Diagnosis Of Constipation Research Articles

Gutted: constipation in children with chronic kidney disease and on dialysis

Functional constipation is a common problem in otherwise healthy children. Children with chronic kidney disease (CKD) and on dialysis have additional disease-related risk factors including the uremic milieu, fluid and dietary restrictions, and decreased physical activity, as well as treatment-related risk factors such as dialysis therapy and polypharmacy that contribute to and compound the problem. Constipation causes significant distress for children and their caregivers. In children on peritoneal dialysis, severe constipation can impede catheter function and ultrafiltration. Accumulating evidence points to a possible bidirectional relationship between constipation and CKD, potentially mediated by gut dysbiosis with consequent increased generation of gut-derived uremic toxins and disruption of intestinal epithelium integrity leading to translocation of noxious luminal contents into the circulation inducing systemic inflammation. Effective management of constipation is required but there is little published data on the safety and effectiveness of treatments in adults or children with CKD. In this review, we discuss the diagnosis and epidemiology of functional constipation, provide an overview of its pathophysiology, summarize the therapeutic management, and reflect on the challenges in children with CKD.

Treatment of Chronic Constipation using Elobixibat in a Real-World Setting: A Retrospective Cohort Study using an Electronic Medical Records Database in Japan

Chronic constipation is a common condition affecting people of all ages; therefore, the socioeconomic burden of chronic constipation is nonnegligible. Elobixibat (ELO), an ileal bail acid transport inhibitor, was launched in Japan in 2018. However, evidence of its use in diverse populations is limited. This study aimed to evaluate the prescription of ELO, risk factors associated with ELO discontinuation, and the continuation of stimulants or saline laxatives during ELO treatment in a real-world setting using an extensive electronic medical records database that primarily includes data from acute-care hospitals. Data of patients prescribed for ELO from April 1, 2018, to March 31, 2022, were extracted from the database. The discontinuation of ELO and stimulant or saline laxatives during ELO treatment was evaluated using the Kaplan-Meier method. The Cox proportional hazards model evaluated risk factors associated with laxative discontinuation. In total, 11,062 patients were evaluated. The rate of ELO discontinuation within 360 days of initiation was 78.7%. Hospitalized at the ELO initiation, stage 5 chronic kidney disease, and diagnosis of constipation by departments of obstetrics and gynecology or by departments of malignant neoplasm were identified as risk factors for discontinuation. Diagnosis of constipation, diabetes mellitus, Parkinson's disease, and previous laxative treatment was associated with a lower risk of ELO discontinuation. The prescription rate of stimulants and saline laxatives markedly decreased after ELO initiation; furthermore, nearly half of patients who were continuously prescribed ELO discontinued these laxatives within 360 days. The discontinuation of ELO was associated with various factors and using ELO may be beneficial in the withdrawal of concurrent stimulants and saline laxatives. These findings may help effectively manage chronic constipation.

Pathophysiology and diagnosis of chronic constipation in clinical settings in Japan

Pathophysiology and diagnosis of chronic constipation in clinical settings in Japan

Progress of research on the treatment of constipation from dietary intervention

Nowadays, with the change in living conditions and the adjustment of dietary structure, together with the influence of psycho-spiritual and social factors, the incidence of constipation has (year by year) increased ^[1], which has seriously affected people's quality of life. There are various Chinese and Western medical diagnostic and treatment methods for constipation of different etiologies, and research on the prevention and treatment of constipation by dietary interventions has become a hot topic not infrequently. Therefore, this paper integrates and summarizes the relevant literature in recent years through the theoretical studies on the role of dietary intervention in constipation and its specific clinical applications, and briefly describes some theoretical and practical experiences and guidance on dietary intervention in constipation, providing new ideas and reference bases for the modern application of dietary intervention in the diagnosis and treatment of constipation.

