Evaluation and Treatment of Functional Constipation in Infants and Children

Tabbers, Merit M.; DiLorenzo, Carlo; Berger, Marjolein Y.; Fauré, Christophe; Langendam, Miranda; Nurko, Samuel; Staiano, Annamaria; Vandenplas, Yvan; Benninga, Marc A.

doi:10.1097/mpg.0000000000000266

Cited by 926 publications

(1,275 citation statements)

References 107 publications

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“…This is also the final conclusion of the guidelines proposed by ESPGHAN and NASPGHAN, suggesting that the diagnosis is primarily clinical and that complementary tests are not necessary to confirm the disease 7. Nevertheless, 40.4% of the respondents deemed necessary to request additional tests.…”

Section: Discussionmentioning

confidence: 68%

“…, 7 - 9 In the aforementioned clinical case, symptom duration was not stated (if>2 months), a factor that can be considered a study limitation. The ESPGHAN and NASPGHAN guidelines recommend that the Rome III criteria be used to define the presence of constipation, except for symptom duration, considering that the two-month interval recommended for older children can contribute to treatment delay 7…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, this is one of the main tests used to rule out the most important differential diagnosis for functional constipation in children, Hirschsprung's disease 1516 However, this test is not required for the final diagnosis, unless the child has suggestive signs, such as an early onset of constipation, delayed passage of meconium and significant abdominal distension 715 …”

Section: Discussionmentioning

confidence: 99%

“…This test also aims to rule out Hirschsprung's disease by disclosing alterations in the anorectal inhibitory reflex 1720 However, it is noteworthy that the examination is not essential for the diagnosis, especially in children after the neonatal period 7. As with the barium enema, ARM should only be performed if there are data suggestive of Hirschsprung's disease and in severe cases refractory to adequate treatment 7…”

Section: Discussionmentioning

confidence: 99%

“…Among the drugs used to treat constipation, polyethylene glycol (PEG) is the most effective when compared to lactulose, magnesium hydroxide, mineral oil or placebo 7. PEG is a compound of high molecular weight, poorly absorbed by the body and not metabolized by intestinal bacteria 17…”

Section: Discussionmentioning

confidence: 99%

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Pediatrician's knowledge on the approach of functional constipation

Vieira

Negrelle

Webber

et al. 2016

Revista Paulista de Pediatria (English Edition)

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Objective:To evaluate the pediatrician's knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation.Methods:A descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013.Results:The majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated.Conclusions:Our results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Pediatrician's knowledge on the approach of functional constipation

Vieira

Negrelle

Webber

et al. 2016

Revista Paulista de Pediatria (English Edition)

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Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada

et al. 2019

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IMPORTANCE Diagnostic imaging overuse in children evaluated in emergency departments (EDs) is a potential target for reducing low-value care. Variation in practice patterns across Canada and the United States stemming from organization of care, payment structures, and medicolegal environments may lead to differences in imaging overuse between countries. OBJECTIVE To compare overall and low-value use of diagnostic imaging across pediatric ED visits in Ontario, Canada, and the United States. DESIGN, SETTING, AND PARTICIPANTS This study used administrative health databases from 4 pediatric EDs in Ontario and 26 in the United States in calendar years 2006 through 2016. Individuals 18 years and younger who were discharged from the ED, including after visits for diagnoses in which imaging is not routinely recommended (eg, asthma, bronchiolitis, abdominal pain, constipation, concussion, febrile convulsion, seizure, and headache) were included. Data analysis occurred from April 2018 to October 2018. EXPOSURES Diagnostic imaging use. MAIN OUTCOME AND MEASURES Overall and condition-specific low-value imaging use. Three-day and 7-day rates of hospital admission and those admissions resulting in intensive care, surgery, or in-hospital mortality were assessed as balancing measures. RESULTS A total of 1 783 752 visits in Ontario and 21 807 332 visits in the United States were analyzed. Compared with visits in the United States, those in Canada had lower overall use of head computed tomography (Canada, 22 942 [1.3%] vs the United States, 753 270 [3.5%]; P < .001), abdomen computed tomography (5626 [0.3%] vs 211 018 [1.0%]; P < .001), chest radiographic imaging (208 843 [11.7%] vs 3 408 540 [15.6%]; P < .001), and abdominal radiographic imaging (77 147 [4.3%] vs 3 607 141 [16.5%]; P < .001). Low-value imaging use was lower in Canada than the United States for multiple indications, including abdominal radiographic images for constipation (absolute difference, 23.7% [95% CI, 23.2%-24.3%])and abdominal pain (20.6% [95% CI, 20.3%-21.0%]) and head computed tomographic scans for concussion (22.9% [95% CI, 22.3%-23.4%]). Abdominal computed tomographic use for constipation and abdominal pain, although low overall, were approximately 10-fold higher in the United States (0.1% [95% CI, 0.1%-0.2%] vs 1.2% [95% CI, 1.2%-1.2%]) and abdominal pain (0.8% [95% CI, 0.7%-0.9%] vs 7.0% [95% CI, 6.9%-7.1%]). Rates of 3-day and 7-day post-ED adverse outcomes were similar. CONCLUSIONS AND RELEVANCELow-value imaging rates were lower in pediatric EDs in Ontario compared with the United States, particularly those involving ionizing radiation. Lower use of imaging in Canada was not associated with higher rates of adverse outcomes, suggesting that usage may be safely reduced in the United States.

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