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Current Gastroenterology Reports

, Volume 9, Issue 3, pp 214–218 | Cite as

Novel and alternative therapies for childhood constipation

  • Olivia Liem
  • Marc A. Benninga
  • Hayat M. Mousa
  • Carlo Di Lorenzo
Article

Abstract

Constipation is a worldwide problem that affects many children. Treatment of constipation is largely based on clinical experience rather than on evidence-based controlled clinical trials. Stool softeners and cathartic agents in combination with behavioral interventions constitute the programs most commonly used to facilitate painless and frequent defecation. Long-term treatment is needed for most patients, and approximately 30% of children beyond puberty continue to struggle with symptoms of constipation, such as infrequent, painful evacuation of stools and fecal incontinence. Not surprisingly, chronicity of these bowel complaints may cause significant interference with the child’s emotional growth and development. Development of new therapeutic strategies is necessary in order to treat these challenging patients more effectively. This review provides an overview of novel and alternative therapies, such as new drugs, surgery, and probiotics, that are being proposed for the treatment of childhood chronic constipation.

Keywords

Constipation Irritable Bowel Syndrome Botulinum Toxin Fecal Incontinence Achalasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Molnar D, Taitz LS, Urwin OM, et al.: Anorectal manometry results in defecation disorders. Arch Dis Child 1983, 58:257–261.PubMedGoogle Scholar
  2. 2.
    van den Berg MM, Benninga MA, Di Lorenzo C: Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006, 101:2401–2409.PubMedCrossRefGoogle Scholar
  3. 3.
    Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006, 43:e1–e13.Google Scholar
  4. 4.
    Loening-Baucke V: Constipation in children. Curr Opin Pediatr 1994; 6:556–561.PubMedGoogle Scholar
  5. 5.
    van Ginkel R, Reitsma JB, Buller HA, et al.: Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 2003; 125:357–363.PubMedCrossRefGoogle Scholar
  6. 6.
    Van den Berg MM, Van Rossum CH, de Lorijn F, et al.: Functional constipation in infants: a follow-up study. J Pediatr 2005, 147:700–704.PubMedCrossRefGoogle Scholar
  7. 7.
    Coffin B, Farmachidi JP, Rueegg P, et al.: Tegaserod, a 5-HT4 receptor partial agonist, decreases sensitivity to rectal distension in healthy subjects. Aliment Pharmacol Ther 2003, 17:577–585.PubMedCrossRefGoogle Scholar
  8. 8.
    Degen L, Petrig C, Studer D, et al.: Effect of tegaserod on gut transit in male and female subjects. Neurogastroenterol Motil 2005, 17:821–826.PubMedCrossRefGoogle Scholar
  9. 9.
    Prather CM, Camilleri M, Zinsmeister AR, et al.: Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology 2000, 118:463–468.PubMedCrossRefGoogle Scholar
  10. 10.
    Rodriguez-Stanley S, Zubaidi S, Proskin HM, et al.: Effect of tegaserod on esophageal pain threshold, regurgitation, and symptom relief in patients with functional heartburn and mechanical sensitivity. Clin Gastroenterol Hepatol 2006, 4:442–450.PubMedCrossRefGoogle Scholar
  11. 11.
    Kellow J, Lee OY, Chang FY, et al.: An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Gut 2003, 52:671–676.PubMedCrossRefGoogle Scholar
  12. 12.
    Novick J, Miner P, Krause R, et al.: A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2002, 16:1877–1888.PubMedCrossRefGoogle Scholar
  13. 13.
    Kamm MA, Muller-Lissner S, Talley NJ, et al.: Tegaserod for the treatment of chronic constipation: a randomized, double-blind, placebo-controlled multinational study. Am J Gastroenterol 2005, 100:362–372.PubMedCrossRefGoogle Scholar
  14. 14.
    Khoshoo V, Armstead C, Landry L: Effect of a laxative with and without tegaserod in adolescents with constipation predominant irritable bowel syndrome. Aliment Pharmacol Ther 2006, 23:191–196.PubMedCrossRefGoogle Scholar
  15. 15.
    Furlano R, Sidler MA, Beglinger C. Tegaserod: A prokinetic agent for the treatment of chronic functional constipation in children? [abstract] J Pediatr Gastroenterol Nutr 2004, 39:S233.Google Scholar
  16. 16.
    Camilleri M, Bharucha AE, Ueno R, et al.: Effect of a selective chloride channel activator, lubiprostone, on gastrointestinal transit, gastric sensory, and motor functions in healthy volunteers. Am J Physiol Gastrointest Liver Physiol 2006, 290:G942–G947.PubMedCrossRefGoogle Scholar
  17. 17.
    Johanson JF, Gargano MA, Patchen ML, et al.: Efficacy and safety of a novel compound, RU-0211, for the treatment of constipation [abstract]. Gastroenterology 2002, 122:A–315.Google Scholar
  18. 18.
    Johanson JF, Gargano MA, Patchen ML, et al.: Phase III study of lubiprostone, a chloride channel-2 (CIC-2) activator for treatment of constipation: safety and primary efficacy. [abstract]. Am J Gastroenterol 2005, 100:S328.Google Scholar
  19. 19.
    Roy S, Liu HC, Loh HH: mu-Opioid receptor-knockout mice: the role of mu-opioid receptor in gastrointestinal transit. Brain Res Mol Brain Res 1998, 56:281–283.PubMedCrossRefGoogle Scholar
  20. 20.
    Tofil NM, Benner KW, Faro SJ, et al.: The use of enteral naloxone to treat opioid-induced constipation in a pediatric intensive care unit. Pediatr Crit Care Med. 2006, 7:252–254.PubMedCrossRefGoogle Scholar