Некоторые аспекты формирования рационов питания детей разных возрастных групп

Aim: to analyze the frequency of eating and the range of products used as snacks and to assess the impact of snacking on the digestive tract of children of different ages. Patients and Methods: a questionnaire survey of 2250 parents of preschoolers (3-6 years old) and 2250 parents of schoolchildren in Saratov city and Saratov region was conducted. Outpatient medical records of 4500 children were analyzed to assess the findings of physical exam performed by gastroenterologist, child's life and medical history, and the results of laboratory and instrumental tests used for evaluating the gastrointestinal system. Results: an adequate dietary pattern (breakfast, second breakfast, lunch, midday meal, dinner) was followed by 64% of preschoolers and 36% of schoolchildren (р<0.05). The majority of preschool- and school-aged children missed the second breakfast. Most of them — 90% of preschoolers and 78% of schoolchildren had snacks 1–3 times a day. Most commonly both preschool- and school-aged children were eating sausage snacks: 35% and 40% of the interviewed individuals, respectively. Fruits (32%) and confectionery products (22%) were the second most popular snacks among the preschool- and school-aged children. Every 5th preschooler and every 3rd schoolchild consumed sausage products weekly. Children who were snacking with sweets and eating sausages daily had more gastrointestinal complaints and more frequently required regular medical check-ups (registered with Group “D”) by gastroenterologist with the diagnoses of gastritis, gastroduodenitis, biliary dyskinesia, and chronic constipation, and this difference was statistically significant. Conclusion: preschool- and school-aged children most commonly get sausage and confectionary products as additional meals which may cause multiple health problems in the future. For the rational development of additional diets for children of different ages it is necessary to regulate such meals and to introduce consensus documents on the rate of consumption and the optimal formulations of food products used as snacks. KEYWORDS: schoolchildren, preschoolers, snacking, nutrition, gastrointestinal disorders. FOR CITATION: Chernenkov Yu.V., Gumenyuk O.I., Glushakov I.A., Glushakova V.D. Some aspects of developing diets for children of different age groups. Russian Journal of Woman and Child Health. 2023;6(2):169–174 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-169-174.

Факторы риска плохой подготовки к колоноскопии и сравнение способов очищения кишечника в педиатрии

Objective. To study the influence of constipation in the anamnesis, diet as risk factors for inadequate bowel preparation for colonoscopy in children, after bowel preparation with sodium picosulfate with magnesium citrate , cleansing enemas or with combination of both. Patients and methods. Children (1 year – 17 years 11 months) were referred for routine colonoscopy to two children's hospitals in Moscow and were randomly assigned three types of preparation for the research. Exclusion criteria were the need for an emergency colonoscopy, kidney disease, or colectomy. All patients were prescribed low-fiber diet during three days before the procedure. Endoscopists did not know about the method of preparation and evaluated the effectiveness of preparation according to the Boston Bowel Preparation Scale (BBPS ), noting the maximum depth of insertion of device (intubation of the cecum, ileum, etc.). Tolerability of methods and adherence of diet were assessed using the questionnaire for patients, as well as by the incidence of undesirable effects. The BBPS of ≥2 in 3 segments of the colon (left, transverse, right) was considered satisfactory, while BBPS <2 in more than 1 segment was considered unsatisfactory. Results. 440 children (mean age 12 years) were randomly assigned to bowel preparation with sodium picosulfate with magnesium citrate (n = 135), cleansing enemas (n = 79) or combination (n = 226) . The satisfactory result of preparation was achieved in 127 (94.1%) patients in the bowel preparation with sodium picosulfate group, in 71 (90%) in the group with cleansing enemas and in 201 (89%) using the combined method (BBPC value for bowel preparation with sodium picosulfate 7.0 (6.0–8.0), Cleansing enemas 7.0 (5.0–8.0), Combination 6.5 (6.0–8.0), p = 0.009). Analysis of logistic regression showed that age, body mass index and the presence of a diagnosis of constipation in the anamnesis did not affect (p > 0.05)to success of achieving the satisfactory result of bowel preparation in all groups (p > 0.05). However, constipation was associated with depth of insertion and intubation of the cecum and/or terminal ileum, which was 6.8 times less likely in patients with constipation (OR = 0.146; 95% CI: 0.036–0.602, p = 0.014). In patients who followed the diet, inadequate bowel preparation was observed with a probability of 7.4 times less (OR = 0.135; 95% CI: 0.053–0.345, p < 0.001). In children who followed the dosage, the probability of inadequate bowel preparation was also 7.393 times lower, regardless of the method of preparation (OR = 0.135; 95% CI: 0.053–0.345, p < 0.001). Frequency of undesirable effects between the groups was almost the same, there was no statistically significant difference (sodium picosulfate 29%, cleansing enemas 27%, combination 39%, p = 0.03). Conclusion. The results of our study show that in children without constipation on diet and adequate doses of medicines makes it easier to tolerate preparation, qualitatively prepare the intestines and conduct full colonoscopy. We consider that these criteria are the most important for bowel cleansing and the quality of the colonoscopy performed in children, regardless of the methods of colon preparation. Key words: colonoscopy, children, pediatrics, preparation

Regional and seasonal variations in functional abdominal pain and functional constipation prevalence among Saudi children.

