在有功能性便秘的儿童中注射门肉毒素的有效性
Dhiren Patel1, Pavithra Saikumar1, Mayuri Jayaraman2
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA.
Journal of pediatric gastroenterology and nutrition
|March 24, 2025
概括
门肉毒素 (BTX) 注射改善了功能性便秘儿童的肠道排便频率,但对便失禁的影响很小. 家长和提供者报告的改善明显高于观察到的结果.
科学领域:
- 儿科胃肠病学 儿科胃肠病学
- 结肠直肠手术 结肠直肠手术
- 神经肌肉医学 神经肌肉医学
背景情况:
- 功能性便秘 (FC) 是儿童中普遍存在的疾病.
- 虽然药和行为疗法是标准的,但门肉毒素 (BTX) 注射正在探索耐火性FC.
- 有限的数据存在于BTX在儿科FC的疗效.
研究的目的:
- 评估门BTX注射在治疗儿科功能性便秘方面的疗效.
- 根据便失禁 (FI) 的存在或不存在来评估结果.
- 将观察到的治疗反应与父母和提供者报告进行比较.
主要方法:
- 对63名儿科患者进行了回顾性,多中心的研究,这些患者患有不耐医疗治疗的FC.
- 患者接受了门BTX注射,并被分为三组:具有FI的FC,没有FI的FC和单独的FI.
- 通过改善肠道排便 (BM) 频率和/或FI的分辨率来衡量结果;父母/提供者报告也被收集.
主要成果:
- 52%的患者每周达到>3个骨,17%的FI有所改善.
- 响应率因群体而异:10% (FC与FI),50% (FC没有FI),14% (仅FI).
- 家长/提供者报告 (70%) 大大高估了观察到的改善 (21%). 没有发现与发育迟缓有任何关联.
结论:
- 门BTX注射可以改善儿科FC的BM频率,但对FI的影响有限.
- 在患有FC和发育迟缓/行为障碍的儿童中,BTX的有效性是可疑的.
- 主观的家长/提供者认知与客观的治疗反应之间存在重大差异.
相关概念视频
01:21Drugs for Treatment of Constipation-Predominant IBS
124
Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
124
01:17Drugs for Treatment of Diarrhea-Predominant IBS
131
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
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...
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...
131
01:26Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin
636
Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
The binding of dantrolene to the RYR1...
636
01:22Drugs Affecting GI Tract Motility: Bulk-Forming and Stimulant Laxatives
151
Laxatives enhance bowel movements and alleviate constipation. They augment the stool's bulk, stimulate intestinal muscle contractions, draw water into the intestines, or soften the stool. There are five key types of laxatives: bulk laxatives, stimulant laxatives, osmotic laxatives, stool softeners, and lubricant laxatives.
Bulk-forming laxatives, such as psyllium, methylcellulose, and polycarbophil, absorb water in the intestine, increasing stool bulk and promoting bowel movement. This...
Bulk-forming laxatives, such as psyllium, methylcellulose, and polycarbophil, absorb water in the intestine, increasing stool bulk and promoting bowel movement. This...
151
01:20Drugs Affecting GI Tract Motility: Other Laxatives
139
Laxatives are primarily used to alleviate constipation, a common gastrointestinal disorder characterized by infrequent bowel movements and difficulty passing stools. They work by various mechanisms to increase the volume or frequency of bowel movements. The primary modes of action of laxatives include increasing stool bulk, softening the stool, stimulating intestinal motility, and osmotically drawing water into the intestines.
Osmotic or saline laxatives, like magnesium hydroxide or milk of...
Osmotic or saline laxatives, like magnesium hydroxide or milk of...
139
01:17Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
145
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
145