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Medline ® Abstracts for References 15-22

of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'

15
TI
Controversies in the management of chronic constipation.
AU
Loening-Baucke V
SO
J Pediatr Gastroenterol Nutr. 2001;32 Suppl 1:S38.
 
AD
Department of Pediatrics, University of Iowa, Iowa City, USA.
PMID
16
TI
Encopresis.
AU
Loening-Baucke V
SO
Curr Opin Pediatr. 2002;14(5):570.
 
A careful history and physical examination will help to differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease. Most children with encopresis with or without functional constipation require no or minimal laboratory workup. Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen. The conventional treatment approach consists of behavior modification and laxative for children with encopresis with constipation and behavior modification alone for the few children with encopresis without constipation. Almost every patient will experience dramatic improvement in encopresis. Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years.
AD
Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Iowa, Iowa City, 52242-1083, USA. vera-loening-baucke@uiowa.edu
PMID
17
TI
Childhood constipation: evaluation and treatment.
AU
Youssef NN, Di Lorenzo C
SO
J Clin Gastroenterol. 2001;33(3):199.
 
Constipation is common in children. It is estimated that between 5% and 10% of pediatric patients have constipation and/or encopresis. Constipation is the second most referred condition in pediatric gastroenterology practices, accounting for up to 25% of all visits. In this article, a practical approach is laid out for those not familiar with constipation in children. Emphasis is placed on the evaluation and management options that are available to the treating practitioner. The diagnosis of constipation requires careful history taking and interpretation. Diagnostic tests are not often needed and are reserved for those who are severely affected. The daily bowel habits of children are extremely susceptible to any changes in routine environment. Constipation and subsequent fecal retention behavior often begins soon after a child has experienced a painful evacuation. Childhood constipation can be very difficult to treat. It often requires prolonged support by physicians and parents, explanation, medical treatment, and, most important, the child's cooperation.
AD
Department of Pediatrics, Division of Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
PMID
18
TI
Long-term follow-up of children with chronic idiopathic constipation.
AU
Staiano A, Andreotti MR, Greco L, Basile P, Auricchio S
SO
Dig Dis Sci. 1994;39(3):561.
 
To determine the outcome of chronic idiopathic constipation, we followed 62 children with chronic idiopathic constipation (mean age: 5.2 +/- 2.8 years) for a period of five years. Each child received the same initial treatment over a 12-week period and was then followed every three months. After five years from diagnosis, chronic idiopathic constipation persisted in 52% of the children; 47% who remained symptomatic were>10 years old at the time of the five-year evaluation. Of the 27 who were constipated in the first year of life, 63% remained constipated after five years. Children who recovered within the five-year interval were significantly different from those that remained symptomatic in age of onset of constipation (P<0.05) and family history of constipation (P<0.05). After five years, both severity of abdominal pain and degree of soiling significantly decreased in both the recovered and unrecovered groups (P<0.05). This study suggests that chronic idiopathic constipation persists for>or = 5 years in at least half of children. Early age of onset and family history of constipation are predictive of persistence. Abdominal pain and soiling improve in long-term follow-up irrespective of constipation outcome.
AD
Department of Pediatrics, II School of Medicine, University of Naples, Italy.
PMID
19
TI
Diagnosis and treatment efficacy of functional non-retentive fecal soiling in childhood.
AU
Benninga MA, Taminiau JA
SO
J Pediatr Gastroenterol Nutr. 2001;32 Suppl 1:S42.
 
AD
Division of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Amsterdam, The Netherlands.
PMID
20
TI
Childhood constipation: longitudinal follow-up beyond puberty.
AU
van Ginkel R, Reitsma JB, Büller HA, van Wijk MP, Taminiau JA, Benninga MA
SO
Gastroenterology. 2003;125(2):357.
 
