Functional Constipation: Pathophysiology, evaluation, and management

Kilgore, Alexandra; Khlevner, Julie

doi:10.1111/apt.17852

Cited by 4 publications

References 71 publications

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Pediatric Functional Constipation: A New Challenge

Bashir,

Khan

2024

Advanced Gut & Microbiome Research

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Functional constipation is a common gastrointestinal disorder worldwide in children, adolescents, and adults. Functional constipation is persistent, difficult, and infrequent hard stooling with incomplete rectal emptying that does not have an identifiable cause, such as underlying illness, anatomical abnormality, or medication, and is a diagnosis of exclusion that causes psychological and physical symptoms in the individual. For early identification of functional constipation in children, a physician must exclude organic causes in children by history, physical examination, and lab studies. Multiple complex pathophysiological mechanisms have been linked to childhood constipation, in which stool‐withholding behavior is the most common factor. Toilet training along with osmotic laxative use is currently the common therapy for childhood constipation. Despite being a common condition and with novel therapies such as prosecretory agents, neuromodulation, and transanal irrigation modalities, it is challenging sometimes to manage constipation in children. This is due to a lack of knowledge among parents and children about the nature of constipation which causes poor adherence to the treatment and ultimately worsen the condition. The complaint of constipation in a child should not be ignored as early evaluation and treatment is beneficial for the child’s physical and psychological growth. More research is needed to prevent functional constipation in children. This review article highlights the factors responsible for pediatric functional constipation, its management, novel therapies, and challenges to managing this condition.

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Pediatric Functional Constipation: A New Challenge

Bashir,

Khan

2024

Advanced Gut & Microbiome Research

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Effect of Lactobacillus Reuteri in Children with Chronic Functional Constipation: A Double-Blind Randomized Clinical Trial

Pourrostami,

Mohammadi,

Forgani

et al. 2024

Preprint

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This double-blind, randomized clinical trial investigated the efficacy of Lactobacillus reuteri in treating chronic functional constipation in children aged 2 to 14 years. Constipation, affecting up to 25% of the pediatric population, is often functional in nature and challenging to manage with standard treatments such as laxatives and dietary modifications. Given the emerging interest in probiotics, this study aimed to evaluate the potential of Lactobacillus reuteri as a complementary treatment alongside polyethylene glycol (PEG). Eighty children diagnosed with chronic functional constipation were randomly assigned to receive either Lactobacillus reuteri DSM 17938 or a placebo, in combination with PEG. Participants were monitored over 7 weeks, with assessments conducted on bowel movement frequency, stool consistency, straining during defecation, abdominal pain, and fecal incontinence. Results demonstrated that the probiotic group experienced significant improvements in bowel movement frequency (mean increase of 2.4 ± 1.1 per week) compared to the placebo group (1.2 ± 0.9; p < 0.001). Secondary outcomes, including stool consistency, straining, and abdominal pain, as well showed notable improvements in the probiotic group. Additionally, fecal incontinence episodes decreased more in the probiotic group than in the placebo group (p = 0.008), with fewer adverse events reported. In conclusion, Lactobacillus reuteri combined with PEG significantly improved constipation symptoms, offering a safe and effective adjunctive therapy for children with chronic functional constipation. These findings suggest that incorporating probiotics into conventional treatment protocols may enhance clinical outcomes and improve the quality of life for pediatric patients.

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Global research trajectories in gut microbiota and functional constipation: a bibliometric and visualization study

Ong,

Xu,

Ang

et al. 2024

Front. Microbiol.

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BackgroundFunctional constipation (FC) negatively impacts quality of life and is associated with gut microbiota (GM) imbalances. Despite the growing interest in this area, a thorough analysis of research trends is missing. This study uses bibliometric methods to assess the global research on GM’s role in FC, pinpointing key topics, impactful studies, and prominent researchers to guide future research and identify gaps.MethodsIn our study, we conducted a performance analysis and science mapping using bibliometric indicators such as publication trends, author and institutional contributions, productivity, impact, keyword analysis, and collaboration networks. We employed software tools like VOSviewer, Biblioshiny, CiteSpace, and SCImago Graphica to automate the assessment of metrics including country, institutional, and journal distribution, authorship, keyword frequency, and citation patterns.ResultsFrom 2013 to 2024, annual publications on GM and FC rose from 29 to 252, with a slight decrease to 192 in 2024. Average citations per publication peaked at 11.12 in 2021, declining to 6.43 by 2024. China led in research output (37.8%), followed by the United States (14.4%) and Japan (7.5%). Bibliometric analysis identified key authors like CHEN W and ZHANG H, with 30 and 27 articles, respectively. Jiangnan University and Harvard University were top contributors, with 131 and 81 articles. Keywords analysis revealed “constipation,” “gut microbiota,” and “probiotic” as central themes, with a shift toward “gut microbiota” and “intestinal flora” in recent years. This study provides a comprehensive overview of the research landscape, highlighting leading authors, institutions, and evolving research priorities in the field.ConclusionOur review synthesizes current GM and FC research, guiding future studies. It suggests exploring GM in various GI disorders, the impact of lifestyle and drugs on GM, advanced research techniques, and probiotics/prebiotics for FC. There’s also a focus on therapies targeting GM’s effect on the gut-brain axis, paving the way for improved FC management.

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Functional Constipation: Pathophysiology, evaluation, and management

Cited by 4 publications

References 71 publications

Pediatric Functional Constipation: A New Challenge

Pediatric Functional Constipation: A New Challenge

Effect of Lactobacillus Reuteri in Children with Chronic Functional Constipation: A Double-Blind Randomized Clinical Trial

Global research trajectories in gut microbiota and functional constipation: a bibliometric and visualization study

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