Current approaches to the treatment of functional constipation in children

Background. Among all functional gastrointestinal disorder, the most common nosological form is functional constipation (FC). In Western countries, it is estimated to be diagnosed in 2–27% of the population. The expansion of ideas about the mechanisms of the formation of FC contributes to the expansion of the possibilities of treating this condition.

Objective. Evaluation of the effectiveness of various treatment regimens for FC in children.

Methods. The study included 106 patients aged 4 to 17 years, 51 (48.1%) were boys and 55 (51 .9%) girls, who underwent outpatient treatment due to FC at the Consultative and Diagnostic Center of the Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency. Rome IV criteria were used for the diagnosis of FC. Drug treatment of FC was carried out in three groups formed in accordance with the treatment regimen: group 1 – lactulose (n=39), group 2 – functional food product (FPP) “multi-grain protein-spelled” bread (n=33), group 3 – lactulose+FPP functional “multi-grain protein-spelled” bread (n=34). Intestinal microbiocenosis in children was assessed at the beginning of treatment and on the 21st day by examining fecal samples by real-time PCR, which was performed at the Department of Molecular Microbiology, Institute of Experimental Medicine.

Results. Complete pain relief after the course of treatment was achieved in 64 children (60.4%). Depending on the chosen drug regimen, there were significant differences in the frequency of complete long-term relief of FC symptoms: in group 1 – in 21 (53.8%), in group 2 – in 19 (57.6%), in group 3 – in 24 (70, 6%). Decrease in the Lactobacillus spp. and Bifidobacterium spp. level was most typical. This indicator was lower than the reference values by 2 lg CFU/g in 22 children from group 3 (64.7.7%) and 24 children from group 2 (72.7%). It should also be noted that the use of functional bread “protein spelled many grains” contributed to the restoration of normal levels of these parameters.

Conclusion. Combination therapy of FC using functional bread “protein spelled many grains” in combination with laxatives increases the effectiveness of treatment, providing a significantly more effective restoration of microbiocenosis parameters and a reduction in the duration of clinical symptoms. The use of functional bread “protein spelled many grains” as monotherapy also had an effect on the symptoms of the disease, contributing to the normalization of the frequency of bowel movements and the reduction of symptoms associated with stool retention.