactyly, and early onset obesity. Uncommon features have been described including sleep apnea, asthma, and resistance to calcitonin. At the national French reference center for rare calcium and phosphate metabolism diseases, a large cohort of patients with iPPSD type 2 and type 3 is followed. Interestingly, digestive manifestations and in particular intractable constipation were regularly reported by families of children with iPPSD type 2 or type 3. OBJECTIVE The aim of our study was therefore to specify the frequency and characteristics of digestive manifestations in children followed up for iPPSD2 or iPPSD3 in our reference center. MATERIAL AND METHODS Thirty-six patients aged between 2 and 18 years (32 followed up for iPPSD2 and 4 for iPPSD3) were included. Parents completed a specific questionnaire to assess any digestive disorders in their child. The diagnosis of constipation was established using the Bristol visual scale in the event of a score of less than 2 according to stool appearance. RESULTS Parents reported constipation through the questionnaires in 22/36 (over 60%) of the children. It was the most frequently reported digestive disorder. Among these 22 children, 19 (87%) had a Bristol score for stool shape and texture between 1 and 2 on a scale of 7, confirming constipation. Dedicated treatment had been initiated for 10 (55%) of them, yet only 3 families (16%) considered this treatment effective. Neonatal vomiting and eating disorders, such as lack of satiety or food selectivity, were also noted in 18 (50%) of patients, as was gastroesophageal reflux present in the neonatal period in 14 (40%) of children. There were no significant differences according to the type of iPPSD or patient age. CONCLUSION Our work shows for the first time that digestive manifestations, including constipation, occur frequently in children followed for iPPSD, suggesting a potential role of Gsα and G protein receptors in the digestive tract. It is well known that constipation and digestive symptoms alter quality of life. Early management is therefore essential to improve the quality of life of children followed for iPPSD. Our data need to be confirmed on a larger cohort.
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Affiliation(s)
- Bérénice Goy
- Pediatric Nutrition and Gastroenterology Department, Reference Center for Rare Disorders, PRADORT (Syndrome de PRADer-Willi et autres Obésités Rares avec Troubles du comportement alimentaire), Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - Jugurtha Berkenou
- AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Paris-Saclay University Hospital, Le Kremlin-Bicêtre, France
| | - Anya Rothenbuhler
- AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Paris-Saclay University Hospital, Le Kremlin-Bicêtre, France
| | - Christelle Audrain
- AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Paris-Saclay University Hospital, Le Kremlin-Bicêtre, France
| | - Agnès Linglart
- AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Paris-Saclay University Hospital, Le Kremlin-Bicêtre, France
- University Paris Saclay, INSERM, Endocrinologie et physiopathologie endocrinienne, Bicêtre Paris Saclay University Hospital, Le Kremlin-Bicêtre, France
| | - Béatrice Dubern
- Pediatric Nutrition and Gastroenterology Department, Reference Center for Rare Disorders, PRADORT (Syndrome de PRADer-Willi et autres Obésités Rares avec Troubles du comportement alimentaire), Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
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22
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Al Khashram N, Al Abdulqader AA, Alarfaj HM, Bu Bshait MS, Kamal AH, Zakaria OM, Albarqi MN, Almulhim MA, Almousa MA, Almaqhawi A. Exploring Community Perspectives on Functional Paediatric Habitual Constipation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1017. [PMID: 39200628 PMCID: PMC11354896 DOI: 10.3390/ijerph21081017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024]
Abstract
(1) Background: Functional habitual constipation (FC) in children is a common gastrointestinal problem. This study aimed to explore the local community's view on this problem, emphasising the challenges that parents face in managing the condition and its impact on the child's quality of life. (2) Methods: A prospective, cross-sectional, community-based study was conducted between March and July 2023. The survey received 933 responses. The target population was adults over 18 years of age living in the Eastern Province of Saudi Arabia. An electronically distributed questionnaire was designed in the Arabic language. (3) Results: The mean knowledge scores were significantly higher in females than males, with t (931) = -2.701 and p = 0.007. The Bonferroni post hoc test results indicated that participants between 20 and 29 years exhibited significantly higher levels of knowledge scores compared to those between 30 and 39 years. Furthermore, the results revealed that those with three or more children had significantly higher knowledge scores compared to those with only one child. (4) Conclusions: This study demonstrated that parents in the local community have a good perceived knowledge of FC, but it needs to be linked with practice. They tended to report high levels of perception and demonstrated better practices. These results emphasise the importance of exploring the local community's view on constipation among children.
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Affiliation(s)
- Nawaf Al Khashram
- Department of Biomedical Sciences, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ahmad A. Al Abdulqader
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Haytham Mohammed Alarfaj
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Mohammed Saad Bu Bshait
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ahmed Hassan Kamal
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ossama M. Zakaria
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Mohammed Nasser Albarqi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | | | | | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
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23
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Mullan PC, Levasseur KA, Bajaj L, Nypaver M, Chamberlain JM, Thull-Freedman J, Ostrow O, Jain S. Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value. Ann Emerg Med 2024; 84:167-175. [PMID: 38349290 DOI: 10.1016/j.annemergmed.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 07/22/2024]
Abstract
Unnecessary diagnostic tests and treatments in children cared for in emergency departments (EDs) do not benefit patients, increase costs, and may result in harm. To address this low-value care, a taskforce of pediatric emergency medicine (PEM) physicians was formed to create the first PEM Choosing Wisely recommendations. Using a systematic, iterative process, the taskforce collected suggested items from an interprofessional group of 33 ED clinicians from 6 academic pediatric EDs. An initial review of 219 suggested items yielded 72 unique items. Taskforce members independently scored each item for its extent of overuse, strength of evidence, and potential for harm. The 25 highest-rated items were sent in an electronic survey to all 89 members of the American Academy of Pediatrics PEM Committee on Quality Transformation (AAP COQT) to select their top ten recommendations. The AAP COQT survey had a 63% response rate. The five most selected items were circulated to over 100 stakeholder and specialty groups (within the AAP, CW Canada, and CW USA organizations) for review, iterative feedback, and approval. The final 5 items were simultaneously published by Choosing Wisely United States and Choosing Wisely Canada on December 1, 2022. All recommendations focused on decreasing diagnostic testing related to respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral respiratory tract infections. A multinational PEM taskforce developed the first Choosing Wisely recommendation list for pediatric patients in the ED setting. Future activities will include dissemination efforts and interventions to improve the quality and value of care specific to recommendations.
