Medline ® Abstracts for References 61,64-66
of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'
Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children.
Pashankar DS, Loening-Baucke V, Bishop WP
Arch Pediatr Adolesc Med. 2003;157(7):661.
OBJECTIVES: To assess the clinical and biochemical safety profile of long-term polyethylene glycol 3350 (PEG) therapy in children with chronic constipation and to assess pediatric patient acceptance of PEG therapy.
DESIGN: Prospective observational study.
SETTING: Pediatric clinics at a referral center. Patients Eighty-three children (44 with chronic constipation, 39 with constipation and encopresis) receiving PEG therapy for more than 3 months.
MAIN OUTCOME MEASURES: Clinical adverse effects related to PEG therapy and acceptance and compliance with PEG therapy. Serum electrolyte levels, osmolality, albumin levels, and liver and renal function test results were measured.
RESULTS: At the time of evaluation, the mean duration of PEG therapy was 8.7 months, and the mean PEG dose was 0.75 g/kg daily. There were no major clinical adverse effects. All blood test results were normal, except for transient minimal alanine aminotransferase elevation unrelated to therapy in 9 patients. All children preferred PEG to previously used laxatives, and daily compliance was measured as good in 90% of children.
CONCLUSIONS: Long-term PEG therapy is safe and is well accepted by children with chronic constipation with and without encopresis.
Division of Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City 52242, USA. Dinesh-Pashankar@uiowa.edu
Polyethylene glycol without electrolytes for children with constipation and encopresis.
J Pediatr Gastroenterol Nutr. 2002;34(4):372.
BACKGROUND: Children with functional constipation and encopresis benefit from behavior modification and from long-term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists.
METHODS: Twenty-eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long-term treatment of functional constipation and encopresis. Children were rated as "doing well," "improved," or "not doing well," depending on resolution of constipation and encopresis.
RESULTS: At the 1-, 3-, 6-, and 12-month follow-ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1-month follow-up, children on polyethylene glycol were soiling more frequently (P<0.01) and fewer were improved (P<0.01). At the 3- and 6-month follow-ups, both groups had similarly improved. At the 12-month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P<0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 +/- 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects.
CONCLUSIONS: Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis.
Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242, USA. email@example.com
Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children.
Pashankar DS, Bishop WP
J Pediatr. 2001;139(3):428.
OBJECTIVE: To determine efficacy, safety, and optimal dose of a laxative, polyethylene glycol (PEG) 3350, in children with chronic constipation.
STUDY DESIGN: Children with chronic constipation (n = 24) were treated with PEG for 8 weeks at an initial dose of 1 g/kg/d. The dose was adjusted every 3 days as required to achieve 2 soft stools per day. A diary was kept to monitor dose, stool frequency and consistency, soiling, and other symptoms. Stool consistency was rated from 1 (hard) to 5 (watery). Subjects were examined for fecal retention. The Student t test and the Fisher exact test were used for data analysis.
RESULTS: All 20 children who completed the study found PEG to be palatable and were satisfied with the treatment. There were no significant adverse effects. Weekly stool frequency increased from 2.3 +/- 0.4 to 16.9 +/- 1.6 (P<.0001) during treatment and stool consistency from 1.2 +/- 0.1 to 3.3 +/- 0.1 (P<.0001). In 9 children with soiling, weekly soiling events declined from 10.0 +/- 2.4 to 1.3 +/- 0.7 (P =.003). The mean effective dose was 0.84 g/kg/d (range, 0.27-1.42 g/kg/d).
CONCLUSION: Daily administration of PEG at a mean dose of 0.8 g/kg is an effective, safe, and palatable treatment for constipation.
Division of Gastroenterology, Department of Pediatrics, University of Iowa College of Medicine, Iowa City, USA.
A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose.
Dupont C, Leluyer B, Amar F, Kalach N, Benhamou PH, Mouterde O, Vannerom PY
J Pediatr Gastroenterol Nutr. 2006;42(2):178.
OBJECTIVES: To determine the doses of polyethylene glycol (PEG) 4000 without additional salts allowing normal bowel habits in childhood functional constipation.
METHODS: This multicenter noncomparative study allocated children to 4 groups: 6-12 months, 13 months-3 years, 4-7 years, and 8-15 years. Constipation was defined as<1 stool/d for more than 1 month in children aged 6-12 months and<3 stools/w for more than 3 months in older children. Children randomly received either a nominal or a double starting dose. Treatment scheduled for 3 months could be adapted. Data were collected daily by the parents and rated at each visit by the investigator.
RESULTS: In the 96 children included, the median (interquartile) effective daily doses were by groups; 3.75 (2.50-5.00) g, 6.00 (4.00-7.43) g, 11.71 (7.00-16.00) g, and 16.00 (16.00-24.00) g, respectively, i.e., around 0.50 g/day/kg with a potential increment of the maintenance dose with higher initial dosages. More children had a final dosage identical to the initial one when started on the nominal dose (73%) than with the double one (42%, P<0.003). More than 90% of children recovered normal bowel habits. Fecal soiling ceased in>60% of children with this symptom at enrolment. Fecal mass in the rectum and abdominal pain were markedly reduced and appetite improved.
CONCLUSIONS: A daily dose of PEG 4000 around 0.50 g/day/kg in children aged 6 months to 15 years is effective in more than 90% of constipated children and 60% of those with fecal soiling.
Service de Neonatologie, Hôpital Cochin-Saint-Vincent-de-Paul, bât. Marcel Lelong, 74-82 Avenue Denfert Rochereau, 75674 Paris Cedex 14, France. firstname.lastname@example.org