Unmet Needs in Pediatric Functional Constipation

Sood, Manu R.; Lichtlen, Peter; Pérez, María Claudia

doi:10.1177/0009922818774343

Cited by 18 publications

(30 citation statements)

References 33 publications

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“…Pediatric functional constipation is one of the most common GI complaints in children, accounting for 3% of visits to general pediatricians and up to 25% of pediatric GI specialist visits in the United States 7 . Children with constipation utilize more outpatient health services, more hospitalizations, and more emergency room visits than children without constipation 8 .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals

Belsky

Stanek

O’Brien

2020

Pediatric Blood & Cancer

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Background: Children with acute lymphoblastic leukemia (ALL) suffer from a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, environmental changes, and opioid use is a common issue for children newly diagnosed with leukemia. Procedure: We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL hospitalized from October 2015 through September 2019. Our objective was to investigate the prevalence, risk factors, and treatment of constipation in hospitalized children with ALL. Results: We identified 4647 unique patients with an ALL induction admission. Constipation was the most common gastrointestinal diagnosis with 1576 (33.9%; 95% confidence interval [CI]: 32.6%-35.3%) patients diagnosed during induction admission and 19.8% in post-induction admissions. The most commonly administered constipation medications were poly-ethyl glycol (n = 3385, 89.6%), followed by senna (n = 1240, 32.8%), lactulose (n = 916, 24.2%), and docusate (n = 914, 24.2%). Multivariate logistic regression revealed the following variables to be significantly associated with the presence of a constipation diagnosis: age < 6 years at induction

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Section: Introductionmentioning

confidence: 99%

“…Despite currently available treatment options, the quality of care for CIC is limited by a lack of guidance for disease management and insufficient data on drug therapies 7,9 . Furthermore, no studies have explored the variability of constipation management for children with ALL receiving constipation‐inducing medications.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals

Belsky

Stanek

O’Brien

2020

Pediatric Blood & Cancer

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“…Chronic functional constipation has a significant impact on the child’s well-being and an adverse effect on health-related quality of life of the child and the parents. 45 – 47 In a systematic review and meta-analysis of 20 studies that provided health-related quality of life data for 2344 children with functional constipation, pooled total quality of life scores of children with functional constipation were lower than those of children without functional constipation (65.6 versus 86.1; p <0.01). 46 The psychosocial consequences of chronic functional constipation include emotional liability, depression, anxiety and aggression.…”

Section: Complicationsmentioning

confidence: 99%

“…Orally, polyethylene glycol (PEG) with or without electrolytes (PEG 3350), 1–1.5 g/kg/day for 3–6 days, is the first-line therapy. 4 , 6 , 45 , 63 PEG without electrolytes is preferred because it is more palatable than PEG with electrolytes and is better accepted by children. In addition, PEG with electrolytes may have to be administered via the nasogastric route as it is not well tolerated orally.…”

Section: Managementmentioning

confidence: 99%

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Paediatrics: how to manage functional constipation

Leung

Hon

2021

DIC

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Background Despite being a common problem in childhood, functional constipation is often difficult to manage. This article provides a narrative updated review on the evaluation, diagnosis and management of childhood functional constipation. Methods A PubMed search was performed with Clinical Queries using the key term ‘functional constipation’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and to the paediatric population. The information retrieved from the above search was used in the compilation of the present article. Results A detailed history and thorough physical examination are important in the evaluation of a child with constipation to establish the diagnosis of functional constipation as per the Rome IV criteria and to catch ‘red flags’ suggestive of organic causes of constipation. These ‘red flags’ include delayed passage of meconium, ribbon stool, rectal bleeding/blood in the stool unless attributable to an anal fissure, failure to thrive, severe abdominal distension, absent anal wink/cremasteric reflex, tight and empty rectum on digital examination and explosive expulsion of liquid stool and gas on withdrawal of the finger, hair tuft/dimple/lipoma/haemangioma in the lumbosacral area, and an anteriorly displaced anus. For functional constipation, pharmacological therapy consists of faecal disimpaction and maintenance therapy. This can be effectively accomplished with oral medications, rectal medications or a combination of both. The most commonly used and most effective laxative is polyethylene glycol. Non-pharmacological management consists of education, behavioural modification and dietary interventions. The combination of pharmacological therapy and non-pharmacological management increases the chance of success. Conclusion Polyethylene glycol is the medication of first choice for both disimpaction and maintenance therapy. If polyethylene glycol is not available or is poorly tolerated, lactulose is the preferred alternative. Other laxatives may be considered as second-line therapy if treatment with osmotic laxatives fails or is insufficient. Maintenance treatment should be continued for at least 2 months. Early treatment will result in a faster and shorter treatment course.

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Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals

Belsky

Batra

Stanek

et al. 2021

Pediatric Blood & Cancer

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Background Childrenwith acute lymphoblastic leukemia (ALL) suffer a litany of chemotherapy‐induced side effects. Constipation secondary to vinca alkaloids, psychological stressors, and opioid use are common issues for children newly diagnosed with leukemia. This study investigated the morbidity associated with constipation including infections, mucositis, and healthcare utilization in hospitalized children with ALL receiving induction chemotherapy. Methods We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1–21 years of age with ALL, hospitalized for induction from October 2015 through December 2019. Data were analyzed using nonparametric statistics, and comparisons of outcomes between those with and without constipation were presented as adjusted odds ratios (aOR). Results We identified 2586 (56%) patients with constipation out of a total of 4622 unique ALL patients in induction. Compared to patients without constipation during induction, patients with constipation were significantly more likely to have mucositis (aOR = 2.30; p = 0.0010), perirectal issues (aOR = 3.21; p = 0.0092), or abdominal radiograph exposure (aOR = 2.40; p < 0.0001). The median length of induction hospitalization was significantly greater in those with constipation compared to those without constipation (10 days vs. 8 days; p < 0.0001). Conclusions Children with ALL suffering from constipation during induction therapy have increased length of stay, mucositis, imaging, and overall healthcare utilization compared to children without constipation. Further research should explore the causative relationship between constipation and infections. Increased attention should be given to constipation management in patients with ALL at the start of induction therapy, particularly in patients with complications or prolonged hospitalizations.

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Unmet Needs in Pediatric Functional Constipation

Cited by 18 publications

References 33 publications

Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals

Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals

Paediatrics: how to manage functional constipation

Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals

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