Treatment Of Constipation In Children Research Articles

Effects of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation: A Randomized, Double-blind Controlled Trial.

Management of intractable childhood constipation is still challenging. The efficacy of retrograde colonic enema (RCE) with fecal microbiota transplantation (FMT) in intractable childhood constipation has not been established although both have demonstrated potential in gastrointestinal diseases. The aim of the current study was to determine the safety and efficacy of RCE-based FMT in the treatment of intractable constipation in children. A randomized, double-blind, controlled trial with 110 children was conducted. The subjects were randomly assigned to the FMT with RCE group or the placebo with RCE group. All participants received a daily RCE followed by a 4-week FMT treatment (twice a week) and a 12-week follow-up period. Spontaneous bowel movements (SBMs) ≥ 3 per week were the main outcomes and the risk ratio (RR) with 95% CI was calculated. Changes in the intestinal bacterial profile were analyzed by BOX-PCR-based DNA fingerprinting and sequencing. The adverse effects were assessed based on symptoms. At the end of the follow-up period, 22 patients (40.0%) in the FMT with RCE group and 10 patients (18.2%) in the placebo with RCE group had ≥ 3 SBMs per week (net difference = 21.8%, 95% CI: 13.2%-30.4%; RR: 1.364, 95% CI: 1.063-1.749; P<0.05). Both RCE and FMT enriched the intestinal bacterial diversity of patients with constipation. The adverse events were all mild self-limiting gastrointestinal symptoms. FMT enhances the efficacy of RCE and the use of RCE-based FMT is a safe and effective method in the treatment of intractable constipation in children.

Functional constipation in preschool and school age children: ways to solve the problem

Functional constipation is a significant medical problem in pediatrics. Constipation often causes discomfort in children of any age and, in the absence of timely and effective treatment, can lead to chronic intoxication and the development of various complications, ultimately affecting the patient's quality of life. The article presents the definition of functional constipation in children over 4 years of age in accordance with the Rome IV Criteria (2016), etiology, pathophysiological mechanisms, clinic, diagnostic criteria and differential diagnosis of functional and organic constipation in preschool and school age children, possible complications. In accordance with the draft Consensus of the Society of Pediatric Gastroenterologists (2013), for a more objective assessment of the nature of the stool, the Bristol scale of stool forms is given. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. In accordance with the recommendations of the National School of Gastroenterology, the National Institute of Health and Clinical Excellence (NICE) in the UK, ESPGHAN and NASPGHAN, the basic principles of constipation therapy in preschool and school age children are given. The main groups of drugs that are used in the treatment of constipation in children of this age are described: stimulating and osmotic laxatives, prokinetics. Numerous foreign studies and clinical recommendations indicate that stimulants are effective and safe for the treatment of functional constipation, including in children's practice and are most in demand. The analysis of the use of one of the main drugs of the group of stimulating laxatives - sodium picosulfate in numerous international and Russian clinical studies is presented. The effectiveness and favorable safety profile of sodium picosulfate, the possibility of individual dose selection in connection with the liquid form of release are shown. A clinical example of the treatment of functional constipation in a 6-year-old child is given.

Constipation in Children and Adolescents.

According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence. We selectively searched the PubMed and Google Scholar databases for articles with the keywords "constipation," "children and adolescents," and "incontinence". Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews. More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30-50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases. The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.

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;

A Randomized, Double-Blind Controlled Trial of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation

A Randomized, Double-Blind Controlled Trial of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation

A Randomized, Double-Blind Controlled Trial of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation

A Randomized, Double-Blind Controlled Trial of Retrograde Colonic Enema Based Fecal Microbiota Transplantation in the Treatment of Childhood Constipation

“The role of L. reuteri DSM17938 in nutritional recovery and treatment of constipation in children and adolescents with anorexia nervosa - a randomized, double blind, placebo controlled study”