This study aimed to evaluate functional abdominal pain disorders and functional constipation prevalence in the central region of Saudi Arabia, and compare it to that of the western region. This was a cross-sectional study using online questionnaires targeting the general population of Riyadh region of Saudi Arabia. Subjects were randomly selected by sharing links on social media groups. Any parent with a 3-18-year-old child was included, and children with chronic medical illnesses or symptoms of organic GI disorders were excluded. Three hundred nineteen subjects were included in the final analysis; the prevalence of functional abdominal pain disorders overall was 6.2% and the prevalence of functional constipation was 8.1%. Functional constipation diagnosis seems to be affected by life stressors or a previous viral illness. Seasonal variations had minimal effect on functional abdominal pain disorder and functional constipation symptom frequency and severity.

Inter and Intraobserver Variation in Interpretation of Fecal Loading on Abdominal Radiographs.

The current gold standard for the diagnosis of functional constipation is the ROME IV criteria. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) guidelines do not support the use of abdominal X-rays in establishing the diagnosis of constipation. Despite these recommendations, abdominal radiography is frequently performed to diagnose constipation. The objective of our study is to evaluate inter and intraobserver variation in interpretation of fecal loading on abdominal radiographs. Electronic records of 100 children seen in the emergency room for gastrointestinal symptoms who had an abdominal radiograph performed were included. Four physicians from each specialty including gastroenterology, radiology, and emergency medicine interpreted the radiographs independently. Initially, subjective interpretations, followed by interpretations for intraobserver variation were obtained. Subsequently, all physicians were trained and asked to score the X-rays objectively using Barr and Blethyn scoring systems. Consistency between inter and intraobserver ratings of radiographic interpretation was evaluated using the Kappa coefficient ( k ) which ranges from 0 (no agreement) to 1.0 (perfect agreement). For subjective interpretations, k values showed a fixed margin k of 0.18 indicating poor agreement among 12 observers. Intraobserver k to look for reproducibility showed significant variability ranging from 0.08 (poor) to 0.61 (fair) agreement. Objective scoring results for Blethyn showed a k of 0.14 indicating poor agreement among 12 providers. Reliability and reproducibility of X-rays for diagnosis and grading of constipation is questionable given poor to fair agreement for both inter and intraobserver comparisons. Our study supports the current recommendation of ESPGHAN and NASPGHAN to not use abdominal X-rays to diagnose constipation.

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.

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Background: Fecal incontinence (FI) is a stressful condition for children and their parents that may affect the patient’s psychological well-being. Evaluating the patients’ psychological status may help physicians manage the disease effectively. Objectives: This study aimed to assess the emotional and behavioral disturbances in children with FI who were referred to the pediatric gastroenterology clinic in Mofid Children’s Hospital from April 2021 to 2022. Methods: This cross-sectional study included children (over four years old) with chronic constipation and fecal incontinence. The diagnosis of chronic constipation and FI were made according to Rome-IV criteria. The Child Behavior Checklist (CBCL) evaluated patients’ emotional, behavioral, and social problems. Results: One hundred one patients with a mean age of 7.96 years were enrolled in the study; 67.32% were males. According to CBCL, 12% (12 patients) indicated emotional and behavioral problems, with CBCL scores in the clinical or at-risk range. We detected anxious/depressed problems in five (4.95%), withdrawn/depressed problems in eight (7.92%), somatic complaints in seven (6.93%), social problems in eight (7.92%), thought problems in nine (8.91%), attention problems in seven (6.93%), rule-breaking behavior in two (1.98%), and aggressive behavior in nine (8.91%) patients. The risk of internalizing and externalizing disorders was reported in four (3.96%) and five (4.95%) patients. Also, eight (7.92%) and seven (6.93%) patients had clinical symptoms of internalizing and externalizing disorders, respectively. There was no significant relationship between patients’ age and gender with the CBCL scores in any subscales. However, there was a significant difference in the total score among the age groups (P = 0.04). Conclusions: The relatively high prevalence of emotional, behavioral, and social problems in our study corroborates the importance of psychological screening of children with FI during the treatment process.

