Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital

Kuizenga-Wessel, Sophie; Koppen, Ilan J.N.; Zwager, Liselotte W.; Lorenzo, Carlo Di; Jong, Justin R. de; Benninga, Marc A.

doi:10.1111/nmo.13005

Cited by 23 publications

(19 citation statements)

References 27 publications

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“…Depending on the results, intestinal diversion, various types of colectomy, and antegrade colonic enema (ACE) procedures have all proven to be beneficial, but the evidence supporting each of these is poor and larger, more rigorous studies are needed. [37, 38]…”

Section: Neurogenic Constipationmentioning

confidence: 99%

Pediatric enteric neuropathies: diagnosis and current management

Westfal¹,

Goldstein

2017

Current Opinion in Pediatrics

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Purpose of Review Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available. Recent Findings The embryologic and histopathologic causes of enteric neuropathies are varied. They range from congenital aganglionosis in Hirschsprung disease, to autoimmune-mediated loss of neuronal subtypes in esophageal achalasia and Chagas disease, to degenerative neuropathies in some cases of chronic intestinal pseudo-obstruction and gastroparesis. Increased awareness of the clinical presentation and diagnostic evaluation of these conditions is essential as it allows for earlier initiation of treatment and improved outcomes. Most current therapies, which include medical management, neurostimulation, and operative intervention, aim to minimize the symptoms caused by these conditions. The evidence base for many of these treatments in children is poor, and multi-institutional prospective studies are needed. An innovative therapy on the horizon involves using neuronal stem cell transplantation to treat the underlying pathology by replacing the missing or damaged neurons in these diseases. Summary While recent advances in basic and clinical neurogastroenterology have significantly improved our awareness and understanding of enteric neuropathies, the efficacy of current treatment approaches is limited. The development of novel therapies, including pharmacologic modulators of neurointestinal function, neurostimulation to enhance gut motility, and neuronal cell-based therapies, is essential to improve the long-term outcomes in children with these disorders.

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Section: Neurogenic Constipationmentioning

confidence: 99%

Pediatric enteric neuropathies: diagnosis and current management

Westfal¹,

Goldstein

2017

Current Opinion in Pediatrics

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“…Currently, surgery of the colon is based on an extensive diagnostic workup including motility testing, often evaluated with colonic manometry. If colonic dysmotility is present, bypassing or removing the dysmotile colonic segment has been shown to be favorable for FC symptoms [67]. However, it has also been shown that dysmotility is potentially reversible and that motility, as measured by colonic manometry, can improve after decompression of the colon or after successful antegrade irrigation [68][69][70][71].…”

Section: Surgical Interventionsmentioning

confidence: 99%

Controversies in the Management of Functional Constipation in Children

Mill

Koppen

Benninga

2019

Curr Gastroenterol Rep

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Purpose of review Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre-and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. Recent findings Pre-and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Summary Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.

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“…In early life, this phenomenon is usually associated with congenital organic diseases such as Hirschsprung's disease, anorectal malformations or other birth defects such as intestinal atresia . However, segmental colonic dilation can also be observed in older children with long‐standing symptoms of functional constipation (FC), in whom underlying organic pathology has been ruled out . The phenomenon of segmental dilation has also been described in adults and this has led to the definitions of megacolon and megarectum, defined by Preston et al.…”

Section: Introductionmentioning

confidence: 99%

“…The same may be true for colonic elongation . These observations have been utilized to advocate for surgical interventions (eg, partial resection of the dilated segment of the colon) . However, to date there is a lack of published data on the relationship between colonic dilation and colonic motility in children with FC.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] However, segmental colonic dilation can also be observed in older children with long-standing symptoms of functional constipation (FC), in whom underlying organic pathology has been ruled out. 6,7,12 The phenomenon of segmental dilation has also been described in adults and this has led to the definitions of megacolon and megarectum, defined by Preston et al as a colonic/ rectal width of >6.5 cm. 13 Absolute cut-off values for megacolon and megarectum have not been established for children and the adult criteria have been used for children in previous studies.…”

Section: Introductionmentioning

confidence: 99%

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