Treatment of intractable constipation in children: experience with cisapride

Area of Science:

• Pediatric Gastroenterology
• Pharmacology
• Clinical Trial Research

Background:

• Intractable constipation is a common and challenging condition in pediatric patients.
• Previous medical therapies often fail to provide adequate relief for these children.
• Pelvic floor dyssynergia is a common comorbidity that requires specific management.

Purpose of the Study:

• To evaluate the efficacy and safety of cisapride in treating pediatric patients with intractable constipation.
• To assess the impact of cisapride on bowel movement frequency, encopresis, and laxative dependence.
• To determine the long-term outcomes of cisapride treatment in this patient population.

Main Methods:

• An open-label trial was conducted on children with intractable constipation who had failed prior medical therapy.
• Eligible children received cisapride (0.2 mg/kg/dose TID) for 12 weeks, excluding those with pelvic floor dyssynergia.
• Patients were prospectively followed for at least 12 months to assess long-term outcomes.

Main Results:

• Cisapride treatment led to a significant increase in weekly bowel movements (1.43 to 6.48) and a significant decrease in daily accidents (2.86 to 0.52).
• Encopresis resolved in 65.2% of cases, and 69% of patients discontinued laxative use.
• After 12 weeks, 66.6% of patients were asymptomatic, and long-term follow-up (20 months) showed 37% recovery.

Conclusions:

• Cisapride is an effective treatment for intractable constipation in children without pelvic floor dyssynergia.
• The medication demonstrates significant short-term and long-term benefits, including reduced encopresis and laxative dependence.
• Cisapride is well-tolerated, offering a valuable therapeutic option for refractory pediatric constipation.