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Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A
Abdol-Mohammad Kajbafzadeh1, Lida Sharifi-Rad2, Behnam Nabavizadeh1
1Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
Insights
Intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) offers a safe and effective treatment for refractory constipation in children. This method shows comparable efficacy to traditional BoNTA injections with added benefits.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Pharmacological Interventions
Background:
- Refractory constipation in children often necessitates advanced treatment strategies beyond conventional therapies.
- Botulinum toxin type A (BoNTA) injections are used for intractable constipation, but alternative administration methods are being explored.
Purpose of the Study:
- To evaluate the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) for treating refractory constipation in children.
- To compare the efficacy of BoNTA/EMDA with standard intrasphincteric BoNTA injections in pediatric patients.
Main Methods:
- A randomized study involving 60 children (aged 5-13) with intractable constipation.
- Participants were assigned to either BoNTA/EMDA or intrasphincteric BoNTA injection groups.
- Bowel habits, constipation scores, pain scores, and quality of life were assessed pre- and post-treatment.
Main Results:
- Both BoNTA/EMDA and intrasphincteric injection significantly reduced constipation criteria fulfillment (80% and 83.3%, respectively) after 1 month.
- Stool form normalization occurred in 73.3% of the BoNTA/EMDA group and 80% of the injection group.
- Constipation and pain scores significantly decreased in both treatment arms.
Conclusions:
- Intrarectal BoNTA/EMDA demonstrates comparable effectiveness to intrasphincteric BoNTA injections for intractable constipation in children.
- The BoNTA/EMDA technique presents advantages including fewer comorbidities, lower cost, and suitability for office-based procedures without general anesthesia.
Introduction:
Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection.
Methods:
From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire.
Results:
After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively).
Discussion:
BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia.
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