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Current practice in the care of children with functional constipation: What is the hold up?
Julia M J van der Zande1,2, Ilan J N Koppen2, Desale Yacob1
1Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Pediatric gastroenterologists worldwide have varying approaches to treating intractable functional constipation (FC) in children. International guidelines are needed to standardize diagnostic testing and surgical decisions for pediatric FC management.
Area of Science:
- Pediatric Gastroenterology
- Functional Bowel Disorders
- Clinical Practice Patterns
Background:
- Intractable functional constipation (FC) in children lacks evidence-based guidelines for evaluation and treatment.
- Current management strategies vary significantly among international pediatric gastroenterologists.
Purpose of the Study:
- To assess and compare the practice patterns of pediatric gastroenterologists globally.
- To identify differences in diagnostic testing and treatment approaches for intractable FC in children.
Main Methods:
- A survey was administered to 90 pediatric gastroenterologists from 18 countries at the 2nd World Congress of Pediatric Neurogastroenterology and Motility.
- The survey covered diagnostic tests, non-pharmacological and pharmacological treatments, and surgical options for intractable FC.
Main Results:
- Anorectal manometry was the most common diagnostic test for intractable FC.
- Significant regional differences were observed, particularly between North American and European practices regarding laxative use, prosecretory medications, and surgical interventions.
- North Americans were more likely to use stimulant laxatives, prosecretory medications, and antegrade continence enemas (ACE).
- Europeans were more likely to require colonic transit testing before surgery.
Conclusions:
- Practice patterns for evaluating and treating intractable pediatric FC are highly variable worldwide.
- There is a clear need for international clinical guidelines to standardize diagnostic and surgical decision-making processes.
Objectives:
For children with intractable functional constipation (FC), there are no evidence-based guidelines for subsequent evaluation and treatment. Our objective was to assess the practice patterns of a large, international cohort of pediatric gastroenterologists.
Methods:
We administered a survey to physicians who attended the 2nd World Congress of Pediatric Neurogastroenterology and Motility held in Columbus, Ohio (USA) in September 2023. The survey included 29 questions on diagnostic testing, nonpharmacological and pharmacological treatment, and surgical options for children with intractable FC.
Results:
Ninety physicians from 18 countries completed the survey. For children with intractable FC, anorectal manometry was the most commonly used diagnostic test. North American responders were more likely than Europeans to use stimulant laxatives (97% vs. 77%, p = 0.032), prosecretory medications (69% vs. 8%, p < 0.001), and antegrade continence enemas (ACE; 83% vs. 46%, p = 0.009) for management. Europeans were more likely than North Americans to require colonic transit testing before surgery (85% vs. 30%, p < 0.001). We found major differences in management practices between Americans and the rest of the world, including use of prosecretory drugs (73% vs. 7%, p < 0.001), anal botulinum toxin injections (81% vs. 58%, p = 0.018), ACE (81% vs. 58% p = 0.018), diverting ileostomies (56% vs. 26%, p = 0.006), and colonic resections (42% vs. 16%, p = 0.012). No differences were found when respondents were compared by years of experience.
Conclusions:
Practice patterns in the evaluation and treatment of children with intractable FC differ widely among pediatric gastroenterologists from around the world. A clinical guideline regarding diagnostic testing and surgical decision-making is needed.
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