Comparing the Quality of Reporting in Randomized Controlled Trial Abstracts at Two International Gastroenterology Meetings in 2010

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BACKGROUND: Osmotic and stimulant laxatives are the mainstay of treatment for children suffering with functional constipation. We systemically evaluated studies which had investigated osmotic and stimulant laxatives for functional constipation in children. METHODS: Randomised controlled trials (RCTs), published between 1966 and October 2010, which compared osmotic and stimulant laxatives with either placebo or other interventions were included. Data sources were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Inflammatory Bowel Disease and functional Bowel Disorders Specialised Register and reference lists of retrieved articles. Data extraction and assessment of methodological quality were performed independently by two reviewers. RESULTS: 16 RCTs met the inclusion criteria. Meta-analysis of 4 studies with 338 participants comparing polyethylene glycol (PEG) with Lactulose showed significantly greater stools per week (stools/wk) with PEG (Mean difference 0.98, 95% confidence interval (CI) 0.49 to 1.46). Those on PEG were less likely to require additional laxative therapies (Odds Ratio 0.49, 95% CI 0.27 to 0.89). No serious adverse events were reported with either agent. Incidence of gastrointestinal symptoms, such as abdominal pain, nausea and vomiting, did not differ between groups. Heterogeneity amongst studies was noted, probably attributable to differences in concomitant medications and follow up times between studies. Meta-analysis of 2 studies with 173 participants comparing PEG with Milk of magnesia showed that the stools/wk was significantly greater with PEG (Mean difference 0.69, 95% CI 0.48 to 0.89). One child was noted to be allergic to PEG, but there were no other serious adverse events reported. 2 studies compared PEG with placebo, but there was insufficient data to allow meta-analysis. Both studies reported a significantly increased number of stools/wk with PEG. Meta-analysis of 2 studies with 287 patients comparing Paraffin with Lactulose showed that the stools/wk following treatment was significantly greater with Paraffin (Mean difference 4.94, 95% CI 4.28 to 5.61). Again, no serious adverse events were reported. CONCLUSIONS: The available evidence suggests that PEG is more effective than placebo and that both liquid paraffin and PEG are more effective than Lactulose for treating children with functional constipation.