Controversies in the Management of Functional Constipation in Children

Mill, M. J. van; Koppen, Ilan J.N.; Benninga, Marc A.

doi:10.1007/s11894-019-0690-9

Cited by 50 publications

(42 citation statements)

References 72 publications

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“…Toilet-trained children were significantly more likely to meet diagnostic criteria for FC than non-toilet-trained children, 41.9% vs 9.3%, respectively (OR 7.06, 95% CI 5.26-9.47, P < .0001). Children that were toilet-trained were also more likely to report 3…”

Section: Functional Constipation and Toilet Trainingmentioning

confidence: 99%

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The impact of incorporating toilet‐training status in the pediatric Rome IV criteria for functional constipation in infant and toddlers

Saps

Velasco-Benítez

Valdés

et al. 2020

Neurogastroenterology Motil

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Background The diagnosis of functional constipation (FC) is based on the Rome criteria. The last edition of the criteria (Rome IV) for infants and toddlers modified the criteria to differentiate toilet‐trained (TT) and non‐toilet‐trained (NTT) children. These changes have not been validated. We aimed to understand the impact of adding toilet training to the diagnostic criteria and to assess the prevalence of FC. Methods Parents of infants and toddlers from six outpatient clinics (four public, two private) located in three geographically dispersed cities in Colombia completed validated questionnaires to diagnose functional gastrointestinal disorders according to Spanish version of Rome IV criteria (QPGS‐IV). Results A total of 1334 children (24.4 months ±15.0) participated: 482 (36%) TT and 852 (64%) NTT. The prevalence of FC was 21.1%. The prevalence increased with age, 0‐1 years 7.7%; 2 years 18.2%; 3 years 23.7%; and 4 years 37.2%. TT vs NTT for FC 41.9% vs 9.3%, respectively (OR 7.06, 95% CI 5.26‐9.47, P < .0001). TT more likely to report ≥ 3 criteria (OR = 2.43, 95% CI 1.41‐4.21, P = .0015). 18.3% of TT had episodes of fecal incontinence that met the frequency required by Rome for FC (≤1 episode/week). However, 87.1% had fecal incontinence less often. 7.4% of them characterized as large quantity. Conclusion We found no changes in the prevalence of FC using the Rome IV criteria vs Rome III. TT children are more likely to have FC. Study suggests that changes in Rome IV criteria were potentially clinically relevant and to have adequate face validity. Future studies should confirm our findings.

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Section: Functional Constipation and Toilet Trainingmentioning

confidence: 99%

“…to be efficacious in childhood. 3,4 Studies have shown that delayed treatment worsens the outcome. 5 Most children develop constipation as infant or toddlers.…”

mentioning

confidence: 99%

The impact of incorporating toilet‐training status in the pediatric Rome IV criteria for functional constipation in infant and toddlers

Saps

Velasco-Benítez

Valdés

et al. 2020

Neurogastroenterology Motil

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“…The other three patients who were older children or in early adulthood had no significant abdominal signs, and their gastrointestinal presentation was only difficulty with defecation. With constipation as a gastrointestinal presentation in older children, more than 90% of the cases are functional in nature [5], and it is uncommon to associate constipation with intractable anemia. Thus, a diagnosis of HD can be missed.…”

Section: Discussionmentioning

confidence: 99%

Hirschsprung’s disease presenting as intractable anemia: a report of two cases and review of the literature

Sun

Chu

et al. 2020

BMC Pediatr

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Background This report summarizes the clinical characteristics of intractable anemia as part of the clinical presentation of Hirschsprung’s disease (HD) and aims to strengthen clinicians’ ability to recognize early signs of HD. Case presentation An 11-year-old boy with a 6-year history of intractable anemia, low hemoglobin level (55 g/L), poor response to oral iron supplementation and blood transfusion, and difficulty with defecation was diagnosed with HD. A 19-month-old boy with a 3-month history of intractable anemia, low hemoglobin level (64 g/L), poor response to oral iron supplementation and blood transfusion, delayed meconium passage, and history of intestinal obstruction was also diagnosed with HD. Both patients underwent surgery, after which anemia was corrected effectively in both cases. Two more cases of intractable anemia as the chief complaint and diagnoses of HD over different durations since the onset of anemia (ranging from 1.7 years to 21 years) were identified in a literature search. Both patients underwent surgery, after which anemia was corrected. Conclusions Intractable anemia as part of the clinical presentation of HD is extremely rare. Detailed inquiries of medical histories and physical examinations are key to early diagnoses and preventing misdiagnoses. Anemia in HD patients may primarily be caused by impaired iron absorption due to HD.

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“…Bowel disorders treated with SNS/SNM include sphincter disruption, evacuation difficulty, neurogenic bowel dysfunction, irritable bowel syndrome (IBS), and constipation (13,43). Three systematic reviews (29,31,34), five reviews (33,(43)(44)(45)(46) (Table 4A) and seven studies (47)(48)(49)(50)(51)(52)(53) (Table 4B) conclude the evidence is limited, and that SNS is not effective for constipation. There may be some value in children (50), but more studies are required (36).…”

Section: Sns/snm and Constipationmentioning

confidence: 99%

Electro-Neuromodulation for Colonic Disorders—Review of Meta-Analyses, Systematic Reviews, and RCTs

Southwell

2020

Neuromodulation: Technology at the Neural Interface

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Background: In the last 20 years, studies have shown that large bowel function can be modified by neural stimulation. While still in its infancy, this area of research is beginning to show promise. Methods: This overview brings together systematic reviews and meta-analyses of electrical stimulation used to treat colonic disorders (fecal incontinence, constipation, slow transit constipation [STC], irritable bowel syndrome [IBS-C], and spina bifidaneurogenic bowel). Different methods of electrical stimulation including through sacral nerves, paraspinal, transabdominal, and using electroacupuncture over the ankle or knee and direct stimulation of the bowel are reviewed. Results and Discussion: Most evidence is low level (pilot and small cohort studies) but with more RCTs appearing. Sacral nerve stimulation (SNS) does improve urinary dysfunction and fecal incontinence but not constipation. It is expensive with high rates of reoperation. Transcutaneous stimulation with interferential current (IFC, alternating current at KHz frequency with 2 channels out of phase) does improve constipation and may provide benefit as an adjuvant to behavioral or exercise therapies. Acupuncture and electro-acupuncture (low/very low-level evidence) may have a benefit for constipation. Conclusion: SNS is effective but expensive and limited to extreme patients. Transcutaneous stimulation is noninvasive and cheap and IFC may be effective for constipation, but many parameters need to be optimized and higher level evidence provided from studies (sham, blinding, and larger patient numbers). The next 20 years should be exciting in the field as higher level studies are performed.

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Controversies in the Management of Functional Constipation in Children

Cited by 50 publications

References 72 publications

The impact of incorporating toilet‐training status in the pediatric Rome IV criteria for functional constipation in infant and toddlers

The impact of incorporating toilet‐training status in the pediatric Rome IV criteria for functional constipation in infant and toddlers

Hirschsprung’s disease presenting as intractable anemia: a report of two cases and review of the literature

Electro-Neuromodulation for Colonic Disorders—Review of Meta-Analyses, Systematic Reviews, and RCTs

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