Chronic Constipation In Children Research Articles

Chronic constipation in children: diagnosis and treatment through the prism of time

Constipation is one of the most frequent nosologies encountered during outpatient consultations with a pediatric gastroenterologist. This article discusses the diagnosis and treatment of chronic constipation (CC) in children on the basis of both international and Russian clinical guidelines. About 70% of children in the world suffer from CC, most of them have functional nature. In 30-52% of children, symptoms persist for the next 5 years, and about 25% of patients continue to suffer from constipation as adults. Children with CC often see a pediatrician and gastroenterologist, are treated as inpatients, or are hospitalized on an emergency basis. Consequently, chronic constipation represents a significant economic problem for the health care system. Constipation in children needs timely diagnosis and comprehensive treatment.

Conductive cryotherapy in medical rehabilitation of children with chronic constipation

Relevance. Medical rehabilitation of children with chronic constipation is one of the urgent and socially significant problems in modern pediatrics due to the high prevalence of the disease and the possibility of developing complications in the form of encopresis, rectal fissures, and paraproctitis. Currently,one of the promising areas of modern physiotherapy is the development of methods for the combined use of physical factors in order to increase the effectiveness of treatment. The article discusses the scientific basis and efficacy of the combined effects of conductive cryotherapy and transcutaneous electrical nerve stimulation in children with chronic constipation. Purpose: scientific substantiation of the use of conductive cryotherapy and its combined effects with transcutaneous electrical nerve stimulation for chronic constipation in children. Material and methods. Clinical and functional studies were carried out in 120 children aged 3 to 15 years. The functional state of the colon before and after treatment was assessed using ballonography and anorectal profilometry. Results. It has been established that the use of the combined effects of conductive cryotherapy and transcutaneous electrical nerve stimulation, i.e. cryoelectrical nerve stimulation, increases the effectiveness of treatment of children with chronic constipation compared to patients who received separate exposure to each of the physical factors, which was confirmed by indicators of the functional state of the colon (ballonography, anorectal profilometry). The obtained results allow substantiating the possibility and necessity of recommending methods of conductive cryotherapy and cryoelectrical nerve stimulation in the medical rehabilitation program for children with chronic constipation.

Effects of TENS and Physiotherapy on Chronic Constipation in Myelomeningocele

Background: Chronic constipation is a common symptom of myelomeningoceles. TENS has been proven to be effective in treating constipation in different populations and parameters. Physiotherapy is a relatively recent treatment for constipation and has not been extensively studied in pediatrics and spina bifida. This study aimed to examine the role of TENS in myelomeningocele and to increase the number of studies on physiotherapy for pediatric constipation. 
 Aims: To determine a new treatment approach that can be applied in chronic constipation in children with spina bifida using physical therapy techniques.
 Study Design: Randomized Controlled Trial 
 Methods: Constipation symptoms, stool pattern, bladder and bowel dysfunction, muscle strength involved in defecation, pressure pain thresholds (ppt) in these muscles, severity of fecal incontinence, and quality of life were assessed prior to treatment. Physical Therapy (PT) group received manual physical therapy techniques and dietary therapy for six weeks while the Physical Therapy and TENS (PT+T) group also received TENS. The post-treatment evaluations were repeated.
 Results: A total of 28 children, 14 in each group, were included in the treatment plan. The stool form in both groups of children was constipated. There was a significant difference in stool pattern only PT+T group (p

Probiotics for treatment of chronic constipation in children: Summary of a Cochrane review

Probiotics for treatment of chronic constipation in children: Summary of a Cochrane review

Laser acupuncture improving functional chronic constipation in children: a randomized controlled trial

