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Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: a systematic
1Paediatric Gastroenterology Service, Royal West Sussex NHS Trust, Chichester PO19 6SE, UK. david.candy@rws-tr.nhs.uk
Insights
Polyethylene glycol (PEG) is an effective treatment for childhood constipation. This systematic review found PEG superior to placebo and comparable or superior to other laxatives in children.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Evidence-Based Medicine
Background:
- Limited evidence exists for pediatric laxative use.
- Childhood constipation management often relies on anecdotal evidence.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) of polyethylene glycol (PEG) for chronic constipation in children.
- To clarify the efficacy and safety of PEG compared to placebo and active comparators.
Main Methods:
- Comprehensive literature search for RCTs involving children (<18 years) with chronic constipation.
- Studies compared PEG against placebo or active laxatives (lactulose, milk of magnesia).
- Outcomes assessed included global effectiveness and defecation rates.
Main Results:
- Seven studies with 594 children were included.
- PEG demonstrated significantly greater effectiveness than placebo.
- PEG was equivalent or superior to active comparators in four out of six comparative studies.
Conclusions:
- Well-designed RCTs now support an evidence-based approach to childhood constipation.
- Polyethylene glycol (PEG) based treatments are effective and well-tolerated first-line options for pediatric constipation.
Abstract:
As the evidence base supporting the use of laxatives in children is very limited, we undertook an updated systematic review to clarify the issue. A comprehensive literature search was carried out to identify randomised controlled trials of polyethylene glycol (PEG) versus either placebo or active comparator, in patients aged <18 years with primary chronic constipation. Outcomes were assessed as either global assessments of effectiveness or differences in defaecation rates. Seven qualifying studies involving 594 children were identified. Five were comparisons of PEG with lactulose, one with milk of magnesia and one with placebo. Study duration ranged from 2 weeks to 12 months. PEG was significantly more effective than placebo and either equivalent to (two studies) or superior to (four studies) active comparator. Differences in study design precluded meaningful meta-analysis. Lack of high quality studies has meant that the management of childhood constipation has tended to rely on anecdote and empirical treatment choice. Recent publication of well designed randomised trials now permits a more evidence-based approach, with PEG-based treatments having been proven to be effective and well-tolerated first-line treatment.
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