Algorithm for the treatment of functional constipation in children: modern concepts


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Functional constipation (FC) in children is a very urgent global health problem. This pathological condition is characterized by reduced bowel movements, hard stool often having a large diameter, painful defecation and fecal incontinence, and may be accompanied by abdominal pain. Such symptoms often negatively affect the well-being of the child and the quality of his life. The management of a constipated patient is a multi-step algorithm that includes education, eating behavior correction, toilet training and drug treatment. The earliest possible initiation of adequate therapy plays a key role in the management of children with FC, since the delay between the onset of symptoms of constipation and the first visit doctor is negatively associated with recovery. This review focuses on current therapeutic approaches for constipation in pediatric patients.

Full Text

Restricted Access

About the authors

Andrey N. Surkov

Research Institute of Pediatrics; Center for Rare Diseases; Institute for Medical Personnel Training National Medical Research Center for Children's Health

Dr. Sci. (Med.), Head of the Gastroenterology Department with the Hepatology Group; Leading Researcher at the Laboratory of Rare Hereditary Diseases; Professor of the Department of Pediatrics and Public Health 2, build. 1, Lomonosovsky Prospect, Moscow 119991, Russian Federation

References

  1. Mugie S.M., Benninga M.A., Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res. Clin Gastroenterol. 2011;25:3-18. doi: 10.1016/j.bpg.2010.12.010.
  2. Dehghani S.M., Kulouee N., Honar N., et al. Clinical manifestations among children with chronic functional constipation. Middle East J Dig Dis. 2015;7:31-5.
  3. Faleiros F.T., Machado N.C. Assessment of health-related quality of life in children with functional defecation disorders. J Pediatr (Rio J.) 2006;82:421-25.
  4. Bongers M.E.J., Benninga M.A., Maurice-Stam H., Grootenhuis M.A. Health-related quality of life in young adults with symptoms of constipation continuing from childhood into adulthood. Health Qual. Life Outcomes. 2009;7:20. doi: 10.1186/1477-7525-7-20.
  5. Kaugars A.S., Silverman A., Kinservik M., et al. Families' perspectives on the effect of constipation and fecal incontinence on quality of life. J Pediatr Gastroenterol Nutr. 2010;51:747-52. doi: 10.1097/MPG.0b013e3181de0651.
  6. Belsey J., Greenfield S., Candy D., Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther 2010;31:938-49.
  7. Silverman A.H., Berlin K.S., Di Lorenzo C., et al. Measuring health-related quality of life with the Parental Opinions of Pediatric Constipation Questionnaire. J Pediatr Psychol. 2015. Doi: 10.1093/ jpepsy/jsv028.
  8. Заболевания органов пищеварения у детей. Под ред. А.А.Баранов, Е.В. Климанская. М., 1999.272 с.
  9. Мазурин А.В., Цветкова Л.Н., Филин В.А. Актуальные вопросы детской гастроэнтерологии. Педиатрия. 2000;5:19-22.10. Сичинава И.В., Горелов А.В. Запоры у детей. Детский доктор. 2001;4:40-4
  10. Сичинава И.В., Горелов А.В. Запоры у детей. Детский доктор. 2001;4:40-4
  11. Abi-Hanna A., Lake A. Constipation andencopresis in childhood. Pediatr Rev. 1998;19(3):23-31.
  12. Blackmer A.B., Farrington E.A. Novel and alternative therapies for childhood constipation. J Pediatr Health Care. 2010;24(6):385-99.
  13. Benninga M., Candy D.C., Catto-Smith A.G., et al. The Paris consensus on childhood constipation terminology (PaCCT) group. J Pediatr Gastroenterol Nutr. 2005;40:273-75. doi: 10.1097/01.mpg.0000158071.24327.88.
  14. Болезни кишечника у детей. Под общей ред. С.В. Бельмера, А.Ю. Разумовского, А.И. Хавкина. Т. 2. М., 2018. 496 с. [Bowel diseases in children. Ed. by S.V Belmer, A. Yu. Razumovsky, A.I. Khavkin. Vol. 2. M., 2018. 496 p. (In Russ.)].
  15. Drossman D.A. The functional gastrointestinal disorders and the Rome III process. Gastroenterol. 2006;130:1377-90.
  16. Hyams J.S., Di Lorenzo C., Saps M., et al. Childhood Functional Gastrointestinal Disorders: Child/ Adolescent. Gastroenterol. 2016;150(6):1469-80.