Functional chronic constipation (FCC) is a disorder caused by low fiber consumption, lack of fluid intake, lack of mobility, or side effects of medications. The objective of this study was to compare the effects of laser acupuncture and the commonly used osmotic laxative, lactulose (as the control), both combined with behavioral therapy and dietary modification, on children with FCC in a randomized controlled trial (RCT). Forty children were randomly chosen, aged 5–15 years with FCC, and randomized into two equal groups (gender ratio (50% male; 50% female), mean ± SD weight (24.2 ± 6.27 kg and 25.7 ± 7.47 kg for groups A and B, respectively)). Study group (group A): used laser acupuncture (650 nm), 30 mW, 0.15 cm2 spot size, 90 s per acupuncture point (ST25, ST36, ST37, BL25, and LI11). Control group (group B): lactulose syrup (1 to 3 mL/kg/day) orally, in divided doses 3 times weekly for 4 weeks, and behavioral training for both groups. Evaluations were conducted before and after the study to assess the efficacy of the therapy. Median value frequency significantly increased in groups A and B post-treatment (4 (6.75–3) and 3 (3.75–2), respectively) compared to pre-treatment (2 (2–1) and 2 (2–0.25), respectively) (p = 0.0001), in favor of group A (p = 0.01). Significant improvement of stool consistency according to Bristol stool scale (BSS) in groups A and B (p = 0.0001), (p = 0.002) respectively in favor of group A (p = 0.03). T-test, Fisher, and Wilcoxon signed rank tests were conducted to compare groups. Non-invasive, painless laser acupuncture therapy can be considered as an alternative therapy for patients with FCC.

Dyssynergic Defecation in Chronically Constipated Children in Korea.

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. 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. 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. 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.

Measurement of Rectal Diameter and Anterior Wall Thickness by Ultrasonography in Children with Chronic Constipation.

Measurement of rectal diameter by ultrasonography helps the clinician in the diagnosis of chronic constipation in children for whom rectal examination cannot be performed. The aim of the study is to determine the rectal diameter and anterior wall thickness values in constipated and healthy children and to evaluate the feasibility of ultrasonography in the diagnosis of functional constipation in children who refuse digital rectal examination. One hundred forty constipated and 164 healthy children participated in the study. All patients were divided into 4 subgroups according to their ages (≤3 years [group I], 3.1-6 years [group II], 6.1-12 years [group III], and >12 years [group IV]) and were referred to the radiology department. The measurement was made from above the symphysis pubis, under the ischial spine, and at the bladder neck. Anterior wall thickness measurement was performed. The measurements were recorded according to the presence or absence of fecal mass in the rectum. Constipated children with fecal mass positive group III was found to have significant difference in all of the planes in rectal diameter measurement. Rectum anterior wall thickness measurement was found to be higher in constipated patients with fecal mass (+) compared to the control. Its measurements in constipated patients in group II, group III, and group IV with no fecal mass were found to be statistically higher than the control group. The measurement of rectal diameter and anterior wall thickness by ultrasonography as a noninvasive method was per formed in children who did not want the digital rectal examination, and it may be useful in the diagnosis of constipation.

Intestinal neuronal dysplasia type B of the duodenum in an adolescent patient

Intestinal neuronal dysplasia type B (IND-B) is a rare neuromuscular, dysmotility disorder that typically affects the lower gastrointestinal tract, commonly presenting as chronic constipation in children. We present the first pediatric case report of successful surgical management of IND-B affecting the duodenum as a likely chronic adaptive sequela to prior obstruction from superior mesenteric artery syndrome.

Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder.

Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility. A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility. Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P = 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P < 0.0001). Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.

Comparison of the effect of polyethylene glycol 40% and fig syrups on the treatment of chronic functional constipation in children: A randomized clinical trial