S167 Comparison of High-Resolution Anorectal Manometry and Magnetic Resonance Defecography in Patients With Obstructive Defecation: Are Both Tests Necessary?

Introduction: Investigation of evacuation disorders is often pursued in patients with symptoms of obstructive defecation. High-resolution anorectal manometry (HR-ARM) is a simple, safe and widely available test to diagnose pelvic floor dysfunction. A more costly and less accessible test is magnetic resonance defecography (MRD). This study aims to qualify the added value of MRD in diagnosing pelvic floor disorders. Methods: HR-ARM and MRD performed in patients with a diagnosis of constipation between 1/1/2020 and 5/15/22 at Mayo Clinic were identified using Epic SlicerDicer. Univariate and multivariate analyses were used to compare findings on MRD in patients with and without abnormal HR-ARM. Results: Seventy-six consecutive patients (81.8% female, 94.8% white, age 19-82) who underwent both HR-ARM and MRD were included. The majority had evidence of dyssynergia on HR-ARM (n=49, 64.5%). Patients with dyssynergia on HR-ARM were significantly more likely to have prolonged balloon expulsion at both >60 and >30 seconds (p< 0.00001) and incomplete gel expulsion on MRD (p=0.00008) (Table). However, they were not more likely to have a clinically significant rectocele measuring >2cm (p=0.5093) or evidence of rectal prolapse (p=0.071). An increased number of vaginal deliveries was correlated with a higher likelihood of having a rectocele >2cm (r=0.24, p< 0.05). Conclusion: Anatomic findings on MRD were similar between patients with and without evidence of dyssynergia identified by HR-ARM. In this retrospective review, undergoing MRD in addition to HR-ARM does not appear to provide additional diagnostic information to guide therapeutic recommendations. Large prospective studies to evaluate the added value of MRD are needed. Table 1. - Findings on MRD and balloon expulsion test in patients with and without dyssynergia on HR-ARM Dyssynergia on HR-ARM No dyssynergia on HR-ARM P value n= 49 (64.5%) n = 27 (35.5%) Balloon Expulsion >60 sec 30 (61.2%) 0 (0.0%) p< 0.00001 Balloon Expulsion >30 sec 32 (65.3%) 2 (7.4%) p< 0.00001 < 50% gel expulsion on MR 26 (53.1%) 2 (7.4%) p=0.00008 Rectocele on MR 26 (53.1%) 22 (81.5%) p=0.0139 >2 cm Rectocele on MR 21 (42.9%) 16 (59.3%) p=0.5093 >3 cm Rectocele on MR 10 (20.4%) 9 (33.3%) p=0.2113 >4 cm Rectocele on MR 3 (6.1%) 3 (11.1%) p=0.4413 Rectal Prolapse 5 (10%) 7 (31.8%) p=0.071

Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery

PurposeFecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation. MethodsA multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests. Results458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p<0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients. ConclusionWe observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care. Level of EvidenceLevel III

Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases.

Background:Radiograph use contributes to low-value care for children in emergency departments (EDs), but little is known about systemic factors associated with their use. This study compares low-value radiograph use across ED settings by hospital type, pediatric volumes and physician specialty.Methods:This is a cross-sectional study of routinely collected administrative data. We included children (age 0–18 yr) discharged from EDs in Ontario, Canada, between 2010 and 2019 with diagnoses of bronchiolitis, asthma, abdominal pain and constipation. Multiple clinical practice guidelines recommend against routine radiograph use in these conditions. Logistic regression evaluated odds of low-value radiograph by ED setting (pediatric academic [referent], adult academic, community with or without pediatric consultation services), pediatric volume and physician specialty (pediatric emergency medicine [PEM, referent], emergency medicine [EM], family medicine with EM training, pediatrics, family medicine), adjusting for demographic, clinical and provider characteristics. We used generalized estimating equations to account for clustering by ED.Results:Of the total 9 862 787 eligible pediatric ED discharges in Ontario, 60 914 children had bronchiolitis, 141 921 asthma, 333 332 abdominal pain and 110 514 constipation; 26.0% received low-value radiographs. Compared with pediatric EDs and PEM physicians (referents), patients with bronchiolitis were most likely to have a chest radiograph in adult academic EDs (adjusted odds ratio [OR] 5.1 [95% confidence interval (CI) 4.6–5.6]) and by family physicians with EM training (adjusted OR 4.8 [95% CI 4.5–5.1]). Patients with asthma were more likely to have a chest radiograph in adult academic EDs (adjusted OR 3.0 [95% CI 2.8–3.2]) and by EM physicians (adjusted OR 2.8 [95% CI 2.6–3.0]). Patients with abdominal pain and constipation were more likely to have abdominal radiographs in community hospitals with pediatric consultation (adjusted OR 1.6 [95% CI 1.6–1.7] and 2.3 [95% CI 2.3–2.4], respectively) and by family physicians with EM training (adjusted OR 1.6 [95% CI 1.6–1.7] and 2.1 [95% CI 2.0–2.2], respectively).Interpretation:Over the decade-long study period, low-value radiograph use was frequent for children with 4 common conditions seen in Ontario EDs. Quality improvement initiatives aimed at reducing unnecessary radiographs in children should focus on EM physicians practising in EDs that primarily treat adult patients.