Anorexia nervosa (AN) carries the risk of potentially irreversible medical complications, especially in children and adolescents. Constipation is frequent and difficult to manage. Due to the symptoms it causes, constipation can further compromise nutritional rehabilitation. To investigate the role of probiotics (Lactobacillus reuteri DSM 17938) in children and adolescent with AN. Randomized, double blind, placebo controlled study in 31 female pediatric AN patients with constipation, referred to nutritional therapy in Pediatric Gastroenterology Department, Sestremilosrdnice University Hospital Centre in Zagreb. At hospitalization, patients were randomly assigned into two groups; one taking L.reuteri, and other placebo for 3 months, along with the conventional nutritional rehabilitation. Patients were followed 3 months after stopping the treatment. The primary outcome was relief of constipation, assessed after 3 months, while secondary outcomes were normalization of body weight, stool frequency and consistency, relief of dyspepsia, weight gain and recovery of malnutrition regarding bone density and vitamin D3 levels. The study showed statistically significant difference between the two groups considering the stool frequency (6.4 vs. 4.2 stools/week; p<0.05) and normalization of body weight (93 vs. 63%; p=0.04) after 6 months, but no significant effect on the rate of relief of constipation (87 vs. 64%; p=0.22) at 3 months. In the L. reuteri group, the normalization of BMD was achieved in 8/15, whereas in the placebo group, in 3/16 patients. However, there was no statistically significant difference compared to the placebo group regarding the BMD recovery as well as the normalization of D3 levels (p=0.056). Probiotics may serve as simple and safe adjuvant therapy of constipation in childhood AN and contribute to faster nutritional recovery. Although a statistically significant difference between the two group in relief of constipation could not be shown after 3 months, a benefit from probiotics could be in increasing stool frequency and nutritional recovery in childhood AN after six months. Registered under ClinicalTrials.gov Identifier no. NCT02004288.

Patient with constipation syndrome at the ambulatory-polyclinic reception: actual aspects of differential diagnosis and treatment

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.

Modern Opportunities of Medical Rehabilitation of Children with Chronic Constipation

This article reviews the methods of medical rehabilitation used in the complex treatment of children with chronic constipation. Medical rehabilitation of children with chronic constipation is a complex system of measures that include rational nutrition, medication therapy, physiotherapy, kinesotherapy, massage, etc. The main objectives of the medical rehabilitation of children with chronic constipation are normalization of the passage through the intestines, improvement of tone of the pelvic floor muscles, restoration of the defecation reflex. The article describes the methods of physiotherapy used in the treatment of chronic constipation in children in combination with diet, daily regimen, drug treatment, physiotherapy exercises and massage: amplipulse therapy, interference therapy, ultrasound therapy, percutaneous electroneurostimulation, fluctotuorization, high-intensity magnetic therapy, transient transduction. The methods of balneotherapy are widely used: the internal and external use of mineral waters, as well as heat therapy and peloidotherapy. Natural and artificial physical factors are assigned differentially, taking into account the type of intestinal motility disorder. One of the promising directions of modern physiotherapy is to study the combined and combined use of two physical factors that increase the effectiveness of the medical rehabilitation program for children with chronic constipation. Methods of medical and psychological correction are of great importance in the medical rehabilitation of children with chronic constipation. The medical rehabilitation of children with chronic constipation is carried out taking into account the individual program of medical rehabilitation of the child, which makes it possible to increase the efficiency of medical rehabilitation and the patient’s quality of life.

A Pilot Study of Non-invasive Sacral Nerve Stimulation in Treatment of Constipation in Childhood and Adolescence.

Background/Aims: Constipation shows both, a high prevalence and a significant impact. However, it is often perceived as minor and treatment choices are limited. The neuromodulation approach is a valuable option to be considered. This study assesses the use of non-invasive sacral nerve stimulation to reduce constipation in children.Methods: Between February 2013 and May 2015, pediatric patients with chronic constipation were treated with this non-invasive neuromodulation procedure, adapted from classical sacral nerve stimulation. A stimulation device attached to adhesive electrodes on the lower abdomen and back generated an electrical field with a stable frequency of 15 Hz via variable stimulation intensity (1–10 V). The effect of therapy was evaluated in routine check-ups and by specialized questionnaires.Results: The study assessed non-invasive sacral nerve stimulation in 17 patients (9 boys, 8 girls, mean age 6.5 years). They underwent stimulation with 6–9 V for a mean of 11 h per day (range 0.5–24 h) over a mean of 12.7 weeks. Improvement of constipation was achieved in more than half of the patients (12/17) and sustained in almost half of these patients (5/12). Complications were minor (skin irritation, electrode dislocation).Conclusions: Non-invasive sacral nerve stimulation appears to be effective in achieving improvement in pediatric patients with chronic constipation. As an additional external neuromodulation concept, this stimulation may represent a relevant addition to currently available therapeutic options. Further studies are needed to confirm these results.