Background and aims: None of the available constipation treatments for children are completely successful. Therefore, the present study aimed to evaluate the effect of the polyethylene glycol (PEG) solution 40% and fig syrup on the treatment of chronic constipation in children. Methods: In this double-blind clinical trial, 120 patients with chronic functional constipation were selected and divided into two groups. The first group received 5 mL of fig syrup without senna 3 times daily, and the second group took PEG 40% syrup at 1 mL/kg of body weight per day (the dose was adjustable according to the patient’s condition and need). At weeks 0, 2, 4, and 6, a checklist containing questions about children’s constipation was completed by the researcher, and the data were analyzed by SPSS version 24. Results: Changes in the frequency of abdominal pain at fourth times 0, 2, 4, and 6 weeks demonstrated statistically significant differences between the two groups (P=0.044), and it was significantly lower the in PEG group; however, the defecation was not statistically significant (P=0.902). After six weeks, the frequency of painful defecation, difficult defecation straining during defecation, and fear of defecation was significantly lower in the group given PEG syrup compared to the fig syrup-receiving group (P=0.001). Conclusion: Overall, PEG syrup was significantly effective in treating chronic functional constipation in children compared to the fig syrup.

Guidelines for the diagnosis and treatment od chronic constipation in children – Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Guidelines for the diagnosis and treatment od chronic constipation in children – Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Probiotics for treatment of chronic constipation in children.

Probiotics for treatment of chronic constipation in children.

Современный взгляд на функциональные запоры у детей раннего возраста: особенности вскармливания и принципы немедикаментозной коррекции

Статья посвящена проблеме хронического запора у детей. Даны рекомендации по профилактике этого состояния. Подчеркнуто, что к медикаментозной терапии рекомендуют прибегать только при отсутствии эффекта от диетотерапии, которая сводится не к строгой диете или соблюдению определенного лечебного стола, а к физиологическому рациону питания. В настоящее время доступны смеси, соответствующие рекомендациям Европейского союза относительно питания специального медицинского назначения, сочетающие в себе одновременно несколько функциональных компонентов, что позволяет решить проблему функциональных запоров у детей раннего возраста, находящихся на искусственном вскармливании. Примером такой инновационной смеси является Нутрилон Комфорт.

УЛЬТРАЗВУКОВАЯ ДИАГНОСТИКА ХРОНИЧЕСКОГО ЗАПОРА У ДЕТЕЙ: РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ИССЛЕДОВАНИЯ

Chronic constipation (CC) is an important medical and social problem, as it can lead to the development of complications, fecal intoxication, social disadaptation and self-isolation of a child, as well as significantly reduce the quality of life. The article presents the results of a clinical study of CC in children using a new diagnostic method - transabdominal and transperianal ultrasound examination (US) of the colon and anorectal zone. The objective of the study was to analyze the course of CC in children depending on the mechanism of its formation according to US of the colon and anorectal zone. Materials and methods of research: the prospective cohort study included 470 children with an established diagnosis of CC at the age of 1 month to 17 years old. The patients were divided into 3 age groups: 1 month. – 3 years (n=166), 4–10 years (n=102), 11–17 years (n=202). The median follow-up was 48 months. The age distribution of children with CC was carried out on the basis of the frequency of visits, against the background of the beginning of attending kindergarten and/or elementary school groups, and the emergence of psychological problems due to the difficulty of going to a public toilet. An evaluation of analysis of the dynamics of US changes in the colon and anorectal zone was carried out by the method of ultrasound diagnosis of Hirschsprung's disease in children (patent № 2547614, authors M.I. Pykov, M.M. Kolisnichenko, I.V. Poddubny). Results: in children aged 1 month to 3 years, 66.9% of cases are statistically significantly dominated by proctogenic constipation type of constipation with US signs of anus spasm and anal sphincter insufficiency. In children aged 4 to 10 years, the mixed mechanism of CC formation prevails (41.1%), and in patients aged 11 to 17 years – cologenic (77.7%), for which the most typical ultrasound signs are dolichocolon (22.8%), anus spasm (8.7%), anal sphincter insufficiency (4.7%). It has been established that despite adequate therapy, the number of patients with the above-described mechanisms of formation of CC increases, which indicates the recurrence and progression of pathological process in children of different age groups. Conclusion: the proposed diagnostic method – transabdominal and transperianal US of the colon and anorectal zone is a highly informative, pathogenetically substantiated method for examining the state of the colon and anorectal zone in children with CC, built on precise objective criteria that are available at any age.

