Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation
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Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.
Abstract
Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.
참고문헌 (80)
- Sepanlou SG, "Burden of gastrointestinal and liver diseases in Middle East and North Africa : results of Global Burden of Diseases Study from 1990 to 2010", Middle East J Dig Dis, 7, pp.201~215 (2015)
- Corazziari E, "Definition and epidemiology of functional gastrointestinal disorders", Best Pract Res Clin Gastroenterol, 18, pp.613~631 (2004)
- Berens S, "Patients with multiple functional gastrointestinal disorders(FGIDs)show increased illness severity : a cross-sectional study in a tertiary care FGID specialty clinic", Gastroenterol Res Pract, 2020, pp.9086340~ (2020)
- Chogle A, "A population-based study on the epidemiology of functional gastrointestinal disorders in young children", J Pediatr, 179, pp.139~143 (2016)[DOI]
- Judith Zeevenhooven, "The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers", Pediatric Gastroenterology, Hepatology & Nutrition, 20(1), pp.1~13 (2017), 대한소아소화기영양학회
- Diaz S, "Constipation" (2021), StatPearls. Treasure Island: StatPearls Publishing
- Tabbers MM, "Evaluation and treatment of functional constipation in infants and children : evidence-based recommendations from ESPGHAN and NASPGHAN", J Pediatr Gastroenterol Nutr, 58, pp.258~274 (2014)
- Sparberg M, "Clinical methods: the history, physical, and laboratory examinations" (1990), Butterworths
- Xinias I, "Constipation in childhood. An update on evaluation and management.", Hippokratia, 19, pp.11~19 (2015)
- Steutel NF, "Prevalence of functional gastrointestinal disorders in European infants and toddlers", J Pediatr, 221, pp.107~114 (2020)
- Fujitani A, "Prevalence of functional constipation and relationship with dietary habits in 3-to 8-year-old children in Japan", Gastroenterol Res Pract, 2018, pp.3108021~ (2018)
- Bellaiche M, "A large-scale study to describe the prevalence, characteristics and management of functional gastrointestinal disorders in African infants", Acta Paediatr, 109, pp.2366~2373 (2020)
- Benninga MA, "Childhood functional gastrointestinal disorders : neonate", toddler, 2016, pp.150, 1443~1455
- Whitfield KL, "Treatment options for functional gastrointestinal disorders : from empiric to complementary approaches", Pediatr Ann, 38, pp.288~290 (2009)
- Fink A, "Consensus methods : characteristics and guidelines for use", Am J Public Health, 74, pp.979~983 (1984)
- Guyatt GH, "GRADE : an emerging consensus on rating quality of evidence and strength of recommendations", BMJ, 336, pp.924~926 (2008)
- Drossman DA, "Functional gastrointestinal disorders : history, pathophysiology, clinical features and Rome IV", Gastroenterology, 150, pp.1262~1279 (2016)[DOI]
- Vandenplas Y, "Middle East consensus statement on the diagnosis and management of functional gastrointestinal disorders in <12 months old infants", Pediatr Gastroenterol Hepatol Nutr, 19, pp.153~161 (2016)
- Loening-Baucke V, "Failure to pass meconium : diagnosing neonatal intestinal obstruction", Am Fam Physician, 60, pp.2043~2050 (1999)
- Mazurek MO, "Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders", J Abnorm Child Psychol, 41, pp.165~176 (2013)
- Samsam M, "Pathophysiology of autism spectrum disorders : revisiting gastrointestinal involvement and immune imbalance", World J Gastroenterol, 20, pp.9942~9951 (2014)
- Mugie SM, "Epidemiology of constipation in children and adults : a systematic review", Best Pract Res Clin Gastroenterol, 25, pp.3~18 (2011)
- Lewis ML, "Prevalence of functional gastrointestinal disorders in children and adolescents", J Pediatr, 177, pp.39~43 (2016)[DOI]
- Saps M, "Prevalence of functional gastrointestinal disorders in Colombian school children", J Pediatr, 164, pp.542~545 (2014)[DOI]
- Huang Y, "Prevalence of functional gastrointestinal disorders in infants and young children in China", BMC Pediatr, 21, pp.131~ (2021)
