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Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation

Yıl 2020, Cilt: 4 Sayı: 7, 515 - 518, 01.07.2020

Meryem Keçeli Başaran

https://doi.org/10.28982/josam.742937

Öz

Aim: Functional constipation is a common illness in children that requires close follow-up and long-term treatment. This study aims to compare the effectiveness of lactulose and PEG 4000 in the treatment of pediatric functional constipation.
Methods: One hundred and twenty-three patients included in this cross-sectional study were all diagnosed with functional constipation according to Rome IV criteria. The ages of the patients, who were all referred to the pediatric gastroenterology outpatient clinic between November 2017 and May 2018, ranged between 8 months and 4 years. Patients with accompanying organic diseases were excluded from the study. Children treated with Lactulose were included in the LAC group and those treated with PEG 4000 were included in the PEG group. The number of bowel movements, Bristol Stool Form Scale (BSFS), pain during bowel movements, formation of anal fissures and fecal impaction at diagnosis and during follow-up were noted from the patient files. A comparison was then made in 1st and 3rd months between the diagnostic findings and follow-up of patients in both groups.
Results: There were no age or gender-based differences between the two groups. Sixty-two (50%) patients received lactulose and the remaining 61 patients (50%) received PEG 4000 as treatment. At the end of the third month, patients had improved significantly more in the PEG group in terms of number of daily bowel movements, the presence of pain during bowel movement and median BSFS score (P<0.001).
Conclusion: While lactulose and PEG 4000 are both effective in the treatment of functional constipation in children, PEG 4000 is a more effective and successful treatment option compared to lactulose without increased side effects.

Anahtar Kelimeler

Child Polyethylene glycol 4000 Lactulose Constipation

Kaynakça

  • 1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527-37.
  • 2. Castiglia PT. Constipation in children. J Pediatr Health Care 2001;15:200-2.
  • 3. Wang MG, Wang BX. Initial therapy of constipation in children. J Appl Clin Pediatr. 2006;7:446-8.
  • 4. Corazziari E, Badiali D, Habib FI, Reboa G, Pitto G, Mazzacca G, et al. Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci. 1996;41:1636-42.
  • 5. Gordon M, Naidoo K, Akobeng AK, Thomas AG. Cochrane review: osmotic and stimulant laxatives for the management of childhood constipation. Evid Based Child Health. 2013;8:57-109.
  • 6. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139:428-32.
  • 7. Sood MR, Di Lorenzo C, Hyams J, Miranda A, Simpson P, Mousa H, et al. Beliefs and attitudes of general pediatricians and pediatric gastroenterologists regarding functional gastrointestinal disorders: a survey study. Clin Pediatr (Phila). 2011;50:891-6.
  • 8. Schurman JV, Hunter HL, Friesen CA. Conceptualization and treatment of chronic abdominal pain in pediatric gastroenterology practice. J Pediatr Gastroenterol Nutr. 2010;50:32-7.
  • 9. Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nat Rev Gastroenterol Hepatol. 2011;8:502-11.
  • 10. McKeown C, Hisle-Gorman E, Eide M, Gorman GH, Nylund CM. Association of constipation and fecal incontinence with attention deficit/hyperactivity disorder. Pediatrics. 2013;132:e1210-5.
  • 11. Hoekman DR, Benninga MA. Functional constipation in childhood: current pharmacotherapy and future perspectives. Expert Opin Pharmacother. 2013;14:41-51.
  • 12. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;(7):CD007570.
  • 13. Brady CE, DiPalma JA, Morawski SG, Santa Ana CA, Fordtran JS. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology. 1986;90:1914-8.
  • 14. Youssef N, Di Lorenzo C. Childhood constipation: Evaluation and treatment. J Clin Gastroenterol. 2001;33:199-205.
  • 15. Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, et al. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr. 2005;41:625-33.
  • 16. Loening-Baucke V. Chronic constipation in children. Gastroenterology. 1993;105:1557-64.
  • 17. Leung AK, Chan PH, Cho HY. Constipation in children. Am Fam Physician. 1996;54:611-8.
  • 18. Voskuijl W, de Lorijn F, Verwijs W, Hogeman P, Heijmans J, Mäkel W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut. 2004;53:1590-4.
  • 19. Poddar U, Singh S, Pawaria A, Srivastava A, Yachha SK. An etiological spectrum, clinical differentiation and efficacy of polyethylene glycol over lactulose in children with constipation: Experience of 316 cases. J Paediatr Child Health.. 2018 Jun 26. [Epub ahead of print]
  • 20. Chen SL, Cai SR, Deng L, Zhang XH, Luo TD, Peng JJ, et al. Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis. Medicine (Baltimore). 2014;93:e65.
  • 21. Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a double-blind comparison of PEG + E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr. 2006;43:65-70.
  • 22. Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr. 2005;146:359-63.
  • 23. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila). 2002;41:225-9.
  • 24. Jarzębicka D, Sieczkowska-Golub J, Kierkus J, Czubkowski P, Kowalczuk-Kryston M, Pelc M, et al. PEG 3350 Versus Lactulose for Treatment of Functional Constipation in Children: Randomized Study. J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):318-24.
  • 25. Candy D, Belsey J. Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: a systematic review. Arch Dis Child. 2009;94:156-60.
  • 26. Bae SH, Son JS, Lee R. Effect of fluid intake on the outcome of constipation in children: PEG 4000 versus lactulose. Pediatr Int. 2010;52:594-7.
  • 27. Wang Y, Wang B, Jiang X, Jiang M, Xu C, Shao C, et al. Polyethylene glycol 4000 treatment for children with constipation: A randomized comparative multicenter study. Exp Ther Med. 2012;3:853-6.
  • 28. Treepongkaruna S, Simakachorn N, Pienvichit P, Varavithya W, Tongpenyai Y, Garnier P, et al. A randomised, double-blind study of polyethylene glycol 4000 and lactulose in the treatment of constipation in children. BMC Pediatr. 2014;14:153.
  • 29. Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD009118. DOI: 10.1002/14651858.CD009118.pub3.
  • 30. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258-74. doi: 10.1097/MPG.0000000000000266.