Controversies on the relationship between increased body mass index and treatment-resistant chronic constipation in children.

There are conflicting reports on the association between children with increased body mass index (BMI), and constipation. This retrospective chart review of two groups of children from a primary care clinic was designed to address the controversy. Group-1: Charts of all children seen in a year for general pediatric care were reviewed for incidences of increased BMI (>85th percentile) and constipation as well as overweight recognition in the final diagnosis; Group-2: Children diagnosed with constipation at the same primary care setting for 5 years were identified by ICD-9 code. These charts were reviewed for prevalence of increased BMI and incidences of referral to subspecialty clinic. Group-1: Three hundred nineteen (33.4%) of the 955 children had increased BMI and 28 (2.93%) had constipation. The prevalence of constipation was not increased among children with increased BMI. Group-2: 24 of the 66 children with constipation were referred to the pediatric gastroenterology clinic. children with increased BMI were three times more likely to be referred (n = 20, p = 0.04). The two groups had a similar prevalence of children with increased BMI (Group 1 = 33.4%; Group 2 = 30.3%). In the general pediatric population, children with an increased BMI were not at an increased risk of developing constipation. However, children with increased BMI and constipation were three times more likely to be referred, presumably for treatment failure, to the pediatric gastroenterology clinic .Hence children with increased BMI were more likely to develop treatment resistant constipation.

Improving the accuracy of contrast enema in diagnosis of Hirschsprung disease

Abstract Background Hirschsprung’s disease (HD) is one of the most important causes of chronic constipation in children due to its possibly fatal Amir Maurice Eskander complications if left untreated. Contrast enema (CE) is the first investigation done to diagnose Hirschsprung’s disease as it’s the safest, least invasive, most widely available and least expensive as compared to anal manometry and rectal biopsy however it had shown a wide range of sensitivity and specificity in previous studies. Aim of the work to improve the accuracy of contrast enema by studying each possible abnormal finding related to Hirschsprung’s disease and calculating its sensitivity and specificity in comparison with biopsy, as a gold standard method to determine the most reliable signs to use for diagnosis. Patients and Methods This cross sectional study was carried at pediatric radiology unit Ain Shams university hospitals, starting from July 2018 to June 2019. 43 patients met all inclusion and exclusion criteria and were included in the study. Contrast enemas results and findings were compared to the patient’s final diagnosis. PPV, NPV, specificity, and sensitivity was calculated for each finding. Results Absence of rectal gas in the plain film, transitional zone, abnormal recto-sigmoid index, enlarged colonic caliber and delayed evacuation showed significant association with HD. Abnormal recto-sigmoid index was the most reliable sign in our study to diagnose HD having the highest sensitivity and specificity. Conclusion CE is an excellent initial investigation in HD and combining it with detailed history taking and clinical examination can lead to decrease in unnecessary rectal biopsies.

Probiotics for treatment of chronic constipation in children

Probiotics for treatment of chronic constipation in children

Utilisation and Safety of Polyethylene Glycol 3350 With Electrolytes in Children Under 2 Years: A Retrospective Cohort.

ABSTRACTObjectives:In the UK, Movicol paediatric plain (polyethylene glycol 3350 with electrolytes [PEG 3350+E], Norgine, UK), is licensed for chronic constipation in children 2 –11 years of age and faecal impaction (FI) from 5 years. This study aimed to investigate usage and characterise the risk profile in children under 2 years of age using PEG 3350+E in the UK.Methods:Retrospective, single exposure cohort study, with patients identified from Clinical Practice Research Datalink (CPRD) GOLD. Patients first prescribed PEG 3350+E under 2 years of age for the treatment of constipation or FI, between September 2003 and July 2019, were included.Results:There were 13,235 patients with a constipation indication and 40 patients with FI. For the constipation cohort: median age of PEG 3350+E first prescription was 1.2 years [interquartile range (IQR) 0.9, 1.6] and 68.4% had one treatment episode (TE). The mean duration of exposure, in the first TE, was 88.9 days. The most common total daily dose was one sachet (6.9 g).In terms of incident events on treatment, 0.5% of patients had abdominal pain, 3.0% had diarrhoea (may be attributed to treatment) and 4.1% had vomiting. 2.0% had signs/symptoms which could (in extreme cases) be associated with electrolyte disturbance, however, none had abnormal electrolyte values.Discussion:The safety aspect of this study did not identify any signals of concern in the constipation cohort. The number of patients in the FI cohort were too small for robust conclusions. If information were available, then a safety study would ideally assess treatment intake per kilogram, including electrolyte intake, before reaching safety conclusions. Nevertheless, these data contribute to real-world evidence on the use of PEG 3350+E in this population.