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Affiliation(s)
- Paul C Mullan
- Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA.
| | - Kelly A Levasseur
- Division of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI
| | - Lalit Bajaj
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Michele Nypaver
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, and Michigan Emergency Department Improvement Collaborative (funded by BCBSM), Ann Arbor, MI
| | - James M Chamberlain
- Division of Emergency Medicine, Pediatrics and Emergency Medicine, George Washington University, Children's National Hospital, Washington, DC
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - Olivia Ostrow
- Division of Emergency Medicine, University of Toronto, the Hospital for Sick Children, Toronto, ON, Canada
| | - Shabnam Jain
- Pediatrics and Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
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24
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Yang WC, Zeng BS, Liang CS, Hsu CW, Su KP, Wu YC, Tu YK, Lin PY, Stubbs B, Chen TY, Chen YW, Shiue YL, Zeng BY, Suen MW, Hung CM, Wu MK, Tseng PT. Efficacy and acceptability of different probiotic products plus laxatives for pediatric functional constipation: a network meta-analysis of randomized controlled trials. Eur J Pediatr 2024; 183:3531-3541. [PMID: 38806862 PMCID: PMC11263257 DOI: 10.1007/s00431-024-05568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/30/2024]
Abstract
The prevalence of pediatric constipation ranges from 0.7 to 29.6% across different countries. Functional constipation accounts for 95% of pediatric constipation, and the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. We aimed to compare the efficacy and acceptability of different probiotic supplements for pediatric functional constipation. The current frequentist model-based network meta-analysis (NMA) included RCTs of probiotic supplements for functional constipation in children. The primary outcome was changes in bowel movement or stool frequency; acceptability outcome was all-cause discontinuation. Nine RCTs were included (N = 710; mean age = 5.5 years; 49.4% girls). Most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives (standardized mean difference (SMD) = 1.87, 95% confidence interval (95% CI) = 0.85 to 2.90) were associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments (SMD = 1.37, 95% CI: 0.32 to 2.43). All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments. Conclusion: The results of our NMA support the application of an advanced combination of probiotics and laxatives for pediatric functional constipation if there is no concurrent contraindication. Registration: PROSPERO (CRD42022298724). What is Known: • Despite of the high prevalence of pediatric constipation, which ranges from 0.7% to 29.6%, the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. The widely heterogeneous strains of probiotics let the traditional meta-analysis, which pooled all different strains into one group, be nonsense and insignificant. What is New: • By conducting a comprehensive network meta-analysis, we aimed to compare the efficacy and acceptability of different strains of probiotic supplements for pediatric functional constipation. Network meta-analysis of nine randomized controlled trials revealed that the most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives was associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments. All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments.
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Affiliation(s)
- Wei-Chieh Yang
- Department of Pediatrics, Ping An Medical Clinic, Tainan, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Pin Su
- Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
- Gender Equality Education and Research Center, Asia University, Taichung, Taiwan.
- Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, No. 1, Sec. 1, Xuecheng Rd., Dashu Dist., Kaohsiung City, 840301, Taiwan.
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
- Prospect Clinic for Otorhinolaryngology & Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan.
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
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van der Zande JMJ, Koppen IJN, Yacob D, Sanchez RE, Puri NB, Vaz K, Di Lorenzo C, Benninga MA, Lu PL. Current practice in the care of children with functional constipation: What is the hold up? J Pediatr Gastroenterol Nutr 2024; 79:301-308. [PMID: 38924156 DOI: 10.1002/jpn3.12295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/22/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES For children with intractable functional constipation (FC), there are no evidence-based guidelines for subsequent evaluation and treatment. Our objective was to assess the practice patterns of a large, international cohort of pediatric gastroenterologists. METHODS We administered a survey to physicians who attended the 2nd World Congress of Pediatric Neurogastroenterology and Motility held in Columbus, Ohio (USA) in September 2023. The survey included 29 questions on diagnostic testing, nonpharmacological and pharmacological treatment, and surgical options for children with intractable FC. RESULTS Ninety physicians from 18 countries completed the survey. For children with intractable FC, anorectal manometry was the most commonly used diagnostic test. North American responders were more likely than Europeans to use stimulant laxatives (97% vs. 77%, p = 0.032), prosecretory medications (69% vs. 8%, p < 0.001), and antegrade continence enemas (ACE; 83% vs. 46%, p = 0.009) for management. Europeans were more likely than North Americans to require colonic transit testing before surgery (85% vs. 30%, p < 0.001). We found major differences in management practices between Americans and the rest of the world, including use of prosecretory drugs (73% vs. 7%, p < 0.001), anal botulinum toxin injections (81% vs. 58%, p = 0.018), ACE (81% vs. 58% p = 0.018), diverting ileostomies (56% vs. 26%, p = 0.006), and colonic resections (42% vs. 16%, p = 0.012). No differences were found when respondents were compared by years of experience. CONCLUSIONS Practice patterns in the evaluation and treatment of children with intractable FC differ widely among pediatric gastroenterologists from around the world. A clinical guideline regarding diagnostic testing and surgical decision-making is needed.
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Affiliation(s)
- Julia M J van der Zande
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Desale Yacob
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Raul E Sanchez
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Neetu B Puri
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karla Vaz
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter L Lu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
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Maselli KM, Shah NR, Speck KE. Approach to Constipation in Children: Recommendations for Evaluation and Management. Adv Pediatr 2024; 71:195-211. [PMID: 38944484 DOI: 10.1016/j.yapd.2024.04.001] [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] [Indexed: 07/01/2024]
Abstract
Constipation is common in childhood, and most patients can be successfully managed by their primary care provider. However, some patients will require more specialized management either due to an underlying congenital colorectal disorder such as Hirschsprung disease or anorectal malformation or due to severe functional constipation that is refractory to medical management.
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Affiliation(s)
- Kathryn M Maselli
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4211, USA
| | - Nikhil R Shah
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4211, USA
| | - Karen Elizabeth Speck
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4211, USA.
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27
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Tuna Kirsaçlioğlu C. Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2170-2179. [PMID: 38088191 DOI: 10.1002/ppul.26801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 07/27/2024]
Abstract
In recent decades, the patient survival is increased due to advances in intensive care units and development of modern mechanic ventilators. Unfortunately, it is not always possible to wean these children from mechanical ventilation. Recently, after placement a tracheostomy tube, these children can be supported at home with noninvasive or invasive mechanical ventilation. Most of the children who need ventilation support at home have neurological impairment. The nutritional issues and gastrointestinal (GI) complications are well defined in critically ill patients, but there are very limited studies on children with tracheostomy. Considering that majority of the patients have neuromuscular disorders, the nutritional and GI problems of the children with tracheostomy are discussed in light of the knowledge of critically ill patients.
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Affiliation(s)
- Ceyda Tuna Kirsaçlioğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ankara University School of Medicine, Ankara, Türkiye
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28
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Winke C, Moore B, Gelman J, Paul S, Rouster A, Guido A. A case of Burkitt Lymphoma discovered by digital rectal exam. JPGN REPORTS 2024; 5:363-366. [PMID: 39149199 PMCID: PMC11322034 DOI: 10.1002/jpr3.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 08/17/2024]
Abstract
Burkitt Lymphoma (BL) is an aggressive B-cell lymphoma predominantly encountered in pediatrics. Sporadic type typically involves the abdomen and/or pelvis. We present an 8-year-old Caucasian male with vomiting, weight loss, fatigue, and abdominal pain. An abdominal X-ray was unremarkable without any acute findings. Pediatric gastroenterology was consulted and recommended esophagogastroduodenoscopy and colonoscopy. A digital rectal exam (DRE) was performed, and a firm lesion was palpated. The colonoscopy was normal. Subsequent magnetic resonance imaging and computed tomography scans revealed a lesion in the left lower quadrant with mass-like processes involving the porta hepatis and encasing the left distal ureter. Tissue biopsy confirmed BL. The patient completed chemotherapy and achieved remission. This case highlights DRE as a basic physical exam skill in the evaluation of patients with nonspecific gastrointestinal symptoms.