Çocuklarda fonksiyonel konstipasyon tedavisinde polietilen glikol 4000 ve laktuloz etkinliklerinin karşılaştırılması

Yıl 2020, Cilt: 4 Sayı: 7, 515 - 518, 01.07.2020

Meryem Keçeli Başaran

https://doi.org/10.28982/josam.742937

Öz

Amaç: Fonksiyonel konstipasyon çocukluk çağında sık görülen ve yakın takip gerektiren bir hastalıktır. Tedavide PEG 4000 tedavisinin daha etkili olduğu düşünülmektedir. Bu çalışmada fonksiyonel konstipasyonu olan çocuklarda PEG 4000 ve laktuloz tedavilerinin etkinliklerini karşılaştırmayı amaçladık.
Yöntemler: Çalışma Roma 4 kriterlerine göre fonksiyonel konstipasyon teşhisi konulan çocukları içermektedir. Bu çalışma karşılaştırmalı ve kesitsel bir çalışmadır. Çocuk Gastroenteroloji polikliniğine Kasım 2017 ve Mayıs 2018 tarihleri arasında başvuran 123 hasta dahil edilmiştir. Eşlik eden organik hastalığı saptanan hastalar çalışma dışı bırakılmıştır. Laktuloz tedavisi verilen çocuklar LAC grup, PEG 4000 tedavisi verilen çocuklar PEG grup olarak tanımlandı. Hastaların tanı ve takipte bağırsak hareketlerinin sayısı, Bristol Stool Score Form Ölçeği (BSFS), bağırsak hareketleri sırasında ağrı, anal fissür oluşumu ve fekal inkontinans kaydedildi. Daha sonra sırasıyla LAC grup ve PEG grup hastaların takibi arasında 1. ve 3. aylarda karşılaştırma yapılmıştır.
Bulgular: Çalışmaya 123 hasta alındı. 62 hastaya (%50) laktuloz ve geri kalan 61 hastaya (%50) tedavi olarak PEG 4000 verildi. Yaş ve cinsiyet açısından iki grup açısından fark saptanmadı. Üçüncü ayın sonunda, PEG grup çocuklarda iyileşme, günlük bağırsak hareketlerinin sayısı, bağırsak hareketi sırasında ağrı varlığı ve medyan BSFS skoru açısından laktuloz tedavisi gören hastalardan anlamlı olarak farklılık saptandı (P<0,001).
Sonuç: Hem laktuloz hem de PEG 4000, çocuklarda fonksiyonel konstipasyonun tedavisinde etkili olsa da, PEG 4000 tedavisi yan etkileri arttırmayan, laktuloza kıyasla daha etkili ve başarılı bir tedavi seçeneğidir.

