Document Detail


Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG.
MedLine Citation:
PMID:  19948614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We hypothesized that enemas and polyethylene glycol (PEG) would be equally effective in treating rectal fecal impaction (RFI) but enemas would be less well tolerated and colonic transit time (CTT) would improve during disimpaction. METHODS: Children (4-16 years) with functional constipation and RFI participated. One week before disimpaction, a rectal examination was performed, symptoms of constipation were recorded, and the first CTT measurement was started. If RFI was determined, then patients were assigned randomly to receive enemas once daily or PEG (1.5 g/kg per day) for 6 consecutive days. During this period, the second CTT measurement was started and a child's behavior questionnaire was administered. Successful rectal disimpaction, defecation and fecal incontinence frequencies, occurrence of abdominal pain and watery stools, CTTs (before and after disimpaction), and behavior scores were assessed. RESULTS: Ninety-five patients were eligible, of whom 90 participated (male, n = 60; mean age: 7.5 +/- 2.8 years). Forty-six patients received enemas and 44 PEG, with 5 dropouts in each group. Successful disimpaction was achieved with enemas (80%) and PEG (68%; P = .28). Fecal incontinence and watery stools were reported more frequently with PEG (P < .01), but defecation frequency (P = .64), abdominal pain (P = .33), and behavior scores were comparable between groups. CTT normalized equally (P = .85) in the 2 groups. CONCLUSION: Enemas and PEG were equally effective in treating RFI in children. Compared with enemas, PEG caused more fecal incontinence, with comparable behavior scores. The treatments should be considered equally as first-line therapy for RFI.
Authors:
Noor-L-Houda Bekkali; Maartje-Maria van den Berg; Marcel G W Dijkgraaf; Michiel P van Wijk; Marloes E J Bongers; Olivia Liem; Marc A Benninga
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Pediatrics     Volume:  124     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-01     Completed Date:  2009-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1108-15     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, Netherlands. n.bekkali@amc.nl
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Child
Child, Preschool
Constipation / drug therapy*
Dioctyl Sulfosuccinic Acid / administration & dosage*
Dose-Response Relationship, Drug
Enema*
Fecal Impaction / drug therapy*
Fecal Incontinence / chemically induced
Female
Gastrointestinal Transit / drug effects
Humans
Male
Polyethylene Glycols / administration & dosage*,  adverse effects
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Miralax; 0/Polyethylene Glycols; 10041-19-7/Dioctyl Sulfosuccinic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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