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Affiliation(s)
- Colin Winke
- Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Brandon Moore
- Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Jacob Gelman
- Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Stephan Paul
- Department of Pediatrics, Section of Hematology/OncologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Audra Rouster
- Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Amy Guido
- Department of Pediatrics, Division of Pediatric Gastroenterology and HepatologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
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29
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Burton LM, Skelton J, Harry O, Zuar L. Systematic review of family and pediatric constipation: An overlooked piece of the puzzle. J Pediatr Gastroenterol Nutr 2024; 79:309-314. [PMID: 38934411 DOI: 10.1002/jpn3.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
The objective of this review is to summarize pertinent literature looking at family dynamics and/or adherence to treatment in pediatric functional constipation. A structured systematic literature search was conducted on MEDLINE, Embase, and Web of Science core collection libraries from the years 2000 to 2023 using specific search terms: constipation, treatment adherence, family dynamics, parenting style, and pediatrics. Seventy-one publications were identified and included for review. After screening based on alignment to the review, 20 publications remained. These publications were placed into three categories depending on their intent and findings: (1) recommendations to further increase adherence, (2) studies analyzing factors of adherence, and (3) studies stating a need for a better understanding of family factors. A future area of research is identifying the associations between family factors on adherence to constipation treatment regimens. Results from such studies would increase the amount of positive treatment outcomes and decrease unnecessary healthcare costs.
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Affiliation(s)
- Landon M Burton
- Department of Biology, Wake Forest University, Winston-Salem, North Carolina, USA
- Wake Forest School of Medicine, Center for Prevention Science in Child and Family Health, Winston-Salem, North Carolina, USA
| | - Joseph Skelton
- Wake Forest School of Medicine, Center for Prevention Science in Child and Family Health, Winston-Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Onengiya Harry
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynsey Zuar
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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30
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Zakaryaei SA, Ravanbakhsh M, Javaherizadeh H, Hakimzadeh M, Shaterzadeh-Yazdi MJ. EFFECT OF VISCERAL MANIPULATION ON CHILDREN WITH REFRACTORY CHRONIC FUNCTIONAL CONSTIPATION: A RANDOMIZED CONTROLLED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23146. [PMID: 39046000 DOI: 10.1590/s0004-2803.24612023-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Functional constipation (FC) is a common global high prevalence issue in children. OBJECTIVE The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. METHODS This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. RESULTS At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). CONCLUSION VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.
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Affiliation(s)
- Seyed Arman Zakaryaei
- Student Research Committee, School of Rehabiliatation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Ravanbakhsh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hazhir Javaherizadeh
- Alimentary Tract Tesearch Center, Clinical Science Research Institute, Rehabilitation Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehran Hakimzadeh
- Alimentary Tract Tesearch Center, Clinical Science Research Institute, Rehabilitation Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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31
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Erkel D, Märzheuser S, Lindert J. Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study. Pediatr Surg Int 2024; 40:202. [PMID: 39030300 PMCID: PMC11271418 DOI: 10.1007/s00383-024-05771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU). METHODS Prospective case-control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986-1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data. RESULTS p value for TRD in all groups significant with p < 0.05 and in grouped follow-up. CONCLUSION Ultrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management.
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Affiliation(s)
- Daniel Erkel
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany.
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
| | - Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
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32
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Di Lorenzo C. Faecal incontinence: Retentive, non-retentive and when to suspect organic pathology. Aliment Pharmacol Ther 2024; 60 Suppl 1:S54-S65. [PMID: 38924573 DOI: 10.1111/apt.17832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Faecal incontinence is a highly prevalent and very distressing condition that occurs throughout the entire paediatric age. AIM To summarise advances in the understanding of the epidemiology, pathophysiology, evaluation and treatment of children with faecal incontinence due to either disorders of gut-brain interaction or organic diseases. METHODS Literature review on prevalence, impact, diagnosis and treatment options for children with faecal incontinence, interspersed with observations from the author's lifelong career focused on evaluation of children with motility disorders. RESULTS Faecal incontinence in children is most commonly due to unrecognised or insufficiently treated functional constipation with overflow incontinence. Non-retentive faecal incontinence (NRFI) is probably more common than previously thought and is particularly challenging to treat. Organic diseases such as anorectal malformations (ARMs), Hirschsprung disease and spinal defects are often associated with faecal incontinence; in these conditions, faecal incontinence has a profound impact on quality of life. Recognition of the different pathophysiologic mechanisms causing the incontinence is essential for a successful treatment plan. A thorough physical examination and history is all that is needed in the diagnosis of the causes of faecal incontinence related to disorders of gut-brain interaction. Colonic transit studies or x-rays may help to differentiate retentive from NRFI. Manometry tests are helpful in determining the mechanisms underlying the incontinence in children operated on for ARMs or Hirschsprung diseases. Multiple behavioural, medical and surgical interventions are available to lessen the severity of faecal incontinence and its impact on the daily life of affected individuals. CONCLUSIONS Recent advances offer hope for children with faecal incontinence.
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Affiliation(s)
- Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Haiden N, Savino F, Hill S, Kivelä L, De Koning B, Kӧglmeier J, Luque V, Moltu SJ, Norsa L, De Pipaon MS, Verduci E, Bronsky J. Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr 2024; 79:168-180. [PMID: 38766683 DOI: 10.1002/jpn3.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.
