J Neurogastroenterol Motil.  2022 Jul;28(3):454-462. 10.5056/jnm21130.

Saccharomyces boulardii and Lactulose for Childhood Functional Constipation: A Multicenter Randomized Controlled Trial

  • 1Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea.
  • 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea (Current address).
  • 3Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
  • 4Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Gyeonggi-do, Korea.
  • 5Department of Pediatrics, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
  • 6Department of Pediatrics, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
  • 7Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
  • 8Department of Pediatrics, Haeundaepaik Hospital, Inje University College of Medicine, Busan, Korea.
  • 9Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea.
  • 10Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.
  • 11Department of Pediatrics, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 12Department of Pediatrics, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea.


The effects of probiotics in children vary based on diseases and probiotic strains. We aim to investigate the effectiveness of Saccharomyces boulardii and lactulose for treating childhood functional constipation.
This open-label randomized controlled trial was conducted at 10 university hospitals in Korea. Children who were diagnosed with functional constipation were allocated to 3 groups (lactulose monotherapy, combination therapy, and S. boulardii monotherapy). The primary outcome was treatment success rate that was accordingly defined as ≥ 3 bowel movements without incontinence at week 12. The cumulative successful maintenance and drug maintenance rates without drug changes were calculated throughout the study period. We compared stool frequency, incontinence, consistency, and painful defecation at week 2 among the 3 groups.
Overall, 187 children were assigned to the lactulose monotherapy (n = 69), combination therapy (n = 68), or S. boulardii monotherapy (n = 50) groups. The primary outcome was significantly higher in the lactulose monotherapy group (26.1%) or combination therapy group (41.2%) than in the S. boulardii monotherapy group (8.0%). The S. boulardii monotherapy group showed a significantly lower cumulative successful maintenance and drug maintenance rate than the other 2 groups. There were no significant intergroup differences in the frequency of defecation, incontinence, painful defecation, or stool consistency during the follow-up at week 2.
S. boulardii monotherapy was not superior to lactulose monotherapy or combination therapy and showed a higher drug change rate, supporting the current recommendation of probiotics in the treatment of childhood functional constipation.


Constipation; Microbiota; Pediatrics; Probiotics
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