Treatments for intractable constipation in childhood.

Area of Science:

• Pediatric Gastroenterology
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Intractable constipation, prolonged constipation unresponsive to conventional therapy, poses treatment challenges in children.
• It significantly impacts quality of life and health systems, necessitating effective and safe interventions.

Purpose of the Study:

• To evaluate the efficacy and safety of various treatments for intractable constipation in children (0-18 years).

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing pharmacological, non-pharmacological, or surgical treatments to placebo or active comparators.
• Searched multiple databases up to June 2023, including CENTRAL, MEDLINE, and Embase.
• Assessed primary outcomes: symptom resolution, defecation frequency, treatment success, and adverse events using GRADE criteria.

Main Results:

• Included 10 RCTs (1278 children). Evidence certainty was very low for most comparisons due to risk of bias and imprecision.
• Low to moderate certainty evidence suggests oral lubiprostone and oral prucalopride may show little to no difference in treatment success and adverse events compared to placebo.
• Data for botulinum toxin A injections, enemas, and biofeedback therapy were highly uncertain.

Conclusions:

• Robust conclusions on treatment efficacy and safety for pediatric intractable constipation are limited due to very low certainty evidence for most interventions.
• Further high-quality RCTs are needed to establish effective and safe treatment options.