Challenging the view that lack of fibre causes childhood constipation

ObjectivesTo assess evidence supporting the view that ‘low fibre causes childhood constipation’.DesignTriangulation integrated three approaches: a systematic review NICE guideline CG99 examining effectiveness of increasing fibre; a cohort study, Avon...

Evaluation and Management of Constipation in Children-Single Centre Study

Background: Constipation in Indian children is on raising mode and most of it is functional; if search the figure in multiple literature constipation is a worldwide common problem in children. Developed and developing countries have equally distributed identified risk factors for constipation in both. The quality of life has affected in constipated patients and increases the mental stress of kids and parents. It also constitutes a challenge for healthcare systems and society by incurring significant burden of expenditure. All the factors specify that childhood constipation is turn up as a significant public health problem.Materials and methodology: Two hundred pediatric patients within two year of study period who presenting with history suggestive of constipation were studied in terms of age, gender, presenting complaints and duration of symptoms. Constipation was assessed by proforma based history and examination including Bristol stool chart in all these patients up to 12 years of age of either sex with history suggestive of constipation included in study were patients with acute abdomen and who not following the criteria of inclusion are excluded from study. Illustrative data were measured in term of qualitative and quantitative variables. Qualitative measures like sex, presenting complaints and presenting symptoms of constipation and stool pattern, percentages and frequencies were calculated and quantitative variables like age, percentages/mean/Standard Deviation (SD) were calculated.Objectives: Early diagnosis and effective treatment of constipation in children, Implementation of guidelines to provide a consistent, coordinated approach and to improve outcome for children and Compare it with the other similar studies.Results: Constipation occurs comparatively frequent among children and functional type of constipation is the most common cause of constipation in pediatric patients. Stool consistency, bowel frequency, large caliber hard and painful defecation are more tactful parameters in diagnose of constipation. Age group 0 to 4 year children's are more commonly affected and male dominance is perceptible in both functional and in organic (pathologic) constipation. Functional constipation (84.5%) is the most common type of constipation presenting in children, though up to 15.5% of patients may have an organic cause in whom history of delayed passage of meconium, presence of distension of abdomen, and fecal mass in rectum are the detectable point to an organic pathology. Children who are constipated may be associated with urinary tract infection.Conclusion: Early diagnosis, adequate therapeutic intervention, toilet training and regular follow up are of key importance in the management of childhood constipation. Most of the patients are functional constipation so that diagnosis can be only by proper history and physical examination; rarely required investigation. Surgical options need to be considered only when medical therapy fails.

Polyethylene glycol 4000 without electrolytesin the treatment of functional chronic intestinal constipation in children: retrospective analysis of 70 patients

Polyethylene glycol 4000 without electrolytesin the treatment of functional chronic intestinal constipation in children: retrospective analysis of 70 patients

Treatment of Constipation in Children with Idiopathic Chest Pain and Constipation Could Resolve Their Chest Pain

Background: Chest pain is one of the most frequent causes of a child’s referral to a cardiologist. Objectives: The present study aimed at determining whether treatment of constipation in 4 - 17-year-old children with idiopathic chest pain stops their chest pain. Methods: The current descriptive study was conducted on all patients aged 4 - 17 years old with idiopathic chest pain referring to the Pediatric Cardiology Clinic of Hejazi Hospital, Shiraz, Iran in 2016. A diagnosis of idiopathic chest pain is established after a thorough history taking, physical examination, and appropriate laboratory investigations in patients with no abnormality in the heart, lung, musculoskeletal system, psychological condition, and upper gastrointestinal tract. The study patients were divided into two groups: 36 patients with constipation as cases and 27 patients without constipation as controls. Patients with constipation were supported with toilet training programs and pharmacological treatment. Relief of chest pain was evaluated in the two groups after four months. Results: There were no significant differences in terms of age, gender, weight, and height between the patients with idiopathic chest pain with and without constipation. The number and length of chest pain were significantly different between the case and control groups (P < 0.001 and 0.047, respectively). After medical treatment of constipation, chest pain was significantly stopped in patients with constipation compared with the ones without constipation (P < 0.001). Conclusions: The current study showed that resolution of constipation stopped chest pain in the patients with idiopathic chest pain and constipation. Physicians should consider treatment of constipation as a first modality in each patient with idiopathic chest pain and constipation due to its easy assessment.

Corrigendum to "A Randomized Controlled Trial of Chinese Patent Medicine Xiao'er Biantong Granules in the Treatment of Functional Constipation in Children".

[This corrects the article DOI: 10.1155/2018/4941505.].

