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Management of the child with refractory constipation
Julia M J van der Zande1,2, Peter L Lu1
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Alimentary Pharmacology & Therapeutics
|June 26, 2024
Summary
Recent advances in treating pediatric refractory constipation offer new hope. New diagnostic tools and treatments like linaclotide and transanal irrigation can improve outcomes for children with difficult-to-manage constipation.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Pediatric Surgery
Background:
- Pediatric refractory constipation presents significant management challenges.
- Current management practices for this condition are highly variable.
- There is a need for updated guidelines and treatment algorithms.
Purpose of the Study:
- To review recent advancements in evaluating and treating pediatric refractory constipation.
- To propose a management algorithm integrating the latest evidence and clinical experience.
- To provide clinicians with an updated approach to complex pediatric constipation cases.
Main Methods:
- Comprehensive literature review on diagnostic tests for refractory constipation in children.
- Review of emerging and established treatment options for pediatric refractory constipation.
- Synthesis of evidence to inform a clinical management algorithm.
Main Results:
- Advanced diagnostics like anorectal and colonic manometry aid in identifying underlying disorders.
- Newer pharmacologic options (e.g., linaclotide) and interventions (e.g., transanal irrigation, botulinum toxin injections) show promise.
- Surgical options including antegrade continence enemas, colonic diversion, and resection are reserved for severe, refractory cases.
Conclusions:
- Recent therapeutic and diagnostic innovations provide improved options for children with refractory constipation.
- An evidence-based algorithm can guide the multidisciplinary management of these complex pediatric cases.
- Further research is ongoing to refine treatment strategies for pediatric refractory constipation.
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