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PROPOSALS TO APPROXIMATE THE PEDIATRIC ROME CONSTIPATION CRITERIA TO EVERYDAY PRACTICE
Helga Verena Leoni Maffei1, Mauro Batista de Morais2
1Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Botucatu,SP, Brasil.
Insights
Pediatric constipation diagnosis can be simplified to one symptom, such as painful bowel movements, to improve early detection. Dietary fiber recommendations should be clearly included for effective treatment and prevention.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- The current pediatric Rome constipation criteria face low acceptance among primary care physicians and researchers.
- This limited adoption suggests a need for re-evaluation of existing diagnostic criteria for pediatric constipation.
Purpose of the Study:
- To review the timing of diagnosis and dietary recommendations within the Rome criteria.
- To propose modifications for better alignment with primary care practices.
Main Methods:
- A literature review of publications cited in the Rome criteria.
- Medline database search for relevant studies up to January 2018.
Main Results:
- Early diagnosis of constipation is crucial to prevent complications, but current criteria may hinder it.
- Simplifying diagnosis to one symptom, like painful bowel movements, could facilitate early detection.
- Dietary fiber recommendations are insufficiently detailed in the criteria, despite their importance in primary care management.
Conclusions:
- A single constipation sign or symptom should be sufficient for diagnosis in primary care settings.
- Incorporate specific daily dietary fiber intake recommendations, based on established guidelines, for treatment and prevention starting from weaning.
Background:
Acceptance of the prevailing pediatric Rome constipation criteria, by primary care physician, is still low. Even for research purposes they have not been universally adopted. Thus, it has been indicated that some re-evaluation of these criteria would be welcome.
Objective:
The authors aimed to look at the timing of diagnosis and the dietary treatment recommendations in the criteria, to make proposals trying to approximate them to everyday practice.
Methods:
The literature cited in the Rome criteria was reviewed and the publications pertinent to the subject, searched by Medline up to January 2018, were included.
Results:
An early diagnosis is fundamental to avoid evolution to bothersome complications and possibly to 'intractable' constipation, but the inclusion of two items of the criteria might hamper it. Thus, one constipation sign/symptom should suffice, usually the easily observable 'painful or hard bowel movements'. Details about dietary fiber recommendations are missing in the criteria, although its increase is usually the first approach in primary care, and overall the data about dietary fiber supplements point to beneficial effects.
Conclusion:
For diagnosis and treatment of pediatric constipation in primary care, one constipation sign/symptom should suffice. The recommended daily dietary fiber intake, according to the American Health Foundation, should be detailed as a treatment measure, and also for prevention, from weaning on.
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