Clinical Features of Severely Constipated Children: Comparison of Infrequent Bowel Movement and Fecal Soiling Groups

Assessing impaired gastric accommodation in children with functional constipation using the water load test

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.

Dyssynergic Defecation in Chronically Constipated Children in Korea

Purpose

Dyssynergic defecation (DSD) is one of the important causes of chronic constipation in children. We aimed to analyze the clinical features, diagnostic test results, and treatments for DSD in children.

Methods

Children diagnosed with DSD using fluoroscopic defecography were enrolled in this study. Clinical data, including the results of colon transit time (CTT) test and biofeedback (BF) therapy, were collected from medical records retrospectively.

Results

Nineteen children were enrolled. The median age was 9 years (6-18 years), the median frequency of bowel movement was 1/7 days (1-10 days), the median duration of constipation was 7.0 years (2-18 years), the median age of onset of constipation was 2.5 years (1-11 years). In the CTT test, outlet obstruction type was noted in 10/18 (55.6%), slow transit type in 5/18 (27.8%), and normal transit in 1/18 (5.6%). The median CTT was 52 hours (40-142 hours). Initial medical therapy was performed with the polyethylene glycol 4000, and the response was good in 9/19 (47.4%), fair in 9/19 (47.4%), and poor in 1/19 (5.0%). BF was performed in 8/19, with good results in 6/8 (75.0%) children and failure in 2/8 (25.0%) children. After long-term medical therapy (11/19), 3/5 showed good response with medication alone, 6/8 showed good response with BF and medication combined.

Conclusion

DSD should be considered as a cause of chronic constipation in children, especially in those with abnormal CTT test results. BF combined with medical therapy is effective even with age-limited cooperation.

Cross-cultural adaptation, validity, and reliability of the pediatric constipation score-parent report in pediatric functional constipation in an Iranian population

Aim

We evaluated the Persian version of the pediatric constipation score-parent report (PCS) validity and reliability.

Background

Functional constipation in children results in physical and psychological problems. Therefore, it is necessary to utilize a questionnaire to assess the health-related quality of life in children with chronic constipation.

Methods

First, our team translated the English version of the questionnaire into the Persian language. Second, the psychometric properties of the Persian version were collected in 149 children with functional constipation referred to a pediatrics hospital by an expert team. We assessed content validity (CV) through the CV index (CVI) and CV ratio (CVR). The construct validity was evaluated by exploratory factor analysis, and reproducibility was tested based on test-retest reliability using the intra-class correlation coefficient (ICC). Internal consistency was calculated using Cronbach's α. we also evaluated the ceiling or floor.

Results

Results showed acceptable CVI in relevancy, clarity, and simplicity, acceptable CVR for all items, moderate internal consistency (Cronbach's alpha=0.548), and almost perfect reproducibility (ICC=0.93). No ceiling or floor effect was seen.

Conclusion

The Persian version of PCS showed good validity and reliability in children with functional constipation in Iran. Therefore, we can use it in clinical and research domains in Persian-speaking countries.

Diagnosis and management of fecal incontinence in children and adolescents

Fecal incontinence (FI) is a commonly occurring disease of high concern. It is characterized by voluntary and involuntary defecation in children and adolescents. It is not only a physical disease but also a psychological and behavioral disorder. FI poses a serious burden on individuals and their families and therefore has become a social problem. Unfortunately, the management of FI among children is still a challenge because the etiology varies widely. Constipation has been found to be the most common cause, while sphincter dysfunction and neurogenic abnormalities may also play a role. Currently, no consensus guidelines exist, and the criteria for selecting optional methods remain unclear. It is therefore necessary to improve the efficacy of diagnosis and management strategies of FI in children. This review focused on the classification and etiology, discussed the diagnosis and management methods of FI in children and adolescents, and aimed to guide future studies.

CLINICAL SPECTRUM OF FUNCTIONAL CONSTIPATION AND BOWEL-HABIT PATTERNS OF SCHOOLCHILDREN RECRUITED FROM TWO ELEMENTARY SCHOOLS AND A SPECIALIZED OUTPATIENT CLINIC

BACKGROUND

Early diagnosis of functional constipation is important for reducing its negative consequences on the health of children and adolescents.

OBJECTIVE

To describe the clinical spectrum of functional constipation and bowel habit patterns in schoolchildren recruited from two primary schools and patients from a pediatric gastroenterology outpatient clinic.