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Affiliation(s)
- Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria
| | - Francesco Savino
- Department of Patologia e cura del bambino "Regina Margherita" Regina Margherita Children Hospital, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Susan Hill
- Nutrition and Intestinal Failure Division, Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Laura Kivelä
- Celiac Disease Research Center, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland; Research Institute, University of Oslo, Oslo, Norway
| | - Barbara De Koning
- Department of Pediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jutta Kӧglmeier
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Veronica Luque
- Serra Húnter Fellow, Paediatric Nutrition and Development Research Unit, Universitat Rovira i Virgili-IISPV, Tarragona, Spain
| | - Sissel J Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway Pediatric, Oslo, Norway
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Miguel Saenz De Pipaon
- Neonatology Hospital La Paz Institute for Health Research - IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elvira Verduci
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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Kilgore A, Khlevner J. Functional Constipation: Pathophysiology, evaluation, and management. Aliment Pharmacol Ther 2024; 60 Suppl 1:S20-S29. [PMID: 38925548 DOI: 10.1111/apt.17852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Functional constipation (FC), a disorder of the gut-brain interaction of multifactorial pathophysiology that is prevalent in paediatrics. It is associated with bothersome symptoms, increased healthcare costs, disgruntled caregivers and impaired health-related quality of life. Paediatric FC is a clinical diagnosis based on the Rome IV criteria and is characterised by decreased bowel movement frequency and/or hard, painful stools and can be complicated by retentive faecal incontinence. Stressful life events, difficult temperaments and emotional and behavioural challenges have been implicated in increasing risk of developing paediatric FC. AIMS To provide current concepts in pathophysiology, evaluation and management of paediatric FC. METHODS We reviewed pertinent literature after a comprehensive search utilising PubMed with keywords FC, chronic childhood constipation and paediatric FC. RESULTS In the last decade, advances in our understanding of paediatric FC have changed the landscape of diagnosing and treating this disorder. Although polyethylene glycol is the first-line treatment for maintenance of FC, the armamentarium of therapeutics has expanded including the first Food and Drug Administration- agent, linaclotide, for children 6-17 years of age in conjunction with more emphasis on behavioural and physical therapy interventions. CONCLUSIONS Treatment approach to paediatric FC should be individualised and integrated focusing on parental education, lifestyle and behavioural modifications, and pharmacological therapy to maximise therapeutic success. This review highlights advances in pathophysiology, diagnosis and treatment of FC in children.
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Affiliation(s)
- Alexandra Kilgore
- Digestive Health Institute, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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35
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Wolfson S, Saps M. Recent advances in treating constipation in children. Expert Rev Gastroenterol Hepatol 2024; 18:325-338. [PMID: 39034812 DOI: 10.1080/17474124.2024.2383636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/19/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Functional constipation (FC) is a common childhood condition, diagnosed via the Rome IV criteria. Standard therapy includes lifestyle and dietary modification followed by initiation of osmotic laxative therapy. About 30% of children continue to experience symptoms related to FC despite appropriate management. New pharmacologic, surgical, and neuromodulatory therapies for FC are now available for use in adult and pediatric populations. In 2023, the first pharmacologic agent, linaclotide, obtained FDA approval for treatment of FC in children 6-17 years old. AREAS COVERED This article reviews current and emerging pharmacologic, surgical, and neuromodulation therapies for the management of FC in pediatric patients. Efficacy and safety data regarding each of these modalities was reviewed and discussed. EXPERT OPINION Advancements in therapeutics available for the management of FC necessitate further investigation on safety and efficacy in pediatric populations. Careful consideration should be taken in choosing an available treatment with limited pediatric evidence as adult and pediatric FC have different underlying pathophysiology and require a different therapeutic approach. Standardization of methodology and pediatric endpoints are needed to optimize ability to compare efficacy of different treatments. We predict the future of pediatric FC management will include a personalized approach to care, resulting in improved outcomes.
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Affiliation(s)
- Sharon Wolfson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology,Hepatology and Nutrition, University of Miami, Miami, FL, USA
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van der Zande JMJ, Lu PL. Management of the child with refractory constipation. Aliment Pharmacol Ther 2024; 60 Suppl 1:S42-S53. [PMID: 38923030 DOI: 10.1111/apt.17847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Caring for children with constipation refractory to conventional treatment can be challenging and management practices vary widely. AIMS To review recent advances in the evaluation and treatment of children with refractory constipation and to propose an algorithm that incorporates the latest evidence and our institutional experience. METHODS We performed a literature review on diagnostic tests and treatment options for children with refractory constipation. RESULTS Evaluation of a child with refractory constipation seeks to better understand factors contributing to an individual child's presentation. Anorectal manometry evaluating for a rectal evacuation disorder and colonic manometry evaluating for colonic dysmotility can guide subsequent treatment. For the child who has not responded to conventional treatment, a trial of newer medications like linaclotide can be helpful. Transanal irrigation offers a safe and effective alternative for families able to administer daily rectal treatment. Despite mixed evidence in children, pelvic floor biofeedback therapy can help some children with pelvic floor dyssynergia. For younger children unable to cooperate with pelvic floor therapy, or older children with refractory symptoms, internal anal sphincter botulinum toxin injection can be beneficial. Antegrade continence enema treatment can be effective for children with either normal colonic motility or segmental dysmotility. Sacral nerve stimulation is generally reserved for symptoms that persist despite antegrade continence enemas, particularly if faecal incontinence is prominent. In more severe cases, temporary or permanent colonic diversion and segmental colonic resection may be needed. CONCLUSIONS Recent advances offer hope for children with refractory constipation.
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Affiliation(s)
- Julia M J van der Zande
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Carson RA, Lyles JL. Cognitive Bias in an Infant with Constipation. J Pediatr 2024; 270:113996. [PMID: 38432294 DOI: 10.1016/j.jpeds.2024.113996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Rebecca A Carson
- Clinical Assistant Professor, Conway School of Nursing, The Catholic University of America, Washington, DC
| | - John L Lyles
- Assistant Professor of Pediatrics, Division of Gastroenterology/Hepatology/Nutrition, Duke University School of Medicine, Durham, NC.
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Cecchi N, Romanelli R, Ricevuti F, Carbone MG, Dinardo M, Cesarano E, De Michele A, Messere G, Morra S, Scognamiglio A, Spagnuolo MI. Bioactives in Oral Nutritional Supplementation: A Pediatric Point of View. Nutrients 2024; 16:2067. [PMID: 38999815 PMCID: PMC11243142 DOI: 10.3390/nu16132067] [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: 05/30/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Oral nutritional supplements (ONSs) are crucial for supporting the nutritional needs of pediatric populations, particularly those with medical conditions or dietary deficiencies. Bioactive compounds within ONSs play a pivotal role in enhancing health outcomes by exerting various physiological effects beyond basic nutrition. However, the comprehensive understanding of these bioactives in pediatric ONSs remains elusive. OBJECTIVE This systematic narrative review aims to critically evaluate the existing literature concerning bioactive compounds present in oral nutritional supplements from a pediatric standpoint, focusing on their types, sources, bioavailability, physiological effects, and clinical implications. METHODS A systematic search was conducted across the major academic databases, including PubMed, Scopus, and Web of Science, employing predefined search terms related to oral nutritional supplements, bioactives, and pediatrics. Studies published between 2013 and 2024 were considered eligible for inclusion. Data extraction and synthesis were performed according to the PRISMA guidelines. RESULTS The initial search yielded 558 of articles, of which 72 met the inclusion criteria. The included studies encompassed a diverse range of bioactive compounds present in pediatric ONS formulations, including, but not limited to, vitamins, minerals, amino acids, prebiotics, probiotics, and phytonutrients. These bioactives were sourced from various natural and synthetic origins and were found to exert beneficial effects on growth, development, immune function, gastrointestinal health, cognitive function, and overall well-being in pediatric populations. However, variations in bioavailability, dosing, and clinical efficacy were noted across different compounds and formulations. CONCLUSIONS Bioactive compounds in oral nutritional supplements offer promising avenues for addressing the unique nutritional requirements and health challenges faced by pediatric populations. However, further research is warranted to elucidate the optimal composition, dosage, and clinical applications of these bioactives in pediatric ONS formulations. A deeper understanding of these bioactive compounds and their interplay with pediatric health may pave the way for personalized and effective nutritional interventions in pediatric clinical practice.