Anahtar Kelimeler

Çocuk Polietilenglikol 4000 Laktuloz Konstipasyon

Kaynakça

  • 1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527-37.
  • 2. Castiglia PT. Constipation in children. J Pediatr Health Care 2001;15:200-2.
  • 3. Wang MG, Wang BX. Initial therapy of constipation in children. J Appl Clin Pediatr. 2006;7:446-8.
  • 4. Corazziari E, Badiali D, Habib FI, Reboa G, Pitto G, Mazzacca G, et al. Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci. 1996;41:1636-42.
  • 5. Gordon M, Naidoo K, Akobeng AK, Thomas AG. Cochrane review: osmotic and stimulant laxatives for the management of childhood constipation. Evid Based Child Health. 2013;8:57-109.
  • 6. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139:428-32.
  • 7. Sood MR, Di Lorenzo C, Hyams J, Miranda A, Simpson P, Mousa H, et al. Beliefs and attitudes of general pediatricians and pediatric gastroenterologists regarding functional gastrointestinal disorders: a survey study. Clin Pediatr (Phila). 2011;50:891-6.
  • 8. Schurman JV, Hunter HL, Friesen CA. Conceptualization and treatment of chronic abdominal pain in pediatric gastroenterology practice. J Pediatr Gastroenterol Nutr. 2010;50:32-7.
  • 9. Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nat Rev Gastroenterol Hepatol. 2011;8:502-11.
  • 10. McKeown C, Hisle-Gorman E, Eide M, Gorman GH, Nylund CM. Association of constipation and fecal incontinence with attention deficit/hyperactivity disorder. Pediatrics. 2013;132:e1210-5.
  • 11. Hoekman DR, Benninga MA. Functional constipation in childhood: current pharmacotherapy and future perspectives. Expert Opin Pharmacother. 2013;14:41-51.
  • 12. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010;(7):CD007570.
  • 13. Brady CE, DiPalma JA, Morawski SG, Santa Ana CA, Fordtran JS. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology. 1986;90:1914-8.
  • 14. Youssef N, Di Lorenzo C. Childhood constipation: Evaluation and treatment. J Clin Gastroenterol. 2001;33:199-205.
  • 15. Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, et al. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr. 2005;41:625-33.
  • 16. Loening-Baucke V. Chronic constipation in children. Gastroenterology. 1993;105:1557-64.
  • 17. Leung AK, Chan PH, Cho HY. Constipation in children. Am Fam Physician. 1996;54:611-8.
  • 18. Voskuijl W, de Lorijn F, Verwijs W, Hogeman P, Heijmans J, Mäkel W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut. 2004;53:1590-4.
  • 19. Poddar U, Singh S, Pawaria A, Srivastava A, Yachha SK. An etiological spectrum, clinical differentiation and efficacy of polyethylene glycol over lactulose in children with constipation: Experience of 316 cases. J Paediatr Child Health.. 2018 Jun 26. [Epub ahead of print]
  • 20. Chen SL, Cai SR, Deng L, Zhang XH, Luo TD, Peng JJ, et al. Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis. Medicine (Baltimore). 2014;93:e65.
  • 21. Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a double-blind comparison of PEG + E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr. 2006;43:65-70.
  • 22. Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr. 2005;146:359-63.
  • 23. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila). 2002;41:225-9.
  • 24. Jarzębicka D, Sieczkowska-Golub J, Kierkus J, Czubkowski P, Kowalczuk-Kryston M, Pelc M, et al. PEG 3350 Versus Lactulose for Treatment of Functional Constipation in Children: Randomized Study. J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):318-24.
  • 25. Candy D, Belsey J. Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: a systematic review. Arch Dis Child. 2009;94:156-60.
  • 26. Bae SH, Son JS, Lee R. Effect of fluid intake on the outcome of constipation in children: PEG 4000 versus lactulose. Pediatr Int. 2010;52:594-7.
  • 27. Wang Y, Wang B, Jiang X, Jiang M, Xu C, Shao C, et al. Polyethylene glycol 4000 treatment for children with constipation: A randomized comparative multicenter study. Exp Ther Med. 2012;3:853-6.
  • 28. Treepongkaruna S, Simakachorn N, Pienvichit P, Varavithya W, Tongpenyai Y, Garnier P, et al. A randomised, double-blind study of polyethylene glycol 4000 and lactulose in the treatment of constipation in children. BMC Pediatr. 2014;14:153.
  • 29. Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD009118. DOI: 10.1002/14651858.CD009118.pub3.
  • 30. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258-74. doi: 10.1097/MPG.0000000000000266.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Araştırma makalesi
Yazarlar

Meryem Keçeli Başaran 0000-0001-8362-8618

Yayımlanma Tarihi 1 Temmuz 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 4 Sayı: 7

Kaynak Göster

APA Keçeli Başaran, M. (2020). Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. Journal of Surgery and Medicine, 4(7), 515-518. https://doi.org/10.28982/josam.742937
AMA Keçeli Başaran M. Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. J Surg Med. Temmuz 2020;4(7):515-518. doi:10.28982/josam.742937
Chicago Keçeli Başaran, Meryem. “Comparison of Effectiveness Between Polyethylene Glycol 4000 and Lactulose in the Treatment of Pediatric Functional Constipation”. Journal of Surgery and Medicine 4, sy. 7 (Temmuz 2020): 515-18. https://doi.org/10.28982/josam.742937.
EndNote Keçeli Başaran M (01 Temmuz 2020) Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. Journal of Surgery and Medicine 4 7 515–518.
IEEE M. Keçeli Başaran, “Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation”, J Surg Med, c. 4, sy. 7, ss. 515–518, 2020, doi: 10.28982/josam.742937.
ISNAD Keçeli Başaran, Meryem. “Comparison of Effectiveness Between Polyethylene Glycol 4000 and Lactulose in the Treatment of Pediatric Functional Constipation”. Journal of Surgery and Medicine 4/7 (Temmuz 2020), 515-518. https://doi.org/10.28982/josam.742937.
JAMA Keçeli Başaran M. Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. J Surg Med. 2020;4:515–518.
MLA Keçeli Başaran, Meryem. “Comparison of Effectiveness Between Polyethylene Glycol 4000 and Lactulose in the Treatment of Pediatric Functional Constipation”. Journal of Surgery and Medicine, c. 4, sy. 7, 2020, ss. 515-8, doi:10.28982/josam.742937.
Vancouver Keçeli Başaran M. Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation. J Surg Med. 2020;4(7):515-8.
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