Efficacy of oral magnesium therapy in the treatment of chronic constipation in spastic cerebral palsy children: a randomized controlled trial.

Constipation is a common problem in children with spastic cerebral palsy (sCP) with a prevalence that reaches 75%. We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care. Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP. A prospective, double-blinded randomized control trial was carried out involving 100 children aged 2-12years with sCP (level III-V of the Gross Motor Functional Classification system) and chronic constipation. They were followed up in the Pediatric neurology clinic, Children's hospital, Ain Shams University, May 2017- January 2019. The intervention group (O-Mg) received oral magnesium sulfate 1mL/kg/day daily for 1month compared to the placebo. Outcome measures were constipation improvement and decrease in bowel evacuation time after 1month. Initially, weekly bowel movements, constipation scores and stool consistency were comparable in both groups. After 1 month of regular administration of oral magnesium sulfate, the constipation score, stool frequency and consistency improved compared to the placebo group (P < 0.001). Effective safe treatment was achieved in 31 (68%) and 4 (9.5%) patients in the O-Mg and placebo groups, respectively (RR, 2.95; 95% CI 2.0-4.5) (P < 0.001). Painful bowel evacuation attempts spent by mothers decreased from 25 (55.6%) of the cases initially to 10 (22%) cases after onemonth in the O-Mg group (P = 0.001). In contrast, in the placebo group, the decrease went from 21 (50%) cases initially to 18 (42.9%) after 1month and was not significant (P = 0.5). Oral magnesium sulfate seems effective in alleviating chronic constipation and pain experience in children with sCP. Consequently, saving maternal time spent in daily bowel evacuation attempts.

Effect of Cow's-milk-free diet on chronic constipation in children; A randomized clinical trial.

Background:Cow’s milk intolerance can lead to chronic constipation in children. The present study seeks to determine the effect of cow’s milk-free diet (CMFD) on chronic constipation in children who are not responding to laxatives.Methods:Seventy children suffering from chronic constipation (described as the Rome III criteria) were enrolled in an open-label randomized clinical study. Each group included 35 children aged 4-14 years treated with laxatives for at least three months with no improvements. The intervention group received CMFD plus calcium supplements for four weeks and the control group did not have any restrictions in consuming cow’s milk and dairy products. Also, both groups received polyethylene glycol (PEG; 1 gr/kg/day) and high-fiber foods (at least 10 gr/day) for four weeks. Responsiveness was described as a reduction in symptoms and signs according to the Rome III criteria after four weeks.Results:After four weeks, 25 (71.4%) children in the CMFD group responded to the treatment compared to four (11.4%) children in the control group (P<0.001). Significant differences were found between the CMFD and control groups in terms of the seven Rome III criteria post-intervention; history of large stools (25% vs. 53.6%), large fecal mass in the rectum during examination (17.1% vs. 50%), history of painful defecation (18.2% vs. 55.6%), history of retentive posturing (10% vs. 46%), ≥1 episode/week of incontinence (25 % vs. 50%, P=0.001), ≤ 2 defecations/week (17.4% vs. 52.3%) and history of thick stool with toilet obstruction (22.2% vs. 52.3%)Conclusion:This study showed that children with functional constipation with no response to laxatives could benefit from a cow’s milk-free and dairy-free diet.