Clinical Features of Severely Constipated Children: Comparison of Infrequent Bowel Movement and Fecal Soiling Groups
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Purpose: To compare the clinical features, diagnostic findings, and medications of children with infrequent bowel movements or fecal soiling. Methods: This study enrolled 333 children (189 male; age range, 1 month to 18 years) diagnosed with functional constipation by Rome III or IV criteria. We classified them into 3 groups (infrequent bowel movement without fecal soiling [G3-a], infrequent bowel movement with fecal soiling [G3-b], and fecal soiling only [G3-c]) and into 2 subgroups of fecal soiling (G2-b) or not (G2-a). Retrospective data on clinical characteristics, colon transit time (CTT) test results, and medications were collected. The Wilcoxon rank-sum test, Kruskal-Wallis test, Chi-square test, and Fisher's exact test were used for the statistical analysis. Results: The median age (months) and interquartile range (IQR) was 33 (45) in G3-a, 54 (40) in G3-b, and 73 (48) in G3-c (p<0.0001). G3-c had the latest onset (median, 18; IQR, 18; p=0.0219) and longest symptom duration (24 [24], p=0.0148). PEG 4000 was used in 60.6% (G3-a), 96.8% (G3-b), and 83.2% (G3-c) of patients (p<0.0001). The median age (months) and IQR were 33.0 (45.0) in G2-a and 63.5 (52.5) in G2-b (p<0.0001). G2-b had later onset (median, 12; IQR, 19.5; p=0.0062) and longer symptom duration than G2-a (24 [12], p=0.0070). PEG 4000 was used in 60.6% (G2-a) and 88.3% (G2-b) of children (p<0.0001). No statistically significant intergroup differences were seen in maintenance laxative dose, CTT, or CTT type. Conclusion: Infrequent bowel movement and fecal soiling represent the advanced stage of chronic functional constipation.
Abstract
Purpose: To compare the clinical features, diagnostic findings, and medications of children with infrequent bowel movements or fecal soiling. Methods: This study enrolled 333 children (189 male; age range, 1 month to 18 years) diagnosed with functional constipation by Rome III or IV criteria. We classified them into 3 groups (infrequent bowel movement without fecal soiling [G3-a], infrequent bowel movement with fecal soiling [G3-b], and fecal soiling only [G3-c]) and into 2 subgroups of fecal soiling (G2-b) or not (G2-a). Retrospective data on clinical characteristics, colon transit time (CTT) test results, and medications were collected. The Wilcoxon rank-sum test, Kruskal-Wallis test, Chi-square test, and Fisher's exact test were used for the statistical analysis. Results: The median age (months) and interquartile range (IQR) was 33 (45) in G3-a, 54 (40) in G3-b, and 73 (48) in G3-c (p<0.0001). G3-c had the latest onset (median, 18; IQR, 18; p=0.0219) and longest symptom duration (24 [24], p=0.0148). PEG 4000 was used in 60.6% (G3-a), 96.8% (G3-b), and 83.2% (G3-c) of patients (p<0.0001). The median age (months) and IQR were 33.0 (45.0) in G2-a and 63.5 (52.5) in G2-b (p<0.0001). G2-b had later onset (median, 12; IQR, 19.5; p=0.0062) and longer symptom duration than G2-a (24 [12], p=0.0070). PEG 4000 was used in 60.6% (G2-a) and 88.3% (G2-b) of children (p<0.0001). No statistically significant intergroup differences were seen in maintenance laxative dose, CTT, or CTT type. Conclusion: Infrequent bowel movement and fecal soiling represent the advanced stage of chronic functional constipation.
