Factors relating to hospitalisation and economic burden of paediatric constipation in the state of <scp>V</scp>ictoria, <scp>A</scp>ustralia, 2002–2009

Ansari, Humaira; Ansari, Zahid; Lim, Teo; Hutson, John M.; Southwell, Bridget R.

doi:10.1111/jpc.12675

Cited by 26 publications

(19 citation statements)

References 42 publications

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“…The cost of paediatric constipation and soiling places a heavy financial burden on the health-care system, costing close to A $5.5million each year. 16 By identifying areas for improvement and streamlining the referral and triage process, we may be able to reduce the financial burden on the paediatric health-care system. A redesign of these pathways could also increase timely management, ensuring that there is a reduced risk of relapse in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Recent internal data from The Royal Children's Hospital (RCH) in Melbourne demonstrated that the median wait time across three specialities (general medicine, encopresis and gastroenterology) for all patient conditions was 2.1 months (range 0–23 months) . Such prolonged wait times are not ideal, particularly for this cohort that is not prioritised as ‘urgent’ and is at risk of impaction and emergency department presentations if constipation is left untreated …”

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confidence: 99%

“…15 Such prolonged wait times are not ideal, particularly for this cohort that is not prioritised as 'urgent' and is at risk of impaction and emergency department presentations if constipation is left untreated. 16 Despite the prevalence of constipation and faecal incontinence, very little is known about referral wait times and triage within Australian tertiary paediatric centres. This study aimed to investigate referral and triage pathways for children with bowel dysfunction referred to specialist clinics at RCH, Melbourne.…”

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confidence: 99%

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Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

Trajanovska

Liew

Gibb

et al. 2019

J Paediatrics Child Health

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Aim This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). Methods We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. Results Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12‐month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). Conclusion Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community‐based primary care, need to be explored to improve timely management.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

Trajanovska

Liew

Gibb

et al. 2019

J Paediatrics Child Health

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“…Constipation is common, affecting 5–30% of children, and accounts for up to 25% of referrals to gastroenterologists . The management of pediatric constipation in hospitals poses a significant financial burden for the health‐care system, so effective treatment options are needed. The World Gastroenterological Association defines constipation as “a disorder characterized by persistent difficulty or seemingly incomplete defecation and/or infrequent bowel movements (once every 3‐4 days, or less) in the absence of alarm symptoms or secondary causes.” The majority of the cases of constipation in children are functional constipation (without an underlying organic etiology) .…”

Section: Introductionmentioning

confidence: 99%

Dietary exclusion of fructose and lactose after positive breath tests improved rapid‐transit constipation in children

et al. 2018

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Declaration of conflict of interest: JH is the treating physician for the patients, and the questionnaire was sent to parents to assess the outcomes of treatment. The questionnaire was filled in online and was not anonymous. Data were deidentified for this study. KW and BS had no relationship to patients and analyzed deidentified data. Less than half of the patients returned questionnaires. Author contribution: KW collated and analyzed the data and wrote the first draft. CL, VP, and JW created the 'Google Poll' questionnaire and data collection link and collected data into an Excel file. JH cosupervised KW. He was the treating physician, organized the transit studies and breath tests and interpreted the results, advised the parents on what to exclude from their child's diet, and suggested they contact dietitians/nutritionists for support. He designed the questionnaire; organized the format with CL, VP, and JW; and sent the questionnaires out to patients. He designed the study and edited drafts. BS supervised KW, supervised data collection and analysis, supervised writing the first draft, and edited drafts. BS had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the analysis. AbstractAims: Exclusion of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is effective in alleviating symptoms of irritable bowel syndrome (IBS) in adults. Rapid-transit constipation (RTC) is a recently discovered subset of chronic constipation and has been linked to food intolerance. The aim of this study was to audit the effect of specific FODMAP elimination diets in children with RTC. Methods: This was an audit of children presenting to a tertiary children's hospital surgeon with refractory chronic constipation who had rapid transit in the proximal colon on nuclear imaging; had hydrogen/methane breath tests for fructose, lactose, and/or sorbitol intolerance; and were advised to exclude positive sugar under clinical supervision. Patients filled in a questionnaire rating severity of constipation, abdominal pain, and pain on defecation with a visual analogue scale (VAS, 0 = none, 10 = high) and stool consistency for 6 months before and after dietary exclusion. Results: In responses from 29 children (5-15 years, 21 males), 70% eliminated fructose, and 40% eliminated lactose. There was a significant reduction in the severity of constipation (VAS mean AE SEM, pre 5.8 AE 0.5 vs post 3.3 AE 0.6, P < 0.0001), abdominal pain (5.1 AE 0.6 vs 2.8 AE 0.5, P = 0.0004), pain on defecation (5.8 AE 0.6 vs 2.6 AE 0.5, P < 0.0001), and increase in stool wetness (Bristol Stool Scale pre 3.3 AE 0.3 vs post 3.9 AE 0.2, P = 0.004). Conclusion: Children with RTC showed significant improvements in constipation and pain after excluding the sugar indicated by positive breath tests, suggesting that specific sugar-exclusion diets may have a role in the management of RTC in children.

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“…Furthermore, healthcare costs for children with constipation are higher than those for control subjects, mostly because of ambulatory care costs and, to a lesser degree, costs related to hospitalizations and emergency room visits [ 11 ]. Estimations of the economic burden caused by childhood FC vary between studies [ 12 , 13 ]. In the USA, the total additional costs for childhood constipation have been estimated to be US$3.9 billion per year [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Management of Functional Constipation in Children: Therapy in Practice

et al. 2015

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Functional constipation is a common healthcare problem among children worldwide and accounts for high healthcare usage and costs. Functional constipation is a clinical diagnosis; the evaluation primarily consists of a thorough medical history and a complete physical examination. Additional investigations are not necessary in most cases. Treatment consists of non-pharmacological and pharmacological interventions. Non-pharmacological interventions involve education and demystification, toilet training (with a reward system), and a defecation diary. Pharmacological treatment comprises three steps: disimpaction, maintenance treatment, and weaning. The treatment of first choice is oral laxatives, preferably polyethylene glycol. When this is insufficient, other therapeutic agents are available. This review discusses the evaluation and management of functional constipation in the pediatric population and provides a summary of drug treatment options.

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Factors relating to hospitalisation and economic burden of paediatric constipation in the state of Victoria, Australia, 2002–2009

Cited by 26 publications

References 42 publications

Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

Dietary exclusion of fructose and lactose after positive breath tests improved rapid‐transit constipation in children

Management of Functional Constipation in Children: Therapy in Practice

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