BACKGROUND&AIMS: Sparse data exist about the prognosis of childhood constipation and its possible persistence into adulthood.
METHODS: A total of 418 constipated patients older than 5 years at intake (279 boys; median age, 8.0 yr) participated in studies evaluating therapeutic modalities for constipation. All children subsequently were enrolled in this follow-up study with prospective data collection after an initial 6-week intensive treatment protocol, at 6 months, and thereafter annually, using a standardized questionnaire.
RESULTS: Follow-up was obtained in more than 95% of the children. The median duration of the follow-up period was 5 years (range, 1-8 yr). The cumulative percentage of children who were treated successfully during follow-up was 60% at 1 year, increasing to 80% at 8 years. Successful treatment was more frequent in children without encopresis and in children with an age of onset of defecation difficulty older than 4 years. In the group of children treated successfully, 50% experienced at least one period of relapse. Relapses occurred more frequently in boys than ingirls (relative risk 1.73; 95% confidence interval, 1.15-2.62). In the subset of children aged 16 years and older, constipation still was present in 30%.
CONCLUSIONS: After intensive initial medical and behavioral treatment, 60% of all children referred to a tertiary medical center for chronic constipation were treated successfully at 1 year of follow-up. One third of the children followed-up beyond puberty continued to have severe complaints of constipation. This finding contradicts the general belief that childhood constipation gradually disappears before or during puberty.
AD
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
PMID
21
TI
Empirically supported treatments in pediatric psychology: constipation and encopresis.
AU
McGrath ML, Mellon MW, Murphy L
SO
J Pediatr Psychol. 2000;25(4):225.
 
OBJECTIVE: To review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence.
METHOD: Sixty-five articles investigating intervention efficacy were identified and reviewed. Twenty-three of the studies were excluded because they were case studies or were less well-controlled single-case designs. The intervention protocol for each study was identified and coded, with studies employing the same interventions matched and evaluated according to the Chambless criteria.
RESULTS: From the literature base to date, no well-established interventions have emerged. However, four probably efficacious treatments and three promising interventions were identified. Two different medical interventions plus positive reinforcement fit the criteria for the probably efficacious category (one with fiber recommendation and one without). Three biofeedback plus medical interventions fit efficacy category criteria: one probably efficacious for constipation with abnormal defecation dynamics (full medical intervention plus biofeedback for paradoxical contraction), and two fit the promising intervention criteria for constipation and abnormal defecation dynamics (full medical intervention plus biofeedback for EAS strengthening, correction of paradoxical contraction and home practice; and biofeedback focused on correction of paradoxical contraction, medical intervention without fiber recommendation, and positive reinforcement). Two extensive behavioral interventions plus medical intervention also met efficacy criteria for constipation plus incontinence (medical intervention without laxative maintenance plus positive reinforcement, dietary education, goal setting, and skills building presented in a small-group format fits criteria for a promising intervention; and positive reinforcement and skills building focused on relaxation of the EAS during defecation, but without biofeedback, plus medical intervention meets the probably efficacious criteria).
CONCLUSIONS: A discussion of the current weaknesses in this research area follows. Specific recommendations for future research are made including greater clarity in treatment protocol and sample descriptions, reporting cure rates rather than success rates, utilization of adherence checks, and investigation of potential differential outcomes for subgroups of children with constipation and incontinence.
AD
Department of Psychology, Tulane University, 2007 Percival Stern Hall, New Orleans, LA 70118-5698, USA. mmcgrath@mailhost.tcs.tulane.edu
PMID
22
TI
Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal.
AU
Brooks RC, Copen RM, Cox DJ, Morris J, Borowitz S, Sutphen J
SO
Ann Behav Med. 2000;22(3):260.
 
This review summarizes the literature on randomized, controlled, published studies involving medical, behavioral, psychological, and biofeedback treatments for encopresis/functional constipation and stool-toileting refusal in preschool-age and school-age children. Nine such studies were located in the literature involving school-age children. No randomized, controlled treatment studies involving preschool-age children have been published. This review revealed no evidence to support the routine use of psychotherapy or anal sphincter biofeedback in the treatment of pediatric fecal elimination dysfunctions, beyond those benefits derived from a comprehensive medical-behavioral intervention. Further, this review indicated that paradoxical constriction of the External Anal Sphincter does not influence the treatment outcome of either biofeedback or medical-behavioral interventions. There are remarkably few controlled treatment outcome studies in this most important clinical area. More research is needed that employs standard treatment outcome variables.
AD
Behavioral Medicine Center, Box 223, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
PMID