참고문헌 (35)
- Youssef NN, "Childhood constipation : evaluation and treatment", J Clin Gastroenterol, 33, pp.199~205 (2001)
- Southwell BR, "Chronic constipation in children : organic disorders are a major cause", J Paediatr Child Health, 41, pp.1~15 (2005)
- Poenaru D, "The pediatric Bowel Management Clinic : initial results of a multidisciplinary approach to functional constipation in children", J Pediatr Surg, 32, pp.843~848 (1997)
- Atchariya Chanpong, "Laxative Choice and Treatment Outcomes in Childhood Constipation: Clinical Data in a Longitudinal Retrospective Study", Pediatric Gastroenterology, Hepatology & Nutrition, 21(2), pp.101~110 (2018), 대한소아소화기영양학회
- Bae SH, "Subtype classification of chronic functional childhood constipation with a colon transit time test: therapeutic perspective", Paper presented at: 5th World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, pp.252~ (2016)
- Treepongkaruna S, "A randomised, double-blind study of polyethylene glycol 4000 and lactulose in the treatment of constipation in children", BMC Pediatr, 14, pp.153~ (2014)
- Mock Ryeon Kim, "Correlation between Colon Transit Time Test Value and Initial Maintenance Dose of Laxative in Children with Chronic Functional Constipation", Pediatric Gastroenterology, Hepatology & Nutrition, 19(3), pp.186~192 (2016), 대한소아소화기영양학회
- Metcalf AM, "Simplified assessment of segmental colonic transit", Gastroenterology, 92, pp.40~47 (1987)
- Clayden GS, "The management of chronic constipation and related faecal incontinence in childhood", Arch Dis Child Educ Pract, 90, pp.ep58~67 (2005)
- Biggs WS, "Evaluation and treatment of constipation in infants and children", Am Fam Physician, 73, pp.469~477 (2006)
- Felt B, "Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor", Arch Pediatr Adolesc Med, 153, pp.380~385 (1999)
- Voderholzer WA, "Clinical response to dietary fiber treatment of chronic constipation", Am J Gastroenterol, 92, pp.95~98 (1997)
- Rao SS, "Constipation : evaluation and treatment of colonic and anorectal motility disorders", Gastroenterol Clin North Am, 36, pp.687~711 (2007)
- Knowles CH, "Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation", Br J Surg, 86, pp.54~60 (1999)
- Knowles CH, "Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies", Neurogastroenterol Motil, 12, pp.181~196 (2000)
- Tzavella K, "Decreased substance P levels in rectal biopsies from patients with slow transit constipation", Eur J Gastroenterol Hepatol, 8, pp.1207~1211 (1996)
- Cortesini C, "Nitric oxide synthase and VIP distribution in enteric nervous system in idiopathic chronic constipation", Dig Dis Sci, 40, pp.2450~2455 (1995)
- Rao SSC, "Handbook of gastrointestinal motility and functional disorders" (2015), SLACK Incorporated
- Saad MRJ, "Handbook of gastrointestinal motility and functional disorders", pp.241~252 (2015), SLACK Incorporated
- Attaluri A, "Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS", Am J Gastroenterol, 105, pp.1407~1411 (2010)
- Kyungmin Kim, "Value of Fluoroscopic Defecography in Constipated Children With Abnormal Colon Transit Time Test Results", Journal of Neurogastroenterology and Motility (JNM), 26(1), pp.128~132 (2020), 대한소화기 기능성질환∙운동학회[DOI]
- Lee G, "Pelvic floor dysfunction in chronic constipated children", Paper presented at: The 68th Fall Conference, The Korean Pediatric Society (2018)
- Nelson RL, "Epidemiology of fecal incontinence", Gastroenterology, 126(1 Suppl 1), pp.S3~7 (2004)
- Lembo AJ, "Sleisenger and Fordtran's gastrointestinal and liver disease", pp.270~296 (2016), Elsevier Inc
- Rajindrajith S, "Review article : faecal incontinence in children : epidemiology, pathophysiology, clinical evaluation and management", Aliment Pharmacol Ther, 37, pp.37~48 (2013)
- Griffiths DM, "The physiology of continence : idiopathic fecal constipation and soiling", Semin Pediatr Surg, 11, pp.67~74 (2002)
- Whitehead WE, "Handbook of gastrointestinal motility and functional disorders", pp.265~278 (2015), SLACK Incorporated
- Kliegman RM, "Nelson textbook of pediatrics", pp.2045~ (2019), Elsevier
- Ha Yeong Yoo, "Colon Transit Time Test in Korean Children with Chronic Functional Constipation", Pediatric Gastroenterology, Hepatology & Nutrition, 19(1), pp.38~43 (2016), 대한소아소화기영양학회
- Benninga MA, "Colonic transit time in constipated children : does pediatric slow-transit constipation exist", J Pediatr Gastroenterol Nutr, 23, pp.241~251 (1996)
- Wagener S, "Colonic transit time--what is normal?", J Pediatr Surg, 39, pp.166~169 (2004)
- Lee-Robichaud H, "Lactulose versus Polyethylene Glycol for chronic constipation", Cochrane Database Syst Rev, (7), pp.CD007570~ (2010)
- Dupont C, "Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children", J Pediatr Gastroenterol Nutr, 41, pp.625~633 (2005)
- Voskuijl W, "PEG 3350(Transipeg)versus lactulose in the treatment of childhood functional constipation : a double blind, randomised, controlled, multicentre trial", Gut, 53, pp.1590~1594 (2004)
- 이소희, "한국인 소아에서 만성 기능성 변비치료 시 전해질이 함유되지 않은 PEG 4000의 유지용량", Clinical and Experimental Pediatrics, 50(12), pp.1212~1216 (2007), 대한소아청소년과학회