Refractory/therapy-resistant/intractable constipation in children

A better understanding of key concepts is required to properly characterise intractable constipation (IC). We aimed to determine how IC is defined by Latin and Ibero-American paediatric gastroenterologists.

A questionnaire was administered to evaluate concepts supporting the definition and use of a unified term for IC. The collected data were analysed using univariate and bivariate analyses. ORs with their corresponding 95% CIs were calculated, p values <0.05 were statistically significant.

A total of 429 paediatric gastroenterologists participated: 45.7% Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) members (group 1), 16.3% Ibero-American LASPGHAN members (group 2) and 38.0% non-LASPGHAN affiliates (group 3). Most respondents considered lower bowel frequency despite receiving 'optimal medical treatment' (94.6%), with 51.0% indicating a period of 2-3 months; defined 'prior treatment failure' as the use of two laxatives (51.7%); selecting the tertiary level care prior to diagnosis (43.1%); wished to include the term 'optimal medical treatment' for diagnostic criteria (93.0%); believed follow-up should be carried out by a paediatrician/specialist (86.7%) and preferred the term refractory constipation (86.7%). When comparing group 1 versus group 2, the Spanish group preferred the term 'treatment-resistant constipation' (OR=1.96; 95% CI 1.08 to 3.55; p=0.0157).

Latin and Ibero-American paediatric gastroenterologists prefer replacing the term 'IC' with 'refractory/treatment-resistant constipation' defined as a form of paediatric FC characterised by the persistence of clinically relevant symptoms despite optimal conventional medical treatment, appropriately prescribed, supervised and adhered to for a minimum period of 2-3 months, after structural, neurological and metabolic organic causes have been excluded.