P0144 PP OUTCOME OF CONSTIPATION IN CHILDHOOD: A TEN YEAR-FOLLOW-UP STUDY

Abstract

Introduction: Little is known on the long term outcome of constipation in childhood. The aim of this study was 1) to study the outcome of patients presenting functional constipation in childhood over a 10 year-period; 2) to determine risk factors for persistent constipation during adolescence and adulthood. Methods: 72 children (1 month to 14 years, mean age 49 months, 40 boys, 32 girls) referred for constipation between 1990 and 1992 were included in the study. Initial work-up included segmental colonic transit time and anorectal manometry in order to classify the constipation into terminal-type constipation (including anorectal dyssynergia) and transit-type constipation, and to rule out Hirschsprung’s disease. Forty-five out of 72 could be reevaluated 10 to 12 years. Constipation was defined by the presence of at least one of the following criteria: infrequent bowel movements (<3/week), painful exoneration and hard stools. The questionnaire assessed the presence of associated symptoms including abdominal pain and encopresis, as well as life style (sport practice, fiber and fluid intake, toilet habits). Results: Twenty one out of 45 (46%) patients remained constipated at follow-up. Encopresis and recurrent abdominal pain were present in 11% and 64% of cases, respectively. Patients who presented constipation at a younger age were more frequently constipated at follow-up than patients who were older at initial presentation: 83% of patients <12 years vs 36% of patients > 12 years, p<0.05. Patients with anorectal dyssynergia (n=26) remained also more frequently constipated at follow-up than the others (n=17): 61 vs 29%, p<0.05. No difference in prevalence of constipation at follow-up was found in relation to sex, sport practice, and food habits. A good initial response to treatment of constipation was not associated with a favorable outcome 10 years later. Conclusion: Almost 50% of patients presenting with constipation during childhood remained constipated at long term follow-up. Young age at presentation and anorectal dyssynergia are associated with a worse prognosis.