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Etiology and clinical spectrum of constipation in Indian children
Vikrant Khanna1, Ujjal Poddar, Surender Kumar Yachha
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Functional constipation is the most common cause of childhood constipation in India. Key indicators like delayed meconium passage and abdominal distension suggest organic causes, differentiating them from functional constipation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pediatrics
Background:
- Constipation is a common pediatric issue with varied etiologies.
- Differentiating functional from organic constipation is crucial for appropriate management.
Purpose of the Study:
- To investigate the causes, clinical features, and outcomes of constipation in children.
- To identify distinguishing factors between functional and organic constipation.
Main Methods:
- Retrospective chart review of 137 children diagnosed with constipation between 2001 and 2006.
- Defined functional constipation by absence of organic pathology; organic constipation included cases with identified causes.
- Lactulose and polyethylene glycol were used for treatment in functional constipation.
Main Results:
- 85% of children had functional constipation; 15% had organic disorders, including Hirschsprung's disease (6%).
- Organic constipation was associated with delayed meconium passage (50% vs 1.7%), early onset symptoms (40% vs 1.7%), and abdominal distension (50% vs 5%).
- Functional constipation commonly presented with fecal impaction (69%), straining (35%), withholding behavior (27.4%), and fecal incontinence (30.8%). 95% of functional cases responded to laxatives.
Conclusions:
- Functional constipation is the predominant form in Indian children.
- Delayed meconium passage, abdominal distension, and lack of fecal impaction are indicators of organic constipation.
- Early identification of organic causes is vital for timely intervention.
Objective:
To analyze the etiology, clinical spectrum and outcome of constipation in children.
Setting:
Tertiary care teaching hospital.
Design:
Retrospective chart review.
Participants:
Consecutive children with constipation from 2001 to 2006.
Inclusion Criteria:
Functional constipation was designated when there was no objective evidence of any causative pathologic condition while the rest were termed as organic constipation.
Intervention:
Lactulose was started after disimpaction with polyethyleneglycol in functional constipation cases.
Outcome Measures:
Clinical and etiological profile, management, and follow-up data.
Results:
137 children (boys, 90); 117 (85%), had functional constipation while the remaining 15% had an associated organic disorder. Hirschsprungs disease accounted for 6% of all patients. Children in organic group more commonly had delayed passage of meconium (50.0% vs 1.7%), symptoms since first month of life (40.0% vs 1.7%), and abdominal distension (50% vs 5%) as compared to functional group, while fecal impaction was less common (69% vs 20%). Besides fecal impaction, straining (35%), withholding behaviour (27.4%), and fecal incontinence (30.8%) were other main clinical characteristics of the functional group. In the functional group, successful outcome to laxatives was obtained in 95% of patients while 10% needed rescue disimpaction.
Conclusions:
Functional constipation is the most common cause of constipation in Indian children. History of delayed passage of meconium, presence of abdominal distension, and absence of fecal impaction point to an organic pathology.
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