Constipation and GI diagnoses in children with solid tumours: prevalence and management

ObjectivesDespite continued development of targeted therapies for children with cancer, patients continue to experience an array of unwanted side effects. Children with solid tumours may experience constipation as a result...

Transabdominal Ultrasound Measurement of the Diameter of Rectal Ampulla as a Less Invasive Modality for Digital Rectal Examination in Children with Functional Constipation

Background: Constipation is one of the most common complaints in children. Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is suspected. However, diagnosis of megarectum by ultrasonography would differentiate children with constipation from those with dysfunctional defecation. Objectives: In this research, we evaluated the utilization of ultrasonography to measure the diameter of rectal ampulla for the diagnosis of functional constipation. Methods: In this study, 94 patients &lt; 14 years old diagnosed with functional constipation were included. Patients were examined by both DRE and ultrasonography before and after a conventional stool softener treatment. Results: The diameter of the rectal ampulla was significantly wider in patients with large stool mass in DRE than in patients with normal digital rectal exams. There was a significant relationship between fecal incontinence and pre-treatment DRA. By increasing the severity of fecal incontinence, the average DRA in patients increased significantly. Additionally, there was a significant statistical difference between the patient’s DRA before and after treatment. Finally, the relationship between constipation and DRA adjusted model showed that the risk of abnormal DRA was 3.1 times larger in patients with three and four symptoms than in patients with two symptoms and this relationship was statistically significant. Conclusions: Ultrasonography can be a suitable replacement for DRE; however, further investigations are required.

A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation

To decrease the percentage of patients undergoing an abdominal radiograph for evaluation of constipation within 24hours of their initial gastroenterology visit. In January 2015, we implemented a quality improvement, evidence-based guideline (EBG) aimed at standardizing the initial assessment of patients presenting for a new outpatient gastroenterology visit with a primary complaint of constipation. Over the subsequent 5years, we followed the clinical impact of this guideline initiation with the goal of decreasing unnecessary abdominal radiograph use by 10% within 1year of EBG launch. Patients older than 6months and younger than 19years were included. In total, 6723 patients completed new patient gastroenterology visits for a primary diagnosis of constipation between 2013 and 2019. Of these, 993 (14.8%) patients had abdominal radiographs taken within 24hours of their initial visit. Over the 7years of this project, a mean frequency of abdominal radiograph use decreased from 24% to less than 11%. In addition, a 57% decrease in hospital charges related to decreased radiograph use for constipation was found. No increases in subsequent emergency department visits or hospitalization for constipation within 30days of patients' initial visits were seen. Through local adoption of an EBG, routine use of abdominal radiographs taken during a patient's initial outpatient gastroenterology visit for constipation decreased by more than 50%. This reduction was maintained over a subsequent 5-year period without any detrimental side effects.

