Stimulant laxatives for constipation and soiling in children

Price, Kath; Elliot, Tracy

doi:10.1002/14651858.cd002040

Cited by 31 publications

(11 citation statements)

References 4 publications

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“…Only Price et al 7 performed a systematic review of the literature; they aimed to investigate the effect of stimulant laxative treatment in children with chronic constipation, however, none of the studies found complied with their strict criteria. Although most guidelines provide a review of available studies, none of these reviews provide a summary of the quantity and quality of all current evidence based on a systematic search of the literature.…”

Section: Comparison With Previous Reviewsmentioning

confidence: 99%

Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

Pijpers

Tabbers

Benninga

et al. 2008

Archives of Disease in Childhood

165

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General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. ABSTRACT Introduction: Constipation is a common complaint in children and early intervention with oral laxatives may improve complete resolution of functional constipation. However, most treatment guidelines are based on reviews of the literature that do not incorporate a quality assessment of the studies. Objective: To investigate and summarise the quantity and quality of the current evidence for the effect of laxatives and dietary measures on functional childhood constipation. Methods: The Medline and Embase databases were searched to identify studies evaluating the effect of a medicamentous treatment or dietary intervention on functional constipation. Methodological quality was assessed using a validated list of criteria. Data were statistically pooled, and in case of clinical heterogeneity results were summarised according to a best evidence synthesis. Results: Of the 736 studies found, 28 met the inclusion criteria. In total 10 studies were of high quality. The included studies were clinically and statistically heterogeneous in design. Most laxatives were not compared to placebo. Compared to all other laxatives, polyethylene glycol (PEG) achieved more treatment success (pooled relative risk (RR): 1.47; 95% CI 1.23 to 1.76). Lactulose was less than or equally effective in increasing the defecation frequency compared to all other laxatives investigated. There was no difference in effect on defecation frequency between fibre and placebo (weighted standardised mean difference 0.35 bowel movements per week in favour of fibre, 95% CI 20.04 to 0.74). Conclusion: Insufficient evidence exists supporting that laxative treatment is better than placebo in children with constipation. Compared to all other laxatives, PEG achieved more treatment success, but results on defecation frequency were conflicting. Based on the results of this review, we can give no recommendations to support one laxative over the other for childhood constipation.

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Section: Comparison With Previous Reviewsmentioning

confidence: 99%

Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

Pijpers

Tabbers

Benninga

et al. 2008

Archives of Disease in Childhood

165

View full text Add to dashboard Cite

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“…18 Stimulant laxatives A Cochrane review (search date 2001) found no randomised controlled trials that adequately met the selection criteria, and it concluded that there is insufficient evidence on the use and effectiveness of stimulant laxatives for the treatment of childhood constipation. 19 The studies identified were all comparative, used multiple interventions, and had small sample sizes. One quasi-randomised study in 37 children (aged 3-12 years) with chronic constipation found that after six months senna was significantly less effective than mineral oil concentrate in achieving daily bowel movements or reducing involuntary soiling.…”

Section: Box 3 Organic Causes Of Constipation and Diagnostic Tests 29mentioning

confidence: 99%

Chronic constipation in children

Rubin

Dale

2006

BMJ

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“…A recent It is prudent to assess the safety profile of agents used for this Cochrane review of the use of stimulant laxatives for the treatment duration. This question was partly answered by Pashankar et al, [35] of constipation and soiling in children [45] found no randomized who investigated biochemical parameters in a case series of 83 controlled trials that met the selection criteria for analysis. The children receiving PEG 3350 therapy for >3 months for childhood authors concluded that there is insufficient evidence to guide the chronic constipation.…”

Section: Polyethylene Glycolmentioning

confidence: 99%

Management of Chronic Functional Constipation in Childhood

2007

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Chronic functional constipation is a common problem in childhood, with soiling a significant issue. The morbidity is high and the treatment is complex. There is a very poor evidence base for the drug treatments used and there are considerable differences in practice in different units. The key to successful management is early diagnosis and prompt treatment with an emphasis on holistic care with multidisciplinary support where needed. For example, the practical approach in our unit at the Southampton General Hospital, Southampton, England emphasizes the non-drug aspects including patient education and behavioral modification and uses stimulant laxatives, usually in a high dose as first-line therapy. There is an urgent need for prospective comparative studies to investigate different treatment regimens and for longitudinal studies to examine the long-term outcome of chronic constipation and the factors that determine it. The lack of a significant evidence base for the use of the most widely used agents proves a significant challenge in the production of evidence-based guidelines and highlights the paucity of data for most of the widely used treatments for childhood constipation.

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Stimulant laxatives for constipation and soiling in children

Cited by 31 publications

References 4 publications

Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

Chronic constipation in children

Management of Chronic Functional Constipation in Childhood

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