- Walter HAW, "OP-12 prevalence of functional constipation in infants and toddlers in Sri Lanka", J Pediatr Gastroenterol Nutr, 61, pp.514~ (2015)
- Bhatia V, "Prevalence of functional gastrointestinal disorders among adolescents in Delhi based on Rome III criteria : a school-based survey", Indian J Gastroenterol, 35, pp.294~298 (2016)
- Hasosah M, "Prevalence, characterization and risk factors of chronic constipation among Saudi children: a cross-sectional study", Int J Adv Res(Indore), 6, pp.1319~1324 (2018)
- Ibrahim ATA, "Prevalence of functional gastrointestinal disorders among school-aged children and adolescents, a multicenter study", QJM, 113(1) (2020)[DOI]
- van Tilburg MA, "Prevalence of functional gastrointestinal disorders in infants and toddlers", J Pediatr, 166, pp.684~689 (2015)
- Kramer EA, "Defecation patterns in infants : a prospective cohort study", Arch Dis Child, 100, pp.533~536 (2015)
- Hill DJ, "Manifestations of milk allergy in infancy : clinical and immunologic findings", J Pediatr, 109, pp.270~276 (1986)
- Bahna SL, "Cow’s milk allergy versus cow milk intolerance", Ann Allergy Asthma Immunol, 89(6 Suppl 1), pp.56~60 (2002)
- Yang QH, "Clinical features of cow’s milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases", Zhongguo Dang Dai Er Ke Za Zhi, 21, pp.271~276 (2019)[DOI]
- Vandenplas Y, "Guidelines for the diagnosis and management of cow’s milk protein allergy in infants", Arch Dis Child, 92, pp.902~908 (2007)
- Iacono G, "Intolerance of cow’s milk and chronic constipation in children", N Engl J Med, 339, pp.1100~1104 (1998)
- van Ginkel R, "Childhood constipation : longitudinal follow-up beyond puberty", Gastroenterology, 125, pp.357~363 (2003)
- Iacono G, "Chronic constipation as a symptom of cow milk allergy", J Pediatr, 126, pp.34~39 (1995)
- Carroccio A, "Evidence of very delayed clinical reactions to cow’s milk in cow’s milk-intolerant patients", Allergy, 55, pp.574~579 (2000)
- Kamer B, "Food allergy as a cause of constipation in children in the first three years of life - own observations", Med Wieku Rozwoj, 15, pp.157~161 (2011)
- Meyer R, "Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-an EAACI Position Paper", Allergy, 75, pp.14~32 (2020)
- Read NW, "Transit of a meal through the stomach, small intestine, and colon in normal subjects and its role in the pathogenesis of diarrhea", Gastroenterology, 79, pp.1276~1282 (1980)
- Lewis SJ, "Stool form scale as a useful guide to intestinal transit time", Scand J Gastroenterol, 32, pp.920~924 (1997)
- Bekkali N, "Infant stool form scale : development and results", J Pediatr, 154, pp.521~526 (2009)[DOI]
- Huysentruyt K, "The Brussels Infant and Toddler Stool Scale : a study on interobserver reliability", J Pediatr Gastroenterol Nutr, 68, pp.207~213 (2019)
- Velasco-Benitez CA, "Utility of the Brussels Infant and Toddler Stool Scale(BITSS)and Bristol Stool Scale in non-toilet-trained children : a large comparative study", Neurogastroenterol Motil, 33, pp.e14015~ (2021)
- Bongers ME, "The clinical effect of a new infant formula in term infants with constipation : a double-blind, randomized cross-over trial", Nutr J, 6, pp.8~ (2007)
- Quinlan PT, "The relationship between stool hardness and stool composition in breast-and formula-fed infants", J Pediatr Gastroenterol Nutr, 20, pp.81~90 (1995)
- Wood HC, "Therapeutics: its principles and practice" (1900), J. B. Lippincott
- Izzo AA, "The osmotic and intrinsic mechanisms of the pharmacological laxative action of oral high doses of magnesium sulphate. Importance of the release of digestive polypeptides and nitric oxide", Magnes Res, 9, pp.133~138 (1996)
- Dupont C, "Efficacy and safety of a magnesium sulfate-rich natural mineral water for patients with functional constipation", Clin Gastroenterol Hepatol, 12, pp.1280~1287 (2014)
- Dupont C, "Time to treatment response of a magnesium-and sulphate-rich natural mineral water in functional constipation", Nutrition, 65, pp.167~172 (2019)
- Naumann J, "Effects of sulfate-rich mineral water on functional constipation : a double-blind, randomized, placebo-controlled study", Forsch Komplement Med, 23, pp.356~363 (2016)
