Abstract
ObjectiveTo evaluate the pediatrician's knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation. MethodsA descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013. ResultsThe majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated. ConclusionsOur results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.
Highlights
In clinical practice, intestinal constipation is a very common finding in children, corresponding to approximately 3% of consultations in general pediatric outpatient clinics and 25% of consultations in pediatric gastroenterology.1---4 When assessing the studies in Brazil, a variation of 14.7---38.8% was found in the prevalence of constipation.[5]
The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North-American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines recommend using the Rome III criteria, except for symptom duration, since the recommended interval of two months can contribute to treatment delay in older children.[7]
Taking into account the prevalence, clinical significance and impact of the disease, this study aims to outline a management panorama adopted by Brazilian pediatricians when treating a case of constipation and establish a parallel with the available literature
Summary
Intestinal constipation is a very common finding in children, corresponding to approximately 3% of consultations in general pediatric outpatient clinics and 25% of consultations in pediatric gastroenterology.1---4 When assessing the studies in Brazil, a variation of 14.7---38.8% was found in the prevalence of constipation.[5]. Intestinal constipation is a very common finding in children, corresponding to approximately 3% of consultations in general pediatric outpatient clinics and 25% of consultations in pediatric gastroenterology.1---4. When assessing the studies in Brazil, a variation of 14.7---38.8% was found in the prevalence of constipation.[5] This wide variation is due both to the heterogeneity of the diagnostic criteria and the differences in study population selection.[5,6]. The Rome III Criteria (2006) states that in children older than 4 years, the diagnosis of constipation is established when there are ≤2 bowel movements per week; at least one episode of fecal incontinence per week; history of retentive posture or excessive voluntary stool retention; history of painful bowel movements; presence of a large fecal mass in the rectal canal; history of large-caliber stools that can clog the toilet bowl. The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North-American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines recommend using the Rome III criteria, except for symptom duration, since the recommended interval of two months can contribute to treatment delay in older children.[7]
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