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Affiliation(s)
- Nicola Cecchi
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Roberta Romanelli
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Flavia Ricevuti
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Maria Grazia Carbone
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Michele Dinardo
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Elisabetta Cesarano
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Alfredo De Michele
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Giovanni Messere
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Salvatore Morra
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Armando Scognamiglio
- Clinical Nutrition Unit, A.O.R.N. Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
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Dorfman L, El-Chammas K, Singh A, Fei L, Mansi S, Santucci NR, Kaul A. Exploring Diagnostic Priorities: The Role of Colonic Manometry in Evaluating Pediatric Patients with Intractable Idiopathic Constipation Prior to Sacral Nerve Stimulation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:768. [PMID: 39062218 PMCID: PMC11274712 DOI: 10.3390/children11070768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Despite the limited understanding of its precise mechanism of action, sacral nerve stimulation (SNS) has proven to be helpful for pediatric patients with constipation, particularly those with fecal incontinence. It is unclear whether the outcome of SNS is impacted by normal or abnormal colonic motility. Our study aimed to determine whether colonic manometry results had an impact on the outcome of SNS as a treatment in pediatric patients with refractory idiopathic constipation. METHODS Electronic medical records of patients with idiopathic constipation who underwent colonic manometry and SNS placement at our center over 6 years were reviewed. A comparison of post-SNS outcomes was performed between patients with normal and abnormal colonic manometry studies. RESULTS Twenty patients [12 (60%) females, median age of 10.2 years] met inclusion criteria, with fecal incontinence in 12 (60%) and abnormal colonic manometry in 6 (30%). Significantly more patients had an improvement in fecal incontinence following SNS placement (p = 0.045). There were no significant differences in post-SNS constipation outcome measures between patients with normal versus abnormal colonic manometry. CONCLUSIONS Colonic manometry did not help with patient selection for those being considered for SNS therapy. Our findings do not support performing colonic manometry as a screening prior to SNS placement.
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Affiliation(s)
- Lev Dorfman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
| | - Khalil El-Chammas
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Azadvir Singh
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
| | - Lin Fei
- Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Sherief Mansi
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Neha R. Santucci
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Ajay Kaul
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.D.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Gordon M, Grafton-Clarke C, Rajindrajith S, Benninga MA, Sinopoulou V, Akobeng AK. Treatments for intractable constipation in childhood. Cochrane Database Syst Rev 2024; 6:CD014580. [PMID: 38895907 PMCID: PMC11190639 DOI: 10.1002/14651858.cd014580.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Constipation that is prolonged and does not resolve with conventional therapeutic measures is called intractable constipation. The treatment of intractable constipation is challenging, involving pharmacological or non-pharmacological therapies, as well as surgical approaches. Unresolved constipation can negatively impact quality of life, with additional implications for health systems. Consequently, there is an urgent need to identify treatments that are efficacious and safe. OBJECTIVES To evaluate the efficacy and safety of treatments used for intractable constipation in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two trials registers up to 23 June 2023. We also searched reference lists of included studies for relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any pharmacological, non-pharmacological, or surgical treatment to placebo or another active comparator, in participants aged between 0 and 18 years with functional constipation who had not responded to conventional medical therapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were symptom resolution, frequency of defecation, treatment success, and adverse events; secondary outcomes were stool consistency, painful defecation, quality of life, faecal incontinence frequency, abdominal pain, hospital admission for disimpaction, and school absence. We used GRADE to assess the certainty of evidence for each primary outcome. MAIN RESULTS This review included 10 RCTs with 1278 children who had intractable constipation. We assessed one study as at low risk of bias across all domains. There were serious concerns about risk of bias in six studies. One study compared the injection of 160 units botulinum toxin A (n = 44) to unspecified oral stool softeners (n = 44). We are very uncertain whether botulinum toxin A injection improves treatment success (risk ratio (RR) 37.00, 95% confidence interval (CI) 5.31 to 257.94; very low certainty evidence, downgraded due to serious concerns with risk of bias and imprecision). Frequency of defecation was reported only for the botulinum toxin A injection group (mean interval of 2.6 days). The study reported no data for the other primary outcomes. One study compared erythromycin estolate (n = 6) to placebo (n = 8). The only primary outcome reported was adverse events, which were 0 in both groups. The evidence is of very low certainty due to concerns with risk of bias and serious imprecision. One study compared 12 or 24 μg oral lubiprostone (n = 404) twice a day to placebo (n = 202) over 12 weeks. There may be little to no difference in treatment success (RR 1.29, 95% CI 0.87 to 1.92; low certainty evidence). We also found that lubiprostone probably results in little to no difference in adverse events (RR 1.05, 95% CI 0.91 to 1.21; moderate certainty evidence). The study reported no data for the other primary outcomes. One study compared three-weekly rectal sodium dioctyl sulfosuccinate and sorbitol enemas (n = 51) to 0.5 g/kg/day polyethylene glycol laxatives (n = 51) over a 52-week period. We are very uncertain whether rectal sodium dioctyl sulfosuccinate and sorbitol enemas improve treatment success (RR 1.33, 95% CI 0.83 to 2.14; very low certainty evidence, downgraded due to serious concerns with risk of bias and imprecision). Results of defecation frequency per week was reported only as modelled means using a linear mixed model. The study reported no data for the other primary outcomes. One study compared biofeedback therapy (n = 12) to no intervention (n = 12). We are very uncertain whether biofeedback therapy improves symptom resolution (RR 2.50, 95% CI 1.08 to 5.79; very low certainty evidence, downgraded due to serious concerns with risk of bias and imprecision). The study reported no data for the other primary outcomes. One study compared 20 minutes of intrarectal electromotive botulinum toxin A using 2800 Hz frequency and botulinum toxin A dose 10 international units/kg (n = 30) to 10 international units/kg botulinum toxin A injection (n = 30). We are very uncertain whether intrarectal electromotive botulinum toxin A improves symptom resolution (RR 0.96, 95% CI 0.76 to 1.22; very low certainty evidence) or if it increases the frequency of defecation (mean difference (MD) 0.00, 95% CI -1.87 to 1.87; very low certainty evidence). We are also very uncertain whether intrarectal electromotive botulinum toxin A has an improved safety profile (RR 0.20, 95% CI 0.01 to 4.00; very low certainty evidence). The evidence for these results is of very low certainty due to serious concerns with risk of bias and imprecision. The study did not report data on treatment success. One study compared the injection of 60 units botulinum toxin A (n = 21) to myectomy of the internal anal sphincter (n = 21). We are very uncertain whether botulinum toxin A injection improves treatment success (RR 1.00, 95% CI 0.75 to 1.34; very low certainty evidence). No adverse events were recorded. The study reported no data for the other primary outcomes. One study compared 0.04 mg/kg oral prucalopride (n = 107) once daily to placebo (n = 108) over eight weeks. Oral prucalopride probably results in little or no difference in defecation frequency (MD 0.50, 95% CI -0.06 to 1.06; moderate certainty evidence); treatment success (RR 0.96, 95% CI 0.53 to 1.72; moderate certainty evidence); and adverse events (RR 1.15, 95% CI 0.94 to 1.39; moderate certainty evidence). The study did not report data on symptom resolution. One study compared transcutaneous electrical stimulation to sham stimulation, and another study compared dietitian-prescribed Mediterranean diet with written instructions versus written instructions. These studies did not report any of our predefined primary outcomes. AUTHORS' CONCLUSIONS We identified low to moderate certainty evidence that oral lubiprostone may result in little to no difference in treatment success and adverse events compared to placebo. Based on moderate certainty evidence, there is probably little or no difference between oral prucalopride and placebo in defecation frequency, treatment success, or adverse events. For all other comparisons, the certainty of the evidence for our predefined primary outcomes is very low due to serious concerns with study limitations and imprecision. Consequently, no robust conclusions could be drawn.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Ciaran Grafton-Clarke