- Bothe G, "Efficacy and safety of a natural mineral water rich in magnesium and sulphate for bowel function : a double-blind, randomized, placebo-controlled study", Eur J Nutr, 56, pp.491~499 (2017)
- Chao HC, "Therapeutic effect of Novalac-IT in infants with constipation", Nutrition, 23, pp.469~473 (2007)
- Marc A. Benninga, "The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study", Pediatric Gastroenterology, Hepatology & Nutrition, 22(3), pp.270~281 (2019), 대한소아소화기영양학회[DOI]
- Ioannis Xinias, "A Synbiotic Infant Formula with High Magnesium Content Improves Constipation and Quality of Life", Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), pp.28~33 (2018), 대한소아소화기영양학회
- Boateng L, "Coconut oil and palm oil’s role in nutrition, health and national development : a review", Ghana Med J, 50, pp.189~196 (2016)
- Bronsky J, "Palm oil and beta-palmitate in infant formula : a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition(ESPGHAN)Committee on Nutrition", J Pediatr Gastroenterol Nutr, 68, pp.742~760 (2019)
- Mancini A, "Biological and nutritional properties of palm oil and palmitic acid : effects on health", Molecules, 20, pp.17339~17361 (2015)
- Alarcon PA, "Gastrointestinal tolerance of a new infant milk formula in healthy babies : an international study conducted in 17 countries", Nutrition, 18, pp.484~489 (2002)
- Lloyd B, "Formula tolerance in postbreastfed and exclusively formula-fed infants", Pediatrics, 103, pp.E7~ (1999)
- Lasekan JB, "Impact of palm olein in infant formulas on stool consistency and frequency : a meta-analysis of randomized clinical trials", Food Nutr Res, 61, pp.1330104~ (2017)
- Hyams JS, "Effect of infant formula on stool characteristics of young infants", Pediatrics, 95, pp.50~54 (1995)
- Savino F, ""Minor"feeding problems during the first months of life : effect of a partially hydrolysed milk formula containing fructo-and galacto-oligosaccharides", Acta Paediatr Suppl, 91, pp.86~90 (2003)
- Wu HJ, "The role of gut microbiota in immune homeostasis and autoimmunity", Gut Microbes, 3, pp.4~14 (2012)
- Clapp M, "Gut microbiota’s effect on mental health : the gut-brain axis", Clin Pract, 7, pp.987~ (2017)
- Davis CD, "The gut microbiome and its role in obesity", Nutr Today, 51, pp.167~174 (2016)
- Hill C, "Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic", Nat Rev Gastroenterol Hepatol, 11, pp.506~514 (2014)
- Davani-Davari D, "Prebiotics : definition, types, sources, mechanisms, and clinical applications", Foods, 8, pp.92~ (2019)
- Ashley C, "Growth and tolerance of infants fed formula supplemented with polydextrose(PDX)and", or galactooligosaccharides(GOS) : double-blind, randomized, controlled trial, 2012, pp.11, 38~
- Skórka A, "To add or not to add probiotics to infant formulae?", An updated systematic review. Benef Microbes, 8, pp.717~725 (2017)
- González-Bermúdez CA, "Effects of different thickening agents on infant gut microbiota", Food Funct, 9, pp.1768~1778 (2018)
- Gordon M, "Osmotic and stimulant laxatives for the management of childhood constipation", Cochrane Database Syst Rev, 2016, pp.CD009118~ (2016)
- Dupont C, "Magnesium sulfate-rich natural mineral waters in the treatment of functional constipation-a review", Nutrients, 12, pp.2052~ (2020)
- Guest JF, "Clinical and economic impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in England and Wales", Curr Med Res Opin, 23, pp.2213~2225 (2007)
- Tannock GW, "Comparison of the compositions of the stool microbiotas of infants fed goat milk formula, cow milk-based formula, or breast milk", Appl Environ Microbiol, 79, pp.3040~3048 (2013)
- Infante DD, "Constipated patients fed goat milk protein formula : a case series study", J Nutr Health Sci, 5, pp.203~ (2018)
- Patrick Tounian, "Effectiveness and Tolerance of a Locust Bean Gum-Thickened Formula: A Real-Life Study", Pediatric Gastroenterology, Hepatology & Nutrition, 23(6), pp.511~520 (2020), 대한소아소화기영양학회[DOI]
- Salvatore S, "Thickened infant formula : what to know", Nutrition, 49, pp.51~56 (2018)