Factors Contributing to Treatment Outcome of Functional Constipation in Children

Abstract

Purpose:The aim of this study was to evaluate the clinical features and factors contributing to treatment outcome for chronic functional constipation in children. Methods: We analyzed the medical records of patients with constipation, who visited the inpatient or outpatient clinic of the Department of Pediatrics of Pusan National University Hospital, between January 1998 and December 2007. The clinical features, outcomes, and factors affecting the treatment response according to the main drug (lactulose vs. PEG 4000) were analyzed retrospectively. Results: Two hundred forty children (142 males and 98 females) were enrolled in this study. The mean age was 51.2±37.9 months. The duration of symptoms was 32.6±33.7 months. The accompanying symptoms were as follows: encopresis, 91 (30.4%); abdominal pain, 76 (31.6%); and blood-tinged stool, 37 (15.4%). The treatment response was achieved earlier in females (p＜0.001), patients with accompanying symptoms (p＜0.05), and patients treated with PEG 4000 (p=0.001). The duration of symptoms (p＜0.05) and stool frequency before treatment (p＜0.05) were related to a delayed treatment response. Relapse occurred in 7 children, all of whom were treated successfully later. Conclusion: Factors contributing to treatment response are female gender, accompanying symptoms, duration of symptoms, and stool frequency before treatment. PEG 4000 is superior to lactulose in response time and taken into consideration as a primary drug for the treatment of functional constipation of children. Early treatment and sufficient treatment time may also be important factors to achieve an early response and prevent relapse. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 36∼43)

Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics

“…In our study, parents have less considered stool withholding as a key cause for constipation than physicians, unlike western countries. A bigger roadblock to a constipation treatment seems to come from the fact that physicians as well as caretakers have several misconceptions for constipation etiology and have been dissatisfied with previous constipation managements, which leads to general reluctance to seek a professional care, to use home remedy, and not to continue with a treatment regimen (9-11, 18). Only 26% of constipated Korean students have sought a professional care for constipation (6) and similar 25% of constipated children reported using a home remedy (18).…”

“…Lactulose and PEG have been the drugs of choice for childhood constipation (18-22). The majority of physicians tried first to educate patients that drinking more water could soften hard stools, and only 19% of physicians have always offered a drug treatment (12).…”

“…The treatment duration increased for patients with a history of repeated failures (15). Early treatment and sufficient treatment time as well as follow-up should be emphasized for a successful treatment (18). In our study, the durations of treatment and follow-up varied depending on the physician.…”

National population‐based study of constipation in children in Korea, 2002–2013

“…Second, only 26% of Korean students with constipation visited the hospital for treatment, and 25% of children with constipation reported using home remedies. 15,16 These patients may have symptoms, but they may not be included in the administrative claim data. Thus, their prevalence may have been underestimated.…”

“…In this regard, reporting the prevalence of constipation using a national billing database could provide a more consistent and pragmatic assessment of the disease burden. Second, only 26% of Korean students with constipation visited the hospital for treatment, and 25% of children with constipation reported using home remedies 15,16 . These patients may have symptoms, but they may not be included in the administrative claim data.…”