- School of Medicine, University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich Hospital, Norwich, UK
| | | | - M A Benninga
- Department of Paediatric Gastroenterology, Emma Children's Hospital/AMC, Amsterdam, Netherlands
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McCague Y, Somanadhan S, Stokes D, Furlong E. The psychosocial implication of childhood constipation on the children and family: A scoping review protocol. HRB Open Res 2024; 6:48. [PMID: 38812827 PMCID: PMC11134151 DOI: 10.12688/hrbopenres.13713.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 05/31/2024] Open
Abstract
Background Constipation is a common problem in childhood that can have psychological, emotional, social, and health-related quality-of-life (HRQOL) consequences on children and their families. Primary or functional constipation (FC) has no known underlying pathology but is associated with lifestyle, psychological, and behavioural factors. Misdiagnosis and inadequate management of constipation can result in chronicity that can continue to adulthood, reducing quality of life for the child and their parents/family. It also causes emotional, psychological and emotional distress and concern for children and their families. This scoping review aims to answer the research question, "What has been reported about the psychosocial implication of childhood constipation among children and their families?" Methods The methodology for this scoping review will draw on the six stages of Arksey and O'Malley Framework and the updated and refined version by Peters et al. (2022). The process and reporting will follow the PRISMA-ScR guidelines. The Population, Concept and Context (PCC) framework will guide the development of inclusion criteria and the search strategy for this scoping review. Systematic literature searches of PUBMED, CINAHL, ASSIA, PsycInfo and Cochrane Library will be conducted from inception to present. The critical appraisal will be performed on selected articles to promote trustworthiness and methodological rigour. Plans for consultation exercise and dissemination of findings will also be presented. Conclusion This scoping review aims to present a comprehensive synthesis of the characteristics and extent of available literature to develop an understanding of and identify gaps in current knowledge regarding the psychosocial implication of childhood constipation on children and their families.
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Affiliation(s)
- Yvonne McCague
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Suja Somanadhan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Diarmuid Stokes
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Leinster, Ireland
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Bedenik T, Cahir C, Bennett K. Building public trust and confidence in secondary use of health data for healthcare improvement and research: a qualitative study pre-protocol. HRB Open Res 2024; 6:47. [PMID: 38947251 PMCID: PMC11214037 DOI: 10.12688/hrbopenres.13711.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/02/2024] Open
Abstract
Background Secondary use of health data provides opportunities to drive improvements in healthcare provision, personalised medicine, comparative effectiveness research, health services innovation, and policy and practice. However, secondary data use requires compliance with relevant legislation, implementation of technical safeguards, ethical data management, and respect for data sharers. Existing evidence suggests widespread support for secondary use of health data among the public, which co-exists with concerns about privacy, confidentiality and misuse of data. Balancing the protection of individuals' rights against the use of their health data for societal benefits is of vital importance, and trust underpins this process. The study protocol explores how to build public trust and confidence in the secondary use of health data through all key stakeholder groups in Ireland, towards developing a culture that promotes a safe and trustworthy use of data. Methods This study will adopt a qualitative cross-sectional approach conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research COREQ guidelines. Participants in the study will include academics and researchers; healthcare professionals, data protection, ethics and privacy experts and data controllers; pharmaceutical industry and patients and public. Purposive and convenience sampling techniques will be utilised to recruit the participants, and data will be collected utilizing focus groups that may be supplemented with semi-structured interviews. Data will be coded by themes using reflexive thematic analysis (TA) and collective intelligence (CI) will be convened post-analysis to explore the preliminary findings with the participants. Ethics and Dissemination Ethical approval was obtained from the Royal College of Surgeons in Ireland Research Ethics Committee (REC202208013). Final data analysis and dissemination is expected by Q1 2024. Findings will be disseminated through peer-reviewed journal publications, presentations at relevant conferences, and other academic, public and policy channels. Lay summaries will be designed for Public and Patient Involvement (PPI) contributors and general public.
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Affiliation(s)
- Tina Bedenik
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
- Science Foundation Ireland (SFI) FutureNeuro Research Centre, Dublin, D02 YN77, Ireland
| | - Caitriona Cahir
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
| | - K. Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, D02 DH60, Ireland
- Science Foundation Ireland (SFI) FutureNeuro Research Centre, Dublin, D02 YN77, Ireland
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Sinopoulou V, Gordon M, Rajindrajith S, Hathagoda W, Rane AB, Sedghi A, Tabbers M, Di Lorenzo C, Saps M, Benninga MA. How do we define therapy-resistant constipation in children aged 4-18 years old? A systematic review with meta-narrative synthesis. BMJ Paediatr Open 2024; 8:e002380. [PMID: 38844387 PMCID: PMC11163682 DOI: 10.1136/bmjpo-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/17/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Therapy-resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements faecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy-resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures. AIM To conduct a systematic review determining how paediatric interventional studies define therapy-resistant constipation. METHOD We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy-resistant constipation were identified. Data were extracted on criteria used for defining therapy-resistant constipation and reported using a meta-narrative approach highlighting areas of convergence and divergence in the findings. RESULTS A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least seven definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy-resistant constipation. Out of them, only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy-resistant constipation. The duration before being diagnosed as therapy-resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation while five adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children. CONCLUSION The current literature has no explicit definition for therapy-resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary and maybe even harmful, invasive diagnostic and therapeutic interventions.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Miguel Saps
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marc A Benninga
- Department of Pediatrics, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
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de Morais MB, Boilesen SN, Dias FC, Tahan S, Melli LCFL. Assessing impaired gastric accommodation in children with functional constipation using the water load test. Neurogastroenterol Motil 2024; 36:e14786. [PMID: 38523297 DOI: 10.1111/nmo.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND This study aimed to evaluate gastric accommodation in pediatric patients with functional constipation using the water load test. METHOD This was a cross-sectional case-control study. Herein, the water load test results of children aged >4 years with functional constipation referred to a Pediatric Gastroenterology Outpatient Clinic (functional constipation group) were compared with those of a control group (without functional constipation or chronic abdominal pain) recruited from two public schools. Clinical manifestations outlined in the Rome IV criteria were used to diagnose functional constipation. Water load tests were performed after 3 h of fasting. For the test, the participants were asked to drink as much water as possible in 3 min. KEY RESULTS A total of 36 patients and 77 students were included in the functional constipation and control groups, respectively. There was no significant difference in age between the groups (8.6 ± 2.3 years and 8.8 ± 1.8 years in the functional constipation and control groups, respectively). The water load test showed intake volumes of 390 ± 245 mL and 528 ± 219 mL in the functional constipation and control groups, respectively (p = 0.001). The maximum volume in the water load test correlated with the 24 h daily intake of energy (rS = +0.42, p = 0.012), protein (rS = +0.48, p = 0.004), and water (rS = +0.39, p = 0.020) only in the group with functional constipation. CONCLUSIONS & INFERENCES According to the water load test, gastric accommodation was impaired in children with severe functional constipation. The impairment of gastric accommodation in children with severe functional constipation is related to food intake.
