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The ten "hard" questions in pediatric functional constipation.

Flora Fedele1, Maria Teresa Fioretti1, Elena Scarpato1

  • 1Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.

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Summary

Chronic functional constipation affects many children, impacting their well-being. This review offers pediatric gastroenterologists a guide for managing childhood constipation using non-pharmacological and pharmacological treatments, primarily polyethylene glycol (PEG).

Keywords:
AdolescentsChildrenChronic constipationFunctional gastrointestinal disordersLaxativesPolyethylenglicole

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Area of Science:

  • Pediatric Gastroenterology
  • Childhood Functional Gastrointestinal Disorders

Background:

  • Functional constipation is prevalent in children, significantly impacting their quality of life.
  • Approximately 95% of childhood constipation cases lack an organic cause, defining chronic functional constipation.
  • Diagnosis relies on the Rome criteria and is primarily clinical, avoiding routine investigations unless alarm symptoms are present.

Purpose of the Study:

  • To provide pediatric gastroenterologists with a practical guide for managing chronic functional constipation in children and adolescents.
  • To outline current evidence-based non-pharmacological and pharmacological treatment strategies.
  • To emphasize the role of polyethylene glycol (PEG) as a first-line therapy.

Main Methods:

  • This is a review article, synthesizing existing literature and clinical guidelines.
  • It focuses on diagnostic criteria, non-pharmacological interventions, and pharmacological management.
  • Key therapeutic agents, particularly osmotic laxatives like PEG, are discussed.

Main Results:

  • Non-pharmacological approaches include education, demystification, and toilet training.
  • Pharmacological management involves disimpaction, maintenance therapy, and medication weaning.
  • Polyethylene glycol (PEG) is the recommended first-choice laxative for both disimpaction and maintenance.

Conclusions:

  • Effective management of childhood functional constipation requires a comprehensive approach combining behavioral and pharmacological strategies.
  • Pediatric gastroenterologists can utilize this review as a tool for optimizing patient care.
  • Early and appropriate intervention, guided by established criteria and treatments like PEG, is crucial for improving outcomes.