Pediatr Gastroenterol Hepatol Nutr.  2018 Apr;21(2):101-110. 10.5223/pghn.2018.21.2.101.

Laxative Choice and Treatment Outcomes in Childhood Constipation: Clinical Data in a Longitudinal Retrospective Study

• Chanpong A
• Osatakul S

• KMID: 2409361
• DOI: http://doi.org/10.5223/pghn.2018.21.2.101

Abstract

PURPOSE
Functional constipation (FC) is a common gastrointestinal (GI) problem affecting children's well-being and quality of life. Although polyethylene glycol (PEG) is recommended as the first line therapy, it is not always applicable in lower socioeconomic populations. Hence, this study aimed to compare clinical courses of FC in children treated with different medications in order to identify prognostic factors related to treatment outcomes.
METHODS
We reviewed the medical records of patients aged ≤15 years diagnosed with FC according to the Rome IV criteria from 2007 to 2015 at the GI clinic, Songklanagarind Hospital. Baseline characteristic, medical history, and treatment outcomes were collected at first and subsequent visits.
RESULTS
Exactly 104 patients (median age at diagnosis, 2.8 years) were diagnosed with FC. The number of follow-up visits per patient ranged from 1 to 35. The median duration of follow-up was 18.0 months (range, 6.0-84.2 months). PEG was given to 21% of patients. During the follow up period, 76% of patients experienced first recovery with a median time to recovery of 9.8 months. There were no significant differences in time until first recovery and relapse between patients who received and those who did not receive PEG (p=0.99 and 0.06, respectively). Age >6 years, normal defecation frequency, no history of cow's milk protein allergy, and use of laxatives were associated with successful outcomes.
CONCLUSION
Treatment outcomes between patients who had and never had PEG demonstrated no significant difference in our study. Hence, current practices in laxative prescriptive patterns may be effective.

Keyword

Constipation; Laxatives; Prognostic factors; Recurrence; Treatment outcome

MeSH Terms

Child
Constipation*
Defecation
Diagnosis
Follow-Up Studies
Humans
Hypersensitivity
Laxatives
Medical Records
Milk Proteins
Polyethylene Glycols
Quality of Life
Recurrence
Retrospective Studies*
Treatment Outcome
Laxatives
Milk Proteins
Polyethylene Glycols

Figure

• 

  Fig. 1 Kaplan-Meier plots of the cumulative probability of having at least one period of recovery showing median time until first recovery of 9.8 months. Dotted lines represent 95% confidence intervals.

• 

  Fig. 2 Kaplan-Meier plots of the cumulative probability of achieving first recovery (A) showing no significant difference between children who received and did not receive polyethylene glycol (PEG, p=0.99) and the cumulative probability of relapse (B) which was not significantly different between children who received and did not receive polyethylene glycol.

• 

  Fig. 3 Kaplan-Meier plots of the cumulative probability of relapse after first recovery from constipation showing a median duration of 24 months. Dotted lines represent 95% confidence intervals.

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