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Affiliation(s)
- Mauro Batista de Morais
- Division of Pediatric Gastroenterology and Postgraduate Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sabine N Boilesen
- Division of Pediatric Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Francine C Dias
- Division of Pediatric Gastroenterology and Postgraduate Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Soraia Tahan
- Division of Pediatric Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lígia C F L Melli
- Division of Pediatric Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Srinivas S, Gasior A, Wood RJ, Fuchs M. Unusual Management of Fecal Impaction in an Adult With Functional Constipation: A Urological Adventure. Urology 2024; 188:125-127. [PMID: 38492758 DOI: 10.1016/j.urology.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
A 27-year-old male with a history of functional constipation presented for ileostomy closure. He had a 12-cm impacted rectal stool ball precluding safe ileostomy takedown. He underwent multiple unsuccessful attempts at removal, including colotomy, antegrade and retrograde enemas, and manual disimpaction. The urological team suggested a novel approach using lithotripsy. A 26-French rigid nephroscope and the Olympus ShockPulse SE ultrasonic lithotripter were utilized transanally to break up the impacted stool ball. The patient was discharged the same day without complication. Ultrasonic lithotripsy is an unusual yet effective modality for prolonged fecal impaction. By employing a unique, multidisciplinary technique, operative morbidity was avoided.
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Affiliation(s)
- Shruthi Srinivas
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Alessandra Gasior
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH; Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard J Wood
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Molly Fuchs
- Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH.
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Chen K, Zhou Z, Nie Y, Cao Y, Yang P, Zhang Y, Xu P, Yu Q, Shen Y, Ma W, Jin S, Liu C. Adjunctive efficacy of Bifidobacterium animalis subsp. lactis XLTG11 for functional constipation in children. Braz J Microbiol 2024; 55:1317-1330. [PMID: 38381349 PMCID: PMC11153453 DOI: 10.1007/s42770-024-01276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Functional constipation (FC) can seriously affect the physical and mental health of children. The goal of this study is to assess the efficacy and safety of Bifidobacterium animalis subsp. lactis XLTG11 in treating FC in children through a randomized, double-blinded, placebo-controlled approach. Eligible children were randomized into either the intervention group (IG, n = 65, receiving conventional treatment with probiotics) or the control group (CG, n = 66, receiving conventional treatment without probiotics). The primary outcome measure was fecal frequency. Fecal gut microbiota analysis and PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) were used to predict gene family abundances based on 16S information. Over the course of treatment, the weekly frequency of feces within each group increased significantly (F = 41.97, p < 0.001). The frequency of feces (times/week (t/w)) in the IG was significantly higher than that in the CG (3.69 ± 2.62 t/w vs.3.18 ± 1.43 t/w, 4.03 ± 2.54 t/w vs. 2.89 ± 1.39 t/w and 3.74 ± 2.36 t/w vs. 2.94 ± 1.18 t/w and 3.45 ± 1.98 vs. 3.17 ± 1.41 t/w for the 1st, 2nd, 3rd, and 4th week after intervention, respectively) (F = 7.60, p = 0.0067). After the intervention, dominate species shifted to Bifidobacterium longum, Bifidobacterium breve, and Escherichia coli in the IG. Additionally, genes related to short-chain fatty acid (SCF) metabolism were upregulated, while methane metabolism was downregulated. Administration of XLTG11 at a dose of 1 × 1010 CFU/day to children increased fecal frequency, induced beneficial changes in gut microbiota, and regulated SCFs and methane metabolism-related genes.
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Affiliation(s)
- Ke Chen
- Department of Nutrition, School of Medicine, Chengdu Women's & Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zengyuan Zhou
- Department of Nutrition, School of Medicine, Chengdu Women's & Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Nie
- Department of Child Health Care, Chongzhou Maternal and Child Health Care Hospital, Chengdu, China
| | - Yanmei Cao
- Department of Child Health Care, Dayi Maternal and Child Health Care Hospital, Chengdu, China
| | - Ping Yang
- Department of Child Health Care, Xindu Maternal and Child Health Care Hospital, Chengdu, China
| | - Ying Zhang
- Department of Child Health Care, Jinniu Maternal and Child Health Care Hospital, Chengdu, China
| | - Ping Xu
- Department of Child Health Care, Qingbaijiang Maternal and Child Health Care Hospital, Chengdu, China
| | - Qinghua Yu
- Laboratory of Microbiology, Immunology and Metabolism, Diprobio (Shanghai) Co, Limited, Shanghai, China
| | - Yang Shen
- Laboratory of Microbiology, Immunology and Metabolism, Diprobio (Shanghai) Co, Limited, Shanghai, China
| | - Weiwei Ma
- College of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shanshan Jin
- Department of Nutrition, School of Medicine, Chengdu Women's & Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Changqi Liu
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
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Meyer R, Vandenplas Y, Lozinsky AC, Vieira MC, Berni Canani R, du Toit G, Dupont C, Giovannini M, Uysal P, Cavkaytar O, Knibb R, Fleischer DM, Nowak-Wegrzyn A, Venter C. Diagnosis and management of food allergy-induced constipation in young children-An EAACI position paper. Pediatr Allergy Immunol 2024; 35:e14163. [PMID: 38825829 DOI: 10.1111/pai.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024]
Abstract
The recognition of constipation as a possible non-Immunoglobulin E (IgE)-mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE-mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non-IgE-Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review.
