Related Experiment Video
Updated: Jan 10, 2026
Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation
Published on: July 5, 2024
Antegrade Continence Enema vs. Botulinum Toxin in Pediatric Chronic Idiopathic Constipation: A 10-Year Retrospective
Prisca C Obidike1, Trevor C Jones1, Chioma Moneme1
1Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA.
Insights
Antegrade Continence Enemas (ACE) and Botulinum Toxin (BT) injections improved pediatric constipation symptoms and reduced laxative use. ACE showed a greater reduction in laxative use but increased healthcare visits compared to BT.
Area of Science:
- Pediatric Surgery
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Chronic Idiopathic Constipation (CIC) is a prevalent pediatric gastrointestinal disorder requiring intervention for refractory cases.
- Surgical options like Antegrade Continence Enemas (ACE) and Botulinum Toxin (BT) injections are considered for severe CIC.
- Evaluating the comparative effectiveness of ACE and BT is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the impact of ACE and BT injections on laxative use in pediatric CIC patients.
- To assess the resolution of constipation-related symptoms and healthcare utilization post-surgery.
- To determine the long-term efficacy and resource utilization of these surgical interventions.
Main Methods:
- A retrospective chart review of pediatric patients (≤18 years) diagnosed with CIC and fecal incontinence (Rome IV criteria) was performed.
- Patients undergoing either ACE channel creation or BT internal anal sphincter injection were included.
- Outcomes measured included changes in daily oral laxative use, symptom resolution (encopresis, abdominal pain, distension), and healthcare visits at 1 year postoperatively.
Main Results:
- Surgery was performed on 47.6% of 125 pediatric CIC patients, with 36.2% receiving ACE and 63.8% receiving BT.
- Daily laxative use decreased significantly in both groups, with a greater reduction observed in the ACE group (41.0% vs. 60.2%).
- Symptom resolution for encopresis, abdominal pain, and distension was significant in both groups, with no intergroup differences. ACE patients had more postoperative outpatient visits, while BT patients had fewer.
Conclusions:
- Both ACE and BT interventions significantly improve constipation symptoms and reduce laxative dependence in pediatric patients.
- ACE demonstrates a superior reduction in daily laxative requirements compared to BT.
- While effective, ACE is associated with increased postoperative healthcare utilization, necessitating careful patient selection and management.
Introduction:
Chronic Idiopathic Constipation (CIC) is a common pediatric gastrointestinal disorder (GI) characterized by persistent difficulty in defecation, with no identifiable underlying cause. Although most patients are successfully treated with medical therapies, surgical intervention is often needed for refractory disease. We evaluated the impact of Antegrade Continence Enemas (ACE) and Botulinum Toxin (BT) injection to the internal anal sphincter on laxative use, symptom resolution, and healthcare utilization.
Methods:
A retrospective chart review was conducted to identify patients ≤ 18 years old presenting to a pediatric surgery clinic with a chief complaint of CIC between 1 March 2014 and 1 March 2024. Patients meeting the Rome IV criteria for idiopathic constipation and fecal incontinence were included. Surgical procedures were categorized into BT injection or ACE channel creation. The primary outcome was change in daily oral laxative use at 1 year, and secondary outcomes included symptom resolution and CIC-healthcare utilization at 1 year postoperatively.
Results:
Of the 125 children who presented with CIC, 47 (37.6%) underwent surgery. Mean age was 6 years at the time of surgery. 17 (36.2%) had ACE channel creation, while 30 (63.8%) received BT injections. At 1 year, daily oral laxative polypharmacy decreased from 60.2% to 41.0%, p < 0.001, with a greater reduction in ACE than BT (adjusted mean difference: -1.05, 95% CI: -1.75 to 0.34, p = 0.004) after adjusting for demographics and baseline clinical factors. Overall, symptom resolution of encopresis (79.1% to 39.5%, p = 0.001), abdominal pain (88.4% to 27.9%, p < 0.001), and abdominal distension (67.4% to 27.9%, p < 0.001) was observed with no significant difference between groups at 1 year. ACE patients had significantly more postoperative outpatient CIC-related visits and no change in ED visits compared to fewer visits in BT patients.
Conclusions:
Both ACE and BT recipients had improvements in constipation-related symptoms and laxative use. However, ACE resulted in a significantly greater reduction in daily laxative use and more postoperative CIC-healthcare visits than BT alone.
Related Concept Videos
01:21Drugs for Treatment of Constipation-Predominant IBS
01:22Drugs Affecting GI Tract Motility: Bulk-Forming and Stimulant Laxatives
Bulk-forming laxatives, such as psyllium, methylcellulose, and polycarbophil, absorb water in the intestine, increasing stool bulk and promoting bowel movement. This...
01:17Drugs for Treatment of Diarrhea-Predominant IBS
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
01:20Drugs Affecting GI Tract Motility: Other Laxatives
Osmotic or saline laxatives, like magnesium hydroxide or milk of...
01:20Drugs Affecting GI Tract Motility: Adsorbents as Antidiarrheal Agents
Adsorbents...
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...