Controversies in the Management of Functional Constipation in Children

Area of Science:

• Pediatric Gastroenterology
• Clinical Trials
• Functional Constipation Treatment

Background:

• Functional constipation (FC) affects up to 32.2% of children globally.
• Most children respond to oral laxatives, but 50% remain symptomatic after 5 years.
• There is a need to evaluate novel therapeutic strategies for refractory pediatric constipation.

Purpose of the Study:

• To review current evidence on emerging treatments for pediatric functional constipation.
• To discuss controversies and efficacy of pre- and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery.
• To identify research gaps in the treatment of childhood constipation.

Main Methods:

• Literature review of studies on new treatments for pediatric functional constipation.
• Analysis of evidence for pre- and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery.
• Consideration of recommendations from the Rome foundation pediatric subcommittee on clinical trials.

Main Results:

• Pre- and probiotics and prucalopride demonstrated no significant efficacy in treating childhood constipation.
• Pelvic physiotherapy and sacral nerve stimulation present promising options, warranting larger clinical trials.
• Surgery is reserved as a last resort for pediatric constipation cases.

Conclusions:

• Current evidence suggests limited effectiveness of certain new treatments for pediatric functional constipation.
• Further large-scale, placebo-controlled trials are essential to validate the efficacy of promising interventions.
• Standardized outcome measures are crucial for advancing the treatment landscape of childhood constipation.