  17. Benninga S., Nurko M.A., Faure C., et al. Childhood Functional Gastrointestinal Disorders: Neonate/ Toddler. Gastroenterol. 2016;150(6):1443-55.
  18. Tabbers M.M., DiLorenzo C., Berger M.Y., et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58:258-74. doi: 10.1097/MPG.0000000000000266.
  19. Castiglia P.T. Constipation in children. J. Pediatr. Health Care. 2001;15:200-2. doi: 10.1016/S0891-5245(01)63945-2.
  20. McKeown C., Hisle-Gorman E., Eide M., et al. Association of constipation and fecal incontinence with attention-deficit/hyperactivity disorder. J Pediatr. 2013;132:e1210-15. doi: 10.1542/peds.2013-1580.
  21. Peeters B., Noens I., Philips E.M., et al. Autism spectrum disorders in children with functional defecation disorders. J Pediatr. 2013;163:873-78. doi: 10.1016/j.jpeds.2013.02.028.
  22. Van Dijk M., de Vries G.-J., Last B.F., et al. Parental child-rearing attitudes are associated with functional constipation in childhood. Arch Dis Child. 2014;100:329-33. doi: 10.1136/archdischild-2014-305941.
  23. Lane M.M., Czyzewski D.I., Chumpitazi B.P.,Shulman R.J. Reliability and validity of a modified Bristol Stool Form Scale for Children. J Pediatr. 2011;159(437-41):e1.
  24. Koppen I.J.N., Lammers L.A., Benninga M.A., Tabbers M.M. Management of Functional Constipation in Children: Therapy in Practice. Pediatr Drugs. 2015;17:349-60. doi: 10.1007/s40272-015-0142-425.
  25. Van der Plas R.N., Benninga M.A., Taminiau J.A., Bller H.A. Treatment of defaecation problems in children: the role of education, demystification and toilet training. Eur J Pediatr. 1997;156:689-92. doi: 10.1007/s004310050691.
  26. Dwyer J.T. Dietary fiber for children: how much? J. Pediatr. 1995;96:1019-22.
  27. Williams C.L., Bollella M., Wynder E.L. A new recommendation for dietary fiber in childhood. J Pediatr. 1995;96:985-88.
  28. Morais M.B., Vitolo M.R., Aguirre A.N., Fagundes-Neto U. Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. J Pediatr Gastroenterol Nutr. 1999;29:132-35. doi: 10.1097/00005176-199908000-00007.
  29. Tabbers M.M., Benninga M.A. Constipation in children: fibre and probiotics. Systematic review 303. BMJ. Clin. Evid. 2015. URL: http://clinicalevidence.bmj.com/x/systematic-review/0303/overview.html Accessed 28 July 2015.
  30. European Food Safety Authority Scientific opinion on dietary reference values for water. EFSA J. 2010;8(3):1459.
  31. Jennings A., Davies G.J., Costarelli V., Dettmar P.W. Dietary fibre, fluids and physical activity in relation to constipation symptoms in pre-adolescent children. J Child Health Care. 2009;13:116-27. doi: 10.1177/1367493509102469.
  32. Driessen L.M., Kiefte-de Jong J.C., Wijtzes A., et al. Preschool physical activity and functional constipation: the Generation R Study. J Pediatr Gastroenterol Nutr. 2013;57:768-74. doi: 10.1097/MPG.0b013e3182a313fc.
  33. Tabbers M.M, Boluyt N., Berger M.Y., Benninga M.A. Clinical practice: diagnosis and treatment of functional constipation. Eur J Pediatr. 2011;170:955-63. doi: 10.1007/s00431-011-1515-5.
  34. Bekkali N.-L.-H., van den Berg M.-M., Dijkgraaf M.G.W., et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. J Pediatr. 2009;124:e1108-15.
  35. Youssef N.N., Peters J.M., Henderson W., et al. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002;141:410-14. doi: 10.1067/mpd.2002.126603.
  36. Candy D.C.A., Edwards D., Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE+E) followed by a double-blind comparison of PEG+E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr. 2006;43:65-70. doi: 10.1097/01.mpg.0000228097.58960.e6.
  37. Gordon M., Naidoo K., Akobeng A.K., Thomas A.G. Cochrane review: osmotic and stimulant laxatives for the management of childhood constipation. Evid Based Child Health. 2013;8:57-109. doi: 10.1002/ebch.1893.
  38. Brady C.E., DiPalma J.A., Morawski S.G., et al. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterol. 1986;90:1914-18.
  39. Lee-Robichaud H., Thomas K., Morgan J., Nelson R.L. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;(7):CD007570.
  40. Treepongkaruna S., Simakachorn N., Pienvichit P., et al. A randomised, double-blind study of polyethylene glycol 4000 and lactulose in the treatment of constipation in children. BMC. Pediatr. 2014;14:153. Doi.: 10.1186/1471-2431-14-153.
