Transanal irrigation in children with functional constipation: A systematic review and meta-analysis

Area of Science:

• Pediatric Gastroenterology
• Bowel Management
• Clinical Effectiveness Research

Background:

• Refractory functional constipation poses significant management challenges in pediatric populations.
• Transanal irrigation (TAI) is established for neurological disorders and anorectal malformations but less studied in functional defecation disorders.

Purpose of the Study:

• To evaluate the effectiveness and safety of transanal irrigation (TAI) in pediatric patients diagnosed with functional constipation.
• To assess the overall outcomes and tolerability of TAI in this specific pediatric cohort.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, and Google Scholar for studies on TAI in functional constipation.
• Data extraction included study design, sample size, patient demographics, TAI response, and adverse events.
• A meta-analysis using the inverse variance heterogeneity model was performed to synthesize findings.

Main Results:

• Five studies involving 192 children (median age 7-12.2 years) were included, utilizing various TAI systems.
• The pooled success rate for TAI was 62% (95% CI: 52%-71%), with 14% successfully weaned off treatment.
• Pain was the most frequent adverse event (21.7%), and 5.7% of children discontinued TAI due to intolerance.

Conclusions:

• Transanal irrigation demonstrates a 62% success rate in managing refractory functional constipation in children.
• Further high-quality, prospective trials are warranted to solidify TAI's role in treating pediatric functional constipation.