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Affiliation(s)
- Rosan Meyer
- Department of Nutrition and Dietetics, University of Winchester, Winchester, UK
- Department of Medicine, KU Leuven, Leuven, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Adriana Chebar Lozinsky
- Department of Allergy and Immune Disorders, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mario C Vieira
- Center for Pediatric Gastroenterology - Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Roberto Berni Canani
- Department of Translational Medical Science and ImmunoNutritionLab at CEINGE - Advanced Biotechnologies Research Center, University of Naples "Federico II", Naples, Italy
| | - George du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Christophe Dupont
- Department of Paediatric Gastroenterology, Necker University Children Hospital, Paris, France
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Pinar Uysal
- Department of Allergy and Clinical Immunology, Adnan Menderes University, Aydin, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Rebecca Knibb
- School of Psychology, Aston University, Birmingham, UK
| | - David M Fleischer
- University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Anna Nowak-Wegrzyn
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
| | - Carina Venter
- University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
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Nichols KR, Streetman DD, Gordon NA, Knoderer CA. Measurement of Polyethylene Glycol 3350 With Standard Household Measuring Devices. J Pediatr Pharmacol Ther 2024; 29:286-291. [PMID: 38863850 PMCID: PMC11163905 DOI: 10.5863/1551-6776-29.3.286] [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: 06/15/2023] [Accepted: 10/10/2023] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Though standard household measuring devices (e.g., teaspoons, tablespoons) are often used in clinical practice to measure pediatric doses of polyethylene glycol 3350 (PEG-3350), no published -literature documents the accuracy of these measurements. Standard dosing for adults is 17 grams, which is 1 capful according to the manufacturer. The objective of this study was to determine the weight of household teaspoons and tablespoons of PEG-3350. METHODS PEG-3350 measurements were performed using 5 different household measuring teaspoons and tablespoons and the cap that accompanies the bottle for 3 different brands of PEG-3350. Using an electronic balance to determine weights, 3 investigators completed 5 measurements for each of the 5 measurement devices and PEG-3350 bottle caps as follows: leveled teaspoons and tablespoons, unleveled teaspoons and tablespoons, "heaping" tablespoons, half-capfuls, and capfuls. RESULTS A leveled teaspoonful of PEG-3350 weighed ∼3.3 grams and an unleveled teaspoonful weighed ∼3.7 grams. A leveled, unleveled, and heaping tablespoon of PEG-3350 weighed about 10, 11, and 15 grams, respectively. Heaping tablespoons, half-capfuls, and capfuls resulted in the most measurement variability. CONCLUSIONS Use of a kitchen scale may be the most precise method of measurement, however not all patients have kitchen scales. Standard household measuring devices (teaspoons and tablespoons) may be used to conveniently measure PEG-3350 doses. Using 1 dedicated measurement device and leveling the dose may improve consistency, which could be beneficial for patients who are sensitive to dose variability.
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Affiliation(s)
- Kristen R Nichols
- Health Sciences Department (KN), Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
| | - Darcie D Streetman
- Health Sciences Department (KN), Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
- Pharmacy Practice Department (CA), Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
- PharmD Candidate, anticipated graduation May 2024, Butler University College of Pharmacy and Health Sciences (NG), Indianapolis, IN
| | - Nicolette A Gordon
- PharmD Candidate, anticipated graduation May 2024, Butler University College of Pharmacy and Health Sciences (NG), Indianapolis, IN
| | - Chad A Knoderer
- Pharmacy Practice Department (CA), Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
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Motil KJ, Beisang A, Smith-Hicks C, Lembo A, Standridge SM, Liu E. Recommendations for the management of gastrointestinal comorbidities with or without trofinetide use in Rett syndrome. Expert Rev Gastroenterol Hepatol 2024; 18:227-237. [PMID: 38869952 DOI: 10.1080/17474124.2024.2368014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Although gastrointestinal (GI) comorbidities are experienced by over 90% of individuals with Rett syndrome (RTT), a neurodevelopmental disorder associated with mutations in the MECP2 gene, many neurologists and pediatricians do not rank the management of these comorbidities among the most important treatment goals for RTT. Trofinetide, the first approved pharmacologic treatment for RTT, confers improvements in RTT symptoms but is associated with adverse GI events, primarily diarrhea and vomiting. Treatment strategies for GI comorbidities and drug-associated symptoms in RTT represent an unmet clinical need. AREAS COVERED This perspective covers GI comorbidities experienced by those with RTT, either with or without trofinetide treatment. PubMed literature searches were undertaken on treatment recommendations for the following conditions: constipation, diarrhea, vomiting, aspiration, dysphagia, gastroesophageal reflux, nausea, gastroparesis, gastritis, and abdominal bloating. EXPERT OPINION The authors recommend a proactive approach to management of symptomatic GI comorbidities and drug-associated symptoms in RTT to enhance drug tolerance and improve the quality of life of affected individuals. Management strategies for common GI comorbidities associated with RTT are reviewed based on authors' clinical experience and augmented by recommendations from the literature.
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Affiliation(s)
- Kathleen J Motil
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Arthur Beisang
- Department of Pediatrics, Gillette Children's Hospital, Saint Paul, MN, USA
| | - Constance Smith-Hicks
- Center for Synaptic Disorders, Rett and Related Disorders Clinic, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anthony Lembo
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shannon M Standridge
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Edwin Liu
- Digestive Health Institute, Children's Hospital Colorado, Denver, CO, USA
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Chatip AT, Acar G, Akçay AA. Comparison of the effects of abdominal massage and osteopathic manipulative treatment home program on constipation in children with cerebral palsy. JGH Open 2024; 8:e13102. [PMID: 38903486 PMCID: PMC11187405 DOI: 10.1002/jgh3.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/22/2024] [Accepted: 05/18/2024] [Indexed: 06/22/2024]
Abstract
Background and Aim The aim of this study is to compare the effects of osteopathic manipulative therapy home program (OMT-H) versus abdominal massage home program (AMHP) in treating constipation in children with cerebral palsy (CP). Methods Twenty-nine children with CP with a mean age of 12.2 ± 3.76 years, who were constipated and were not on medication, were divided into three randomized groups: (i) control group (n = 10), (ii) AMHP (n = 10), and (iii) OMT-H (n = 9). In AMHP and OMT-H groups, treatment was applied as 20-min sessions every other day for 10 sessions for 3 weeks. Modified Constipation Assessment Scale (MCAS), Rome III criteria, and the Bristol Stool Form Scale (BSFS) were used for evaluation before treatment and once a week during treatment. Results While there was no change in constipation symptoms in the control group, there was an improvement in constipation symptoms after treatment in the AMHP and OMT-H groups (AMHP, P = 0.003; OMT-H, P = 0.000014). While the treatment showed to be effective from the first week in the OMT-H group, the change in BSFS (P = 0.026) and MCAS sub-parameters was found to be superior. Conclusion AMHP and OMT-H are effective and beneficial in treating constipation. In children with CP, OMT-H was found to be quicker and more successful compared with AMHP. The OMT-H can be effectively used in clinical practice in relieving constipation in CP.
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Affiliation(s)
- Aisel T Chatip
- Yıldız Special Education and Rehabilitation Center for ChildrenIstanbulTurkey
| | - Gönül Acar
- Department of Physiotherapy and RehabilitationMarmara University Faculty of Health SciencesIstanbulTurkey
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