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Impact of Neurodevelopmental Disorders on Bowel Management Outcomes in Children with Functional Constipation
Gabriella R Seidler1, Maria E Knaus2,3, Tariku J Beyene3
1From the The Ohio State University College of Medicine and Medical Student Research Program, The Ohio State University Wexner Medicial Center.
Insights
Structured bowel management programs (BMPs) significantly improved stool and urinary continence in children with functional constipation (FC), including those with neurodevelopmental disorders. These findings highlight BMPs as an effective treatment for pediatric functional constipation.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Disorders
- Bowel Management Programs
Background:
- Functional constipation (FC) is a common pediatric condition.
- Standard management often fails, necessitating structured interventions like bowel management programs (BMPs).
- The efficacy of BMPs in children with FC, particularly those with neurodevelopmental disorders, requires further evaluation.
Purpose of the Study:
- To evaluate the efficacy of BMPs for children with FC.
- To compare outcomes in children with FC only versus those with FC and neurodevelopmental disorders.
Main Methods:
- Retrospective review of 156 children with FC from 2014-2021.
- Assessment of stool/urinary continence, bowel regimens, and parent-reported outcomes (PROMs) pre- and post-BMP (≥9 months).
- Included PROMs: Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score, and Pediatric Quality of Life Inventory (PedsQL).
Main Results:
- Significant improvements in bowel movement frequency and stool/urinary continence for both FC-only and FC with neurodevelopmental disorder groups (P < 0.001 for bowel, P < 0.02 for urinary).
- Most PROMs showed significant improvement post-BMP.
- Clinically meaningful improvement in overall PedsQL scores was observed in both groups.
Conclusions:
- BMPs are effective in improving stool and urinary continence in children with FC, regardless of neurodevelopmental disorder status.
- Further research is needed to assess the long-term durability of these improvements in this complex pediatric cohort.
Objectives:
Patients experiencing functional constipation (FC) can participate in structured bowel management programs (BMPs) to manage constipation or fecal incontinence when standard management fails. We sought to evaluate the efficacy of BMPs for children with FC with and without neurodevelopmental disorders.
Methods:
We performed a retrospective review of children with FC who participated in our BMP from 2014 to 2021. Stool/urinary continence, bowel regimen, surgical history, parent-reported outcomes measures (PROMs: Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and Pediatric Quality of Life Inventory (PedsQL) were assessed pre- and at least 9 months post-BMP.
Results:
The cohort included 156 patients with a median age of 9 years and follow-up of 627 days (IQR: 389-808 days). Two sub-cohorts included patients with FC only (69%) and FC plus a neurodevelopmental disorder (31%): 59% attention-deficit/hyperactivity disorder, 33% autism spectrum disorder, and 8% obsessive-compulsive disorder. Both groups had significantly improved follow-up bowel movement frequency and continence (39%-90% neurodevelopmental, 44%-82% FC only, P < 0.001) and urinary continence (65%-90% neurodevelopmental, 69%-91% FC only, P < 0.02). There was a significant improvement in most of the PROMs at follow-up. Both groups experienced a clinically meaningful improvement in overall PedsQL scores (pre- and postBMP difference of >4.5).
Conclusions:
Patients with FC with and without a neurodevelopmental disorder had significant improvement in stool and urinary continence after undergoing a BMP. Further studies are needed to see if this improvement is durable over a longer period of time in this challenging cohort.
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