Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation

Unmet Needs in Pediatric Functional Constipation

“…Oral laxatives are the most commonly prescribed treatments for fecal disimpaction and maintenance therapy, but their long-term use has not been adequately evaluated. 14 - 17 The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) guidelines recommend polyethylene glycol (PEG) with or without electrolytes, dosed orally (1-1.5 g/kg/d) for 3 to 6 days as the first-line treatment for children presenting with fecal impaction. 16 If PEG is unavailable, lactulose is recommended as the first-line maintenance treatment, whereas milk of magnesia, mineral oil, and stimulant laxatives may be considered as additional or second-line treatment.…”

“… 16 While significant improvements in constipation symptoms have been reported with both osmotic (eg, PEG) and stimulant (eg, senna) laxatives in RCTs, approximately 40% to 50% of children with functional constipation experience at least 1 episode of relapse within the first 5 years after initial recovery. 14 , 16 , 18 Dietary fibers, traditional medicine, and probiotics are commonly used; however, the clinical evidence supporting their use is not clear. 16 , 19 - 22 Prebiotics and probiotics may be effective at improving clinical symptoms, but data from RCTs are limited.…”

“…In a recent RCT conducted in constipated children with anorectal malformations, senna demonstrated greater efficacy than PEG on the endpoints assessed, including presence of daily bowel movements, absence of fecal soiling, and a clean abdominal X-ray obtained after passing stool. 14 However, in previous studies senna was less effective than lactulose or mineral oil, and was associated with worsened fecal incontinence. 28 Taken together, existing studies do not provide conclusive evidence favoring any particular treatment option for PFC.…”

“…29 These findings highlight the need for well-designed clinical studies of sufficient duration that permit investigation of current treatments on constipation outcomes over an extended period (6-12 months). [8][9][10] • Growing use of probiotics/ fiber 10,[12][13][14][15] Randomized controlled trials: 22…”

The Efficacy and Safety of Combined Senna and Probiotic-Based Bowel Preparation for Colonoscopy in Children

“…Another study by Yenidogan et al reported that same-day administration of senna was safe and effective for bowel cleansing before colonoscopy and that patients were positive about using the same product in the future [16]. Another study conducted in the pediatric population showed that a three-day regimen of senna was comparable to a one-day regimen of PEG-bisacodyl [17]. A clinical trial conducted by Santos-Jasso et al compared the effects of senna vs. PEG in constipated pediatric patients with anorectal malformation; the trial suggested that senna should be the laxative of choice for bowel management in pediatric patients [18].…”