METHODS

This cross-sectional study included 452 students from two elementary schools in the city of Osasco and 81 patients with functional constipation seen in an outpatient clinic specializing in pediatric gastroenterology. All children were aged between 6 and 12 years. The Rome IV criteria (two features for more than 1 month) and the Bristol scale were used.

RESULTS

The prevalence of functional constipation among the elementary school students was 22.3% (n=101). Among the 351 students who did not have functional constipation, 182 (51.9%) had one of the clinical manifestations of the Rome IV criteria. Bristol stool scale types 1 and 2 were observed in 14 (8.3%) of the 169 students without any clinical manifestation of the Rome IV criteria and in 28 (15.4%) of the 182 students who presented one of the Rome IV criteria for functional constipation (P=0.060). A comparison of the clinical manifestations of children with functional constipation identified at school in relation to those seen at the specialized clinic showed the following differences: fewer than two bowel movements per week (21.8% and 54.3%; P<0.001, respectively), one or more episodes of fecal incontinence per week (14.8% and 53.1%; P<0.001), and retentive posturing (70.3% and 40.7%, P<0.001). Only 18 (17.8%) of the 101 students identified at the schools with functional constipation had received any treatment for this disease in the previous 2 months.

CONCLUSION

As expected, the frequency of more severe clinical manifestations was higher in children seen at specialized clinics. Only a small proportion of the children identified with functional constipation at primary schools had undergone any form of treatment in the previous 2 months. More than half of the children without functional constipation in elementary schools reported one of the Rome IV clinical manifestations. Finally, functional constipation has a broad clinical spectrum and also requires attention for the prevention and the management of its early clinical manifestations.

Prevalence of Defecation Disorders and their Symptoms is Comparable in Children and Young Adults: Cross-Sectional Study

PURPOSE

We aimed to compare the prevalence rates and associated symptoms of constipation and fecal incontinence in children and young adults and evaluate how these patient groups cope with these disorders.

METHODS

A cross-sectional study was performed in which 212 children (8-17 years) and 149 young adults (18-29 years) from the general Dutch population completed a questionnaire about defecation disorders.

RESULTS

Constipation occurred in 15.6% of children and 22.8% of young adults (p=0.55), while the prevalence of fecal incontinence was comparable between groups (7%, p=0.91). The symptoms associated with constipation occurred as often in children as in young adults, while most fecal incontinence symptoms occurred more often in young adults. Approximately 43% of children had constipation for more than 5 years, while 26% of young adults experienced constipation since childhood. Only 27% of constipated children and 21% of constipated young adults received treatment (mostly laxatives). For fecal incontinence, 13% of children and 36% of young adults received treatment (mostly antidiarrheal medications or incontinence pads).

CONCLUSION

In contrast to the general belief, the prevalence of defecation disorders and associated symptoms seem to be comparable in children and young adults. Only a few people with defecation disorders receive adequate treatment.

Subtype classification of functional constipation in children: polyethylene glycol versus lactulose

BACKGROUND

This study aimed to evaluate the usefulness, from a therapeutic perspective, of classifying the subtypes of functional childhood constipation using a colon transit time (CTT) test.

METHODS

A total of 190 children were enrolled in this study, which was based on data collected from a defecation diary, a CTT test, and medical records.

RESULTS

Polyethylene glycol (PEG) 4000 was prescribed in 51.1% (N = 47/92) of normal transit type constipation cases (NT) and 91.8% (N = 90/98) of abnormal transit type constipation cases (P < 0.001). In terms of the subtype of CTT test, PEG 4000 was prescribed in 51.1% (N = 47/92) of NT cases, 96.2% (N = 25/26) of outlet obstruction type cases (OT), and 90.3% (N = 65/72) of slow transit type cases (ST) (P < 0.001). Polyethylene glycol 4000 was administered in 97.2% (N = 35/36) of the fecal incontinence group and 66.2% (N = 102/154) of the non-fecal incontinence group (P < 0.001). In the non-fecal incontinence group, PEG 4000 was prescribed in 47.3% (N = 40/84) of NT cases, 94.4% (N = 17/18) of OT cases, and 86.5% (N = 45/52) of ST cases (P < 0.001). In the fecal incontinence group, PEG 4000 was prescribed in 87.5% (N = 7/8) of NT cases, 100% (N = 8/8) of OT cases, and 100% (N = 20/20) of ST cases (P = 0.165).

CONCLUSIONS

Subtype classification of functional constipation based on the CTT test provides important information for the initial choice of drugs in children.