Çocukluk Çağında Fonksiyonel Kabızlık Tedavisi: Senna, Trimebutin ve Laktülozun Karşılaştırılması

Abstract

Objective: Data for the drugs used in maintenance therapy of functional constipation is limited in childhood. We aimed to evaluate the efficacy of senna, trimebutine, and lactulose in children with functional constipation (FC) or functional fecal incontinence (FFI).Material and Methods: Patients (2-18 years old) diagnosed as FC or FFI according to Rome III criteria who were treated with lactulose (n=36), senna (n=29), and trimebutine (n=33)were included. Patients completed a 0-5 Likert scale questionnaire about their symptoms. Stool consistency was evaluated by the Bristol Stool Chart. Compliance and tolerance to treatment and side effects were recorded. Clinical improvement and pharmacoeconomic evaluation were performed.Results: Clinical improvement in the senna group was significantly higher (p=0.036). Senna showed the highest improvement in stool consistency (p<0.001) and decreased fecal incontinence (p=0.039). Abdominal distention, abdominal pain, nausea/vomiting, and anal fissure were improved by trimebutine (p<0.05). Both senna and trimebutine decreased painful defecation and stool withholding. Lactulose improved anorexia and anal fissure. Senna was the most cost-effective drug. Conclusion:Treatment options for constipation should be tailored according to the predominant symptom. Lactulose may be recommended as the initial treatment for children with anorexia or anal fissure, trimebutine for abdominal distention, abdominal pain, nausea/vomiting, or anal fissure, respectively. Senna may be prescribed for the cost-effectiveness with high clinical improvement and less unpleasant taste.