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Polyethylene glycol-electrolyte solution for intestinal clearance in children with refractory encopresis. A safe and
1Department of Pediatrics, University of California, San Francisco.
Insights
Polyethylene glycol-electrolyte solution effectively cleanses the bowel in children with severe constipation and encopresis unresponsive to other treatments. This safe and efficient method minimizes side effects and hospitalization needs for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Disorders
- Pharmacology
Background:
- Children with encopresis and severe fecal retention often require hospitalization and invasive treatments.
- Conventional therapies like cathartics and enemas may be insufficient for refractory cases.
- A need exists for safe and effective bowel-cleansing agents in pediatric populations.
Purpose of the Study:
- To evaluate the safety and efficacy of polyethylene glycol-electrolyte solution for bowel preparation in children.
- To assess its utility in treating severe fecal impaction in encopretic children.
- To compare its use in encopretic children versus children undergoing colonoscopy.
Main Methods:
- A prospective study involving 24 pediatric patients (mean age 8.1 years).
- Administration of polyethylene glycol-electrolyte solution at 14-40 mL/kg/h until clear rectal effluent.
- Measurements included weight, CBC, electrolytes, BUN, creatinine, and abdominal X-rays for encopretic patients.
Main Results:
- Successful intestinal cleansing was achieved in all 24 patients with minimal side effects.
- Encopretic children required significantly more solution (11.8 L) over a longer duration (22.5 hours) than those for colonoscopy (4.0 L, 7.5 hours).
- No significant changes in weight, serum electrolytes, or creatinine were observed; minor hematocrit decrease in encopretic patients.
Conclusions:
- Polyethylene glycol-electrolyte solution is a safe and effective option for bowel cleansing in children, including those with severe encopresis.
- It offers a viable alternative to prolonged hospitalization and conventional treatments for refractory constipation.
- Further research may explore optimal dosing and duration for specific pediatric conditions.
Abstract:
Severely constipated children with encopresis in whom outpatient management has failed frequently require several days of hospitalization, as well as conventional treatments involving cathartics and enemas. A balanced electrolyte solution of the nonabsorbable polymer polyethylene glycol (GoLytely, Braintree [Mass] Laboratories Inc) offers a safe and efficient method for clearing the intestine. Twenty-four patients with a mean age of 8.1 years (range, 0.8 to 17.6 years) and an average weight of 31.5 kg received polyethylene glycol-electrolyte solution: eight patients with encopresis were given it as treatment for severe fecal retention unresponsive to outpatient management; the other 16 were being prepared for colonoscopy. Weight, complete blood cell count, and serum electrolyte, serum urea nitrogen, and serum creatinine levels were measured before solution administration and two hours afterward. Abdominal roentgenograms were obtained from the encopretic patients. The two groups were comparable in age and weight. Polyethylene glycol-electrolyte solution was given at a rate of 14 to 40 mL/kg/h until clear fluid was excreted through the rectum. Intestines were cleaned out successfully in all patients, and side effects were minimal. Children with encopresis required an average of 11.8 L (574 mL/kg) given over 22.5 hours, while the other children needed only 4.0 L (128 mL/kg) given over 7.5 hours. Weight and serum electrolyte and creatinine levels did not change significantly in any patient. The hematocrit decreased only in encopretic patients (0.38 to 0.36 [37.6% to 35.8%]) and the serum urea nitrogen level decreased in the patients undergoing colonoscopy (3.6 to 2.0 mmol/L [10 to 8 mg/dL]).