Lack of Benefit of Lactobacillus reuteri DSM 17938 as an Addition to the Treatment of Functional Constipation.

The aim of this study was to investigate the role of Lactobacillus reuteri DSM 17983 in the treatment of functional constipation in children. The trial was a single-center randomized, double-blind, placebo-controlled study. Patients were allocated into the 2 groups; intervention group which received L reuteri DSM 17983 and lactulose and placebo group which received placebo and lactulose. Due to small recruitment rate study was terminated prematurely; therefore, only 33 children (12 girls, median age 4.5 years, range 2-16) were randomized. There was no difference between groups in the stool frequency, stool consistency, pain, soiling rate and dose of the lactulose. This study found that L reuteri DSM 17938 adds no benefit to the treatment of constipation in children. Due to small sample size, these results, however, should be interpreted with caution.

Correction to: Macrogol (polyethylene glycol) 4000 without electrolytes in the symptomatic treatment of chronic constipation: a profile of its use.

[This corrects the article DOI: 10.1007/s40267-018-0532-0.].

Physiotherapy plus conventional treatment versus conventional treatment only in the treatment of functional constipation in children: design of a randomized controlled trial and cost-effectiveness study in primary care

BackgroundOur aim was to design a study to evaluate the effectiveness and cost-effectiveness of adding physiotherapy to conventional treatment for children with functional constipation in primary care. Physiotherapy is focusing on improving the coordination between the pelvic floor and abdominal musculature during bowel movement, while conventional treatment is mainly focusing on symptomatic relief of symptoms, therefore, we expect the effects of physiotherapy will be more sustainable than the effects of conventional treatment. In this paper we describe the final study design and how the design was adapted, to overcome recruitment problems.MethodsWe designed a randomized controlled trial of children aged 4–17 years with functional constipation diagnosed by a general practitioner or pediatrician. Children in the intervention group received physiotherapy plus conventional treatment, and those in the control group received conventional treatment only. Follow-up measurements took place at 4 and 8 months. The primary outcome was treatment success defined according to the Rome-III criteria as the absence of functional constipation, with no laxative use. Secondary outcomes were absence of functional constipation irrespective of laxative use, quality of life, global perceived effect, and costs.Children were recruited from September 2014 to February 2017. Initially, we aimed to include children with recent symptom onset. However, in the first phase of enrollment we were confronted with an unforeseen recruitment problem: many children and their parents refused randomization because physiotherapy was considered too burdensome for the stage of disease. Therefore, we decided to also include children with a longer duration of symptoms. In total 134 children were included.DiscussionThe target number of participants is achieved. Therefore, the results may change thinking about the management of functional constipation in children.Trail registrationNetherlands Trial Register (NTR4797), registered 8 September 2014.

Prospects for using probiotics in the treatment of constipation in children

Every paediatrician faces the problem of how to diagnose and treat constipation in children in the daily practice. According to the sociological survey of parents and doctors, on average every third child has a delay in evacuating stool. According to the 2016 Rome VI criteria, the diagnosis of functional constipation in children from 0 to 4 years of age is based on diagnostic signs that differ for children older than 4 years old. This article considers the mechanisms of constipation development in children of different age groups, and discusses the influence of microbiota on the development of motor and neurosensory intestinal disorders. The use of probiotics in constipation therapy is still controversial. The article presents recent studies of the efficacy of different probiotic strains in the treatment of constipation in children. So far, only Lactobacillus reuteri (DSM 17938) has a proven effect for the treatment of constipation in using monostam probiotics.

Macrogol (polyethylene glycol) 4000 without electrolytes in the symptomatic treatment of chronic constipation: a profile of its use.

Macrogol 4000, a biologically inert, non-absorbable osmotic laxative, is a highly effective and well-tolerated first-line option for the treatment of the symptoms of chronic idiopathic/functional constipation in children and adults. High-molecular-weight (HMW) macrogols ± electrolytes have generally similar efficacy profiles; however, the taste of macrogol 4000 is generally preferred over that of macrogol 3350 + electrolytes. Macrogol 4000 is more effective than lactulose in improving stool frequency and consistency, and is associated with less vomiting and flatulence. Comparisons with other osmotic and bulk-forming laxatives are limited, with macrogol 4000 being at least as, or more effective than, psyllium hydrocolloid and magnesium hydroxide in treating chronic constipation. Current clinical treatment guidelines recommend the use of HMW macrogols over the use of lactulose and bulk-forming laxative in the symptomatic treatment of constipation in children and adults.