Constipation in children in the practice of a pediatrician

Constipation in children is currently one of the major complaints that parents present at a pediatrician's appointment. The article discusses the issues of diagnosis and treatment of functional constipation in children based on the international and Russian clinical guidelines. The following are some major causes of constipation in young children. Constipation is most often caused by colon dyskinesia (hypo- and hypermotor disorders), impaired and painful bowel movement (spasm of the rectal sphincters, weakened smooth muscle tone, etc.) or a combination of these factors. In rare cases, the cause of constipation is organic disorders. Also, low parental socio-economic status, low educational level, depression, neuroticism, attitude of parents towards their children's upbringing such as being overprotective, and attitudes that promote high or low levels of autonomy, increase the risk of functional constipation. In addition, the article sets detailed factors leading to constipation in older children and adolescents. The pathogenesis of functional constipation is given, and the problem of psychological constipation is described. The outlined therapeutic approach includes dietary intervention, compliance with drinking water treatment, behavioural and drug therapy. The author presents its own experience of using sodium picosulfate to treat constipation in children. Constipation in children is a common problem, functional constipation accounts for 95% of cases, therefore in most cases they do not require clarifying diagnostic methods. Besides, you shouldn't forget about the possibility of organic pathology, malformations in young children. Constipation in children requires the timely administration of complex treatment.

Evaluation of the efficacy of inulin use in children with functional constipation

Functional constipation (FC) is a common pediatric problem accounting for 3 % visits to a general pediatrician and up to 25 % visits to a pediatric gastroenterologist. Presence of FC significantly impacts a child’s health‑related quality of life and the healthcare cost burden. The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition Guideline (NASPGHAN) recommends supportive treatment with laxatives, training, recommendations on fiber and fluid intake, and physical activity in constipation in children. Modern pharmacological treatments may be ineffective in some patients — not optimal dosage, poor compliance or use of drugs with mechanisms of action that do not affect the main pathophysiological moments. Many patients with constipation report dissatisfaction with traditional treatments due to perceived lack of efficacy.&#x0D; Objective — to study the effectiveness of the prebiotic Inulin Neo for pediatric patients with functional constipation aged 3 to 18 years.&#x0D; Materials and methods. Observation involved 48 children aged 3 to 18 years with a diagnosis of functional constipation. Patients were divided into two groups. The main group consisted of 29 children who received the prebiotic Inulin Neo. The control group included 19 children who did not receive prebiotic.&#x0D; Results. After 30 days of treatment, children of the main group vs control group demonstrated significantly better positive dynamics of the following indices: relief of abdominal pain and pain during defecation, decrease in colic and bloating, normalized frequency of defecation and consistency of stools, increased bifidoflora amount and normalized coprological indicators. The results suggest effectiveness of Inulin Neo and feasibility of its inclusion into the treatment of functional constipation in children.&#x0D; Conclusions. Symptoms of functional constipation significantly decreased or disappeared in children who received Inulin Neo, most of the indices of microbiocenosis and coprological investigations considerably improved, whereas pediatric patients of the control group demonstrated only the trend to their improvement. No intolerability signs or adverse events during Inulin Neo administration have been revealed.&#x0D;

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

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

Constipation Is a Frequent Problem Associated with Vascular Complications in Patients with Type 2 Diabetes: A Cross-sectional Study.

Objective Diabetes is recognized as an underlying disease of constipation. However, the prevalence of constipation varies according to the diagnostic criteria applied. We investigated the prevalence of constipation based on the new guideline for constipation in Japanese patients with type 2 diabetes and examined the relationship with the clinical background, including diabetic vascular complications. Methods Questionnaire surveys including items concerning the diagnosis and treatment status of constipation were administered to 410 patients with type 2 diabetes. Results Although 29% of the patients considered that they had experienced constipation (self-judged), only 14% had consulted a physician about constipation. The prevalence of chronic constipation based on the guideline was 26%. After including laxative users, constipation was finally found in 36%. Despite the use of laxatives (n=81), 51% of the patients were still diagnosed with chronic constipation. Patients with constipation (chronic constipation or laxative use) were significantly older and had a longer duration of diabetes than those without constipation. The body mass index (BMI) of patients with constipation (24.9±3.8 kg/m2) was significantly lower than that of those without constipation (26.3±4.6 kg/m2). Diabetic neuropathy (49% vs. 32%) and coronary heart disease (CHD) (27% vs. 13%) were significantly more frequent in the patients with constipation than in those without constipation. A multivariate logistic regression analysis revealed that gender, BMI, diabetic neuropathy, insulin use, and CHD were significantly associated with constipation. Conclusion An accurate diagnosis of constipation is desirable in patients with type 2 diabetes because constipation is independently associated with CHD.