  21. 21.
    Szajewska H, Ruszczynski M, Radzikowski A: Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 2006, 149:367–372.PubMedCrossRefGoogle Scholar
  22. 22.
    Marteau P, Cuillerier E, Meance S, et al.: Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther 2002, 16:587–593.PubMedCrossRefGoogle Scholar
  23. 23.
    Koebnick C, Wagner I, Leitzmann P, et al.: Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol 2003, 17:655–659.PubMedGoogle Scholar
  24. 24.
    Banaszkiewicz A, Szajewska H: Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. J Pediatr 2005, 146:364–369.PubMedCrossRefGoogle Scholar
  25. 25.
    Salminen S, Salminen E: Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand J Gastroenterol 1997, 222(Suppl):45–48.Google Scholar
  26. 26.
    Foligne B, Grangette C, Pot B: Probiotics in IBD: mucosal and systemic routes of administration may promote similar effects. Gut 2005, 54:727–728.PubMedGoogle Scholar
  27. 27.
    Abrams P, Blaivas JG, Fowler CJ, et al.: The role of neuromodulation in the management of urinary urge incontinence. BJU Int 2003, 91:355–359.PubMedCrossRefGoogle Scholar
  28. 28.
    Humphreys MR, Vandersteen DR, Slezak JM, et al.: Preliminary results of sacral neuromodulation in 23 children. J Urol 2006, 176:2227–2231.PubMedCrossRefGoogle Scholar
  29. 29.
    Bernstein AJ, Peters KM: Expanding indications for neuromodulation. Urol Clin North Am 2005, 32:59–63.PubMedCrossRefGoogle Scholar
  30. 30.
    Jarrett ME, Mowatt G, Glazener CM, et al.: Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 2004, 91:1559–1569.PubMedCrossRefGoogle Scholar
  31. 31.
    Malouf AJ, Wiesel PH, Nicholls T, et al.: Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg 2002, 26:166–170.PubMedCrossRefGoogle Scholar
  32. 32.
    Kenefick NJ, Vaizey CJ, Cohen CR, et al.: Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg 2002, 89:1570–1571.PubMedCrossRefGoogle Scholar
  33. 33.
    Chase J, Robertson VJ, Southwell B, et al.: Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment-resistant constipation and soiling in children. J Gastroenterol Hepatol 2005, 20:1054–1061.PubMedCrossRefGoogle Scholar
  34. 34.
    Campbell A: The origins of acupuncture. Acupunct Med 2002, 20:141.PubMedCrossRefGoogle Scholar
  35. 35.
    Broide E, Pintov S, Portnoy S, et al.: Effectiveness of acupuncture for treatment of childhood constipation. Dig Dis Sci 2001, 46:1270–1275.PubMedCrossRefGoogle Scholar
  36. 36.
    Klauser AG, Rubach A, Bertsche O, et al.: Body acupuncture: effect on colonic function in chronic constipation. Z Gastroenterol 1993, 31:605–608.PubMedGoogle Scholar
  37. 37.
    Hall N: Reflexology. London: Thorsons; 1996.Google Scholar
  38. 38.
    Bishop E, McKinnon E, Weir E, et al.: Reflexology in the management of encopresis and chronic constipation. Paediatr Nurs 2003, 15:20–21.PubMedGoogle Scholar
  39. 39.
    Klauser AG, Flaschentrager J, Gehrke A, et al.: Abdominal wall massage: effect on colonic function in healthy volunteers and in patients with chronic constipation. Z Gastroenterol 1992, 30:247–251.PubMedGoogle Scholar
  40. 40.
    Ciamarra P, Nurko S, Barksdale E, et al.: Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin. J Pediatr Gastroenterol Nutr 2003, 37:315–319.PubMedCrossRefGoogle Scholar
  41. 41.
    Langer JC, Birnbaum E: Preliminary experience with intrasphincteric botulinum toxin for persistent constipation after pull-through for Hirschsprung’s disease. J Pediatr Surg 1997, 32:1059–1061.PubMedCrossRefGoogle Scholar
  42. 42.
    Youssef NN, Langseder AL, Verga BJ, et al.: Chronic childhood constipation is associated with impaired quality of life: a case-controlled study. J Pediatr Gastroenterol Nutr 2005, 41:56–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Mousa HM, van den Berg MM, Caniano DA, et al.: Cecostomy in children with defecation disorders. Dig Dis Sci 2006, 51:154–160.PubMedCrossRefGoogle Scholar
  44. 44.
    Rivera MT, Kugathasan S, Berger W, et al.: Percutaneous colonoscopic cecostomy for management of chronic constipation in children. Gastrointest Endosc 2001, 53:225–228.PubMedCrossRefGoogle Scholar
  45. 45.
    Youssef NN, Barksdale JE, Griffiths JM, et al.: Management of intractable constipation with antegrade enemas in neurologically intact children. J Pediatr Gastroenterol Nutr 2002, 34:402–405.PubMedCrossRefGoogle Scholar
  46. 46.
    van den Berg MM, Hogan M, Caniano DA, et al.: Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg 2006, 4:730–736.Google Scholar
  47. 47.
    Griffiths DM, Malone PS: The Malone antegrade continence enema. J Pediatr Surg 1995, 30:68–71.PubMedCrossRefGoogle Scholar
  48. 48.
    Cascio S, Flett ME, De La HM, et al.: MACE or caecostomy button for idiopathic constipation in children: a comparison of complications and outcomes. Pediatr Surg Int 2004, 20:484–487.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Olivia Liem
    • 1
  • Marc A. Benninga
  • Hayat M. Mousa
  • Carlo Di Lorenzo
  1. 1.Department of Pediatric Gastroenterology and NutritionColumbus Children’s HospitalColumbusUSA

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