  41. Chen S.-L., Cai S.-R., Deng L., et al. Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis. Med. (Baltimore). 2014;93:e65. doi: 10.1097/MD.0000000000000065.
  42. Hoekman D.R., Benninga M.A. Functional constipation in childhood: current pharmacotherapy and future perspectives. Expert Opin Pharmacother. 2013;14:41-51. doi: 10.1517/14656566.2013.752816.
  43. Wald A. Is chronic use of stimulant laxatives harmful to the colon? J Clin Gastroenterol. 2003;36:386-89. doi: 10.1097/00004836-200305000-00004.
  44. Price K.J., Elliott T.M. What is the role of stimulant laxatives in the management of childhood constipation and soiling? Cochrane Database Syst. Rev. 2001;(3):CD002040.
  45. Spiller H.A., Winter M.L., Weber J.A., et al. Skin breakdown and blisters from senna-containing laxatives in young children. Ann Pharmacother. 2003;37:636-39. doi: 10.1345/aph.1C439.
  46. Plunkett A., Phillips C.P., Beattie R.M. Management of chronic functional constipation in childhood. Paediatr Drugs. 2007;9:33-46. doi: 10.2165/00148581-200709010-00004.
  47. Sharif F., Crushell E., O'Driscoll K., Bourke B. Liquid paraffin: a reappraisal of its role in the treatment of constipation. Arch Dis Child. 2001;85:121-24. doi: 10.1136/adc.85.2.121.
  48. Urganci N., Akyildiz B., Polat T.B. A comparative study: the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Pediatr Int. 2005;47:15-9. doi: 10.1111/j.1442-200x.2004.02001.x.
  49. Farahmand A. A randomised trial of liquid paraffin versus lactulose in the treatment of chronic functional constipation in children. Acta Med Iran. 2007;45:183-88.
  50. Rafati M., Karami H., Salehifar E., Karimzadeh A. Clinical efficacy and safety of polyethylene glycol3350 versus liquid paraffin in the treatment of pediatric functional constipation. Daru. 2011;19:154-58.
  51. Sondheimer J.M., Gervaise E.P. Lubricant versus laxative in the treatment of chronic functional constipation of children: a comparative study. J Pediatr Gastroenterol Nutr. 1982;1:223-26. doi: 10.1097/00005176-198201020-00012.
  52. Zanetti G., Marchiori E.,GasparettoT.D., Escuissato D.L., Soares Souza A. Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients. Pediatr Radiol. 2007;37:1135-39. doi: 10.1007/s00247-007-0603-1.
  53. Van W.ering H.M., Tabbers M.M., Benninga M.A. Are constipation drugs effective and safe to be used in children? A review of the literature. Expert Opin Drug Saf. 2012;11:71-82. doi: 10.1517/14740338.2011.604631.
  54. Ford A.C., Suares N.C. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and metaanalysis. Gut. 2011;60:209-18. doi: 10.1136/gut.2010.227132.
  55. Hyman P.E., Di Lorenzo C., Prestridge L.L., et al. Lubiprostone for the treatment of functional constipation in children. J Pediatr Gastroenterol Nutr. 2014;58:283-91. doi: 10.1097/MPG.0000000000000176.
  56. Love B.L., Johnson A., Smith L.S. Linaclotide: a novel agent for chronic constipation and irritable bowel syndrome. Am J Health Syst Pharm. 2014;71:1081-91. doi: 10.2146/ajhp130575.
  57. Parker C.H., Yuan Y., Liu L.W.C. Linaclotide: a new option for the treatment of irritable bowel syndrome with constipation and chronic idiopathic constipation in adults. Clin. Med. Insights Gastroenterol. 2013;6:21-32.
  58. Diederen K.,.Mugie S.M., Benninga M.A. Efficacy and safety of prucalopride in adults and children with chronic constipation. Expert Opin Pharmacother. 2015;16:407-16.
  59. Winter H.S., Di Lorenzo C., Benninga M.A., et al. Oral prucalopride in children with functional constipation. J Pediatr Gastroenterol Nutr. 2013;57:197-203. doi: 10.1097/MPG.0b013e318292f9ea.
  60. Michaud L., Lamblin M.-D., Mairesse S., et al. Outcome of functional constipation in childhood: a 10-year follow-up study. Clin Pediatr (Phila). 2009;48:26-31.
  61. Van Ginkel R., Reitsma J.B., Büller H.A., et al. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterol. 2003;125:357-63. doi: 10.1016/S0016-5085(03)00888-6.
  62. Bongers M.E.J., van Wijk M.P., Reitsma J.B., Benninga M.A. Long-term prognosis for childhood constipation: clinical outcomes in adulthood. Pediatr. 2010;126:e156-62. doi: 10.1542/peds.2009-1009.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies