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Velasco-Benitez C, Villamarin E, Mendez M, Linero A, Hungria G, Saps M. Efficacy of transcutaneous posterior tibial nerve stimulation in functional constipation. Eur J Pediatr 2023; 182:1309-1315. [PMID: 36637541 PMCID: PMC9838342 DOI: 10.1007/s00431-022-04798-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/07/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children. Single-center, prospective interventional study. Children 4-14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). Twenty completed the study (4-14 years), (8.4 ± 3.2 years, 71.4% female). We found significant improvement in the consistency of bowel movements (BM) (p = 0.005), fecal incontinence (FI) (p = 0.005), abdominal pain presence (p = < 0.001) and intensity (p = 0.005), and a significant for improvement in blood in stools (p = 0.037). There was 86.3% improvement in abdominal pain. 96.7% reported treatment satisfaction. Only one child required rescue therapy. CONCLUSION We found significant improvement in stool consistency, FI, abdominal pain, and hematochezia. This suggests that transcutaneous PTNS could be a promising noninvasive treatment for FC in children. Large studies are needed. WHAT IS KNOWN • Functional constipation is one of the most common disorders in children. • Current management of functional constipation consists of an integrative approach that includes medications, diet and behavioral strategies. WHAT IS NEW • Posterior tibial nerve stimulation is a novel noninvasive and easy to use therapy that can improve stool consistency, fecal incontinence and blood in stools.
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Affiliation(s)
| | - Eder Villamarin
- Universidad del Valle, Calle 13 # 100-00, Cali Valle Del Cauca, Cali, Colombia
| | - Melissa Mendez
- Universidad del Valle, Calle 13 # 100-00, Cali Valle Del Cauca, Cali, Colombia
| | - Alfredo Linero
- Universidad Santiago de Cali, Cl. 5 #No. 62 -00, Cali, Valle del Cauca, Colombia
| | | | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami, Mailman Center, 1601 NW 12 AVE, Suite 3005A, Miami, FL, 33136, USA.
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AGAKISIYEVA G, YILDIRIM D, HIZARCIOGLU-GULSEN H, GUMUS E, KARHAN AN, KARABULUT E, OZEN H, DEMIR H, SALTIK-TEMIZEL IN. Nutritional characteristics of patients with functional constipation aged 4 years and older. Minerva Pediatr (Torino) 2022; 74:468-476. [DOI: 10.23736/s2724-5276.20.05978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
ABSTRACT Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.
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Affiliation(s)
- Monique Raymond
- At the time this article was written, Monique Raymond was a student in the PA program at Franklin Pierce University in West Lebanon, N.H. She now practices in pain management at the Orthopedic Center of Florida in Ft. Myers, Fla. Priscilla Marsicovetere is dean of the College of Health & Natural Sciences at Franklin Pierce University and practices addiction medicine at Better Life Partners in Hanover, N.H. Katrina DeShaney is an assistant professor in the PA program at Franklin Pierce University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Dong F, Yu H, Wu L, Liu T, Ma X, Ma J, Gu X. Association between gastrointestinal heat retention syndrome and respiratory tract infections in children: A prospective cohort study. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2021. [DOI: 10.1016/j.jtcms.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Leung AKC, Hon KL. Paediatrics: how to manage functional constipation. Drugs Context 2021; 10:2020-11-2. [PMID: 33828605 PMCID: PMC8007206 DOI: 10.7573/dic.2020-11-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. METHODS A PubMed search was performed with Clinical Queries using the key term 'functional constipation'. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. RESULTS A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch 'red flags' suggestive of organic causes of constipation. These 'red flags' include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. CONCLUSION Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, University of Calgary, and Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
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Tang J, Li H, Tang W. Efficacy of Non-pharmacologic Auxiliary Treatments in Improving Defecation Function in Children With Chronic Idiopathic Constipation: A Systematic Review and Network Meta-analysis. Front Pediatr 2021; 9:667225. [PMID: 33987155 PMCID: PMC8110729 DOI: 10.3389/fped.2021.667225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Non-pharmacologic auxiliary treatments have been considered crucial therapies for treating chronic idiopathic constipation (CIC) during the past decades worldwide. Several treatment patterns are available, but their relative efficacy is obscure because there are no head-to-head randomized controlled trials, especially in children. We conducted this network meta-analysis to evalute the effectiveness of these therapies in improving defecation function based on their direct comparisons with standard medical care. Methods: Medline, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) published in English from inception to October 2020, assessing the efficacy of auxiliary therapies (behavior therapy, physiotherapy, biofeedback, or anorectal manometry) in children with CIC. We extracted data for endpoints, risk of bias, and evidence quality. Eligible studies in the meta-analysis reported the data of a dichotomous assessment of overall response to treatment (response or not) or defecation frequency per week after treatment. The hierarchical Bayesian network meta-analysis was used in the study. We chose a conservative methodology, random effects model, to pool data which could handle the heterogeneity well. The relative risk (RR) with 95% confidence intervals (CIs) was calculated for dichotomous outcomes. For continuous results, weighted mean difference (WMD) with related CIs was calculated. The included treatments were ranked to define the probability of being the best treatment. Results: Seven RCTs (838 patients) met inclusion and endpoint criteria. Based on an endpoint of the absence of constipation (Rome criteria) with laxatives allowed, physiotherapy plus standard medical care (SMC) had the highest probability (84%) to bethe most effective therapy. When the treatment response was defined as an absence of constipation with not laxatives allowed, biofeedback plus SMC ranked first (probability 52%). Physiotherapy plus SMC ranked first when the endpoint was based on defecation frequency per week with laxatives allowed (probability 86%). Conclusion: Almost all auxiliary therapies are effective complementary therapies for treating CIC, but they needed to be used simultaneously with SMC. Nevertheless, because of the small number of eligible studies and their small sample sizes, the differences in treatment duration and the endpoints, large sample RCTs with long-term follow-up are required for further investigation.
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Affiliation(s)
- Jie Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Huijuan Li
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Yıldırım A, Biçer Ş, Hacıhasanoğlu-Aşılar R, Özdamar MY, Şahin H, Gül V. The Effect of Education Given to Children with Functional Constipation and Fecal Incontinence and Their Mothers on Anxiety and Constipation Management. Florence Nightingale Hemsire Derg 2020; 28:321-332. [PMID: 34263211 PMCID: PMC8134022 DOI: 10.5152/fnjn.2020.19134] [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: 08/09/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study aimed to determine the effect of multidimensional training program on children with constipation and fecal incontinence and their mothers on anxiety and their constipation management. METHOD The study had an experimental design with a pretest-posttest control group. The intervention group consisted of children diagnosed with functional constipation (n=20) and fecal incontinence (n=21) and their mothers in the Pediatric Surgery Clinic. The control group consisted of healthy (n=20) children who applied to two different Family Health Centers for any reason. Data were collected between February 2016 and June 2017 using a descriptive questionnaire, a nutrient consumption frequency form, the Rome III diagnostic criteria form, and the Trait Anxiety Scale for Children. RESULTS After the training program, the mean score of the Trait Anxiety Scale for Children decreased in both intervention groups (p<0.01) and increased in the control group (p<0.05). In addition, the frequency of the consumption of milk, caffeinated drinks, and white bread was reduced in the children of both intervention groups after the training program. The consumption of dried legumes, vegetables, and whole wheat bread increased. According to the Rome III diagnostic criteria, it was determined that constipation symptoms were not observed in 50% of the children. CONCLUSION The training program had a significant influence on the prevention and management of constipation and anxiety. Given that constipation is associated with both physical and mental health outcomes, the approach for the treatment should be holistic in nature, involving a multidisciplinary team.
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Affiliation(s)
- Arzu Yıldırım
- Department of Psychiatric Nursing, Yalova University Faculty of Health Sciences, Yalova, Turkey
| | - Şenol Biçer
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | | | - Mustafa Yaşar Özdamar
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | - Hilal Şahin
- Division of Dietetics, Department of Nutrition and Dietetics, Erzincan Binali Yildirim University Faculty of Health Sciences, Erzincan, Turkey
| | - Vahdet Gül
- Division of Medical Biochemistry / Internal Medicine, Department of Mental Health and Diseases, Erzincan Binali Yildirim University School of Medicine, Basic Medical Sciences, Erzincan, Turkey
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García Sánchez P, de Miguel Lavisier B, González Bertolín I, Bote Gascón P, Molina Gutiérrez MÁ, de Ceano-Vivas La Calle M. An Unusual Case of Abdominal Pain and Constipation: Lymphatic Malformation. J Emerg Med 2020; 58:e261-e263. [PMID: 32362375 DOI: 10.1016/j.jemermed.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/06/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
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