An Update of Pharmacological Management in Children with Functional Constipation

Geus, Anna de; Koppen, Ilan J.N.; Flint, Robert B.; Benninga, Marc A.; Tabbers, Merit M.

doi:10.1007/s40272-023-00563-0

Cited by 19 publications

(6 citation statements)

References 123 publications

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“…Therefore, it is imperative to recognize that an educational program must educate medical primary care clinicians about effective treatment options according to published procedures and avoid the consequences of poorly treated constipation. [22][23][24][25] A distinguishing study reported painful defecation and hard stools in 43 and 92% of infants and young children, respectively. 26 Indeed, a history of painful or hard bowel movements may encourage the child to retain their stools to avoid this unpleasant experience.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2023

JPNC

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Purpose: To assess and compares sociodemographic, clinical, anthropometric, and treatment characteristics in two subgroups of children with FC: 1) with onset in the first 12 months old and 2) with onset after 13 months old.Methods: Observational, retrospective cohort study, including consecutive cases of children/adolescents for initial evaluation of constipation. Data were collected in a predesigned standard protocol, and the parents answered all the questions during the first visit. Inclusion criteria: age between 01 month to 15 years of age, with a diagnosis of FC defined according to the Rome Criteria III and Rome IV criteria. Exclusion criteria: constipation of organic etiology; other chronic health problems such as neurological, genetic, mental/ psychiatric disorders or growth and development disorders. The stool form was evaluated according to Bristol Stool Form Scale. Two experienced pediatric gastroenterologists determined the patients' final diagnoses of FC. Approval was obtained from the ethics committee.Results: Five hundred and four children were identified with constipation at their initial visit. Thirty-two were excluded based on the inclusion and exclusion criteria. The remaining 472 children (225 with onset within the first 12 months and 247 after 13 months) were included. There was a long time to first visit in those with onset in the first 12 months of life. There is no difference in BMI/age scores between the two groups. FC onset in the first 12 months has more scybalous stools, painful defecation, bloody stools, a lower proportion with bowel toilet training, and bladder control. In FC starting in the first 12 months of life, only half of the children (55%) were treated with laxatives, and an entire group used rectal treatment. Conclusion:FC is a common Functional Gastrointestinal Disorder affecting infants during the first months of life. The primary inadequate treatment and referral delay implies worsening symptoms, chronicity, and non-implementing North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines.

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Section: Discussionmentioning

confidence: 99%

Untitled

2023

JPNC

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“…PEG 3350 and PEG 4000 are effective in childhood constipation without differences in efficacy between both treatments [ 67 ]. However, the addition of electrolytes has been demonstrated to deteriorate the taste and palatability of PEG with consequent poor adherence to the treatment [ 68 , 69 ]. With regards to safety, as reported in a randomized double-blind multicenter study, children aged from 6 months to 16 years did not present any difference in the long-term use of PEG 3350 with electrolytes compared to PEG 4000 without electrolytes [ 70 ].…”

Section: What Pharmacological Treatments Are Recommended For Disimpac...mentioning

confidence: 99%

“…However, even if the constipation lasts more than a year, maintenance therapy needs to be continued without any risk for the child [ 22 , 62 , 84 ]. Taking into account that a considerable proportion of children will need long-term PEG treatment in order to maintain clinical remission, the taste and palatability of orally administered drugs should be carefully evaluated to improve the adherence [ 69 ].…”

Section: How Long the Maintenance Therapy Should Be Continued?mentioning

confidence: 99%

The ten “hard” questions in pediatric functional constipation

Fedele,

Fioretti,

Scarpato

et al. 2024

Ital J Pediatr

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Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the “so-called” chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. In case of alarm signs and symptoms that may suggest organic diseases, further investigations can be required. The therapeutic management is based on non-pharmacological and pharmacological approaches. Education, demystification of constipation and reward-based toilet training represent the cornerstones of nonpharmacological management. Disimpaction, maintenance treatment and weaning of medication are all elements of pharmacological treatment. Osmotic laxatives, mainly polyethylene glycol (PEG), are considered the first-choice laxative for both disimpaction and maintenance treatment. The aim of this review is to provide pediatric gastroenterologists with a practical tool to support the clinical and therapeutic management of children and adolescents affected by chronic functional constipation.

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“…Current treatment for childhood FC includes rectal or oral disimpaction and maintenance therapy 3,7 with over‐the‐counter or pharmacologic treatments. Until recently, there were no approved therapies to treat FC in children in the United States or European Union, and the current treatment of choice, polyethylene glycol, is used off label 8,9 …”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of linaclotide in children aged 6−17 years with functional constipation

Di Lorenzo,

Nurko,

Hyams

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesLinaclotide, a guanylate cyclase‐C agonist, was recently approved in the United States for treatment of children 6−17 years old with functional constipation (FC). This study evaluated the safety and efficacy of several linaclotide doses in children 6−17 years old with FC.MethodsIn this multicenter, randomized, double‐blind, placebo‐controlled phase 2 study, 173 children with FC (based on Rome III criteria) were randomized to once‐daily linaclotide (A: 9 or 18 μg, B: 18 or 36 μg, or C: 36 or 72 μg) or placebo in a 1:1:1:1 ratio for 6‐ to 11‐year‐olds (dosage determined by weight: 18 to <35 or ≥35 kg) and linaclotide (18, 36, 72, or 145 μg) or placebo in a 1:1:1:1:1 ratio for 12‐ to 17‐year‐olds. The primary efficacy endpoint was change from baseline in weekly spontaneous bowel movement (SBM) frequency throughout the 4‐week treatment period. Adverse events (AE), clinical laboratory values, and electrocardiograms were monitored.ResultsEfficacy and safety were assessed in 173 patients (52.0% aged 6−11 years; 48.0% aged 12−17 years); 162 (93.6%) completed the treatment period. A numerical improvement in mean SBM frequency was observed with increasing linaclotide doses (1.90 in 6‐ to 11‐year‐olds [36 or 72 μg] and 2.86 in 12‐ to 17‐year‐olds [72 μg]). The most reported treatment‐emergent AE was diarrhea, with most cases being mild; none were severe.ConclusionsLinaclotide was well tolerated in this pediatric population, with a trend toward efficacy in the higher doses, warranting further evaluation.

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An Update of Pharmacological Management in Children with Functional Constipation

Cited by 19 publications

References 123 publications

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The ten “hard” questions in pediatric functional constipation

Randomized controlled trial of linaclotide in children aged 6−17 years with functional constipation

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