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Cisapride for intractable constipation in children: observations from an open trial
R D Murray1, B U Li, H J McClung
1Department of Pediatrics, Ohio State University, Columbus Children's Hospital 43205.
Insights
Cisapride improved encopresis and stool consistency in children with chronic constipation. This prokinetic agent offered significant symptom relief, allowing withdrawal of other therapies in most cases.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
Background:
- Chronic constipation is a common pediatric issue.
- Many children with functional constipation are refractory to standard treatments like emollients and laxatives.
Purpose of the Study:
- To evaluate the efficacy and safety of Cisapride, an investigational prokinetic agent, in children with chronic constipation.
- To assess Cisapride's impact on encopresis, stool consistency, and need for disimpaction.
Main Methods:
- A study was conducted on twelve pediatric patients (8 boys, 4 girls) aged 2-13 years with chronic constipation.
- Patients received Cisapride (0.14-0.3 mg/kg/dose) for 26-72 weeks.
- Outcomes measured included stool frequency, consistency, encopresis, urinary complaints, and need for disimpaction.
Main Results:
- Cisapride significantly improved stool consistency in 5 of 7 patients and resolved encopresis in 8 of 10 cases.
- The need for alternative anticonstipation therapies decreased significantly (p < 0.001).
- Urinary symptoms improved in 2 of 3 affected patients; side effects were infrequent and mild.
Conclusions:
- Cisapride demonstrates significant efficacy in managing chronic constipation, particularly encopresis and stool hardness, in pediatric patients.
- It offers a valuable therapeutic option for refractory cases, potentially reducing the need for other interventions.
- The agent was generally well-tolerated with a favorable safety profile in this cohort.
Abstract:
Twelve patients with chronic constipation refractory to the vigorous use of emollients, enemas, and/or laxatives were chosen for study of the investigational prokinetic agent, Cisapride. The patients included 8 boys and 4 girls with diagnoses of functional constipation. Ages ranged from 2 to 13 years; duration of symptoms before Cisapride use ranged from 1.5 to 9.75 years; duration of previous treatment ranged from 0.75 to 6 years. The mean number of doses of anticonstipation agents employed per week was 14. Of the 12 patients, 10 had persistent encopresis, while 11 required hospitalization for disimpaction an average of 1.6 times in the year prior to Cisapride use. Three had chronic urinary tract complaints. Anal manometry suggested a sensory deficit in 8 of 10 patients tested. Ganglion cells were identified by rectal biopsy in all 12 patients. Cisapride treatment (0.14-0.3 mg/kg/dose) spanned 26-72 weeks (61 +/- 12). Stool frequency per week was not significantly changed, but five of seven patients who had reported hard stools had softer stools on the drug (p less than 0.05). Encopresis ceased in 8 of 10 cases, while the number of episodes decreased substantially in the other 2 cases (p less than 0.05). All alternate forms of anticonstipation therapy were withdrawn in 8 of 12 cases (p less than 0.001). Urinary problems improved in two of the three patients reporting symptoms. One patient showed no improvement in any parameter while on the agent, despite 26 weeks of administration. Side effects were infrequent, generally occurred early, and were limited to cramping, nausea, mild vomiting, anorexia, and headaches. One patient ceased use of the drug for persistent headaches.(ABSTRACT TRUNCATED AT 250 WORDS)