Functional constipation

Background: Early diagnosis of functional constipation is important for reducing its negative consequences on the health of children and adolescents. Objective: To describe the clinical spectrum of functional constipation and bowel habit patterns in schoolchildren recruited from two primary schools and patients from a pediatric gastroenterology outpatient clinic. Methods: This cross-sectional study included 452 students from two elementary schools in the city of Osasco and 81 patients with functional constipation seen in an outpatient clinic specializing in pediatric gastroenterology. All children were aged between 6 and 12 years. The Rome IV criteria (two features for more than 1 month) and the Bristol scale were used. Results: The prevalence of functional constipation among the elementary school students was 22.3% (n=101). Among the 351 students who did not have functional constipation, 182 (51.9%) had one of the clinical manifestations of the Rome IV criteria. Bristol stool scale...

To study the evidence on the role of water and fluid intake in the prevention and treatment of functional intestinal constipation in children and adolescents. A search was carried out in the Medline database (between 1966 and 2016) for all published articles containing the following words: constipation, water, and fluids, published in Portuguese, English, and Spanish. All original articles that assessed children and adolescents were selected by title and abstract. The references of these articles were also evaluated. A total of 1040 articles were retrieved. Of these, 24 were selected for reading. The study included 11 articles that assessed children and adolescents. The articles were divided into two categories, those that evaluated water and fluid intake as a risk factor for intestinal constipation and those that evaluated their role in the treatment of intestinal constipation. Five articles were included in the first category. The criteria for assessing fluid intake and bowel rhyt...

To compare three radiological scores in the study of fecal impaction in children with constipation. To investigate whether these radiological scores are useful in the assessment of fecal disimpaction therapy and if they present a relation with total colonic transit time. The Barr, Blethyn and Leech scores were measured by three observers, independently, in 123 abdominal radiographs. Interobserver agreement in the diagnosis of fecal impaction was calculated for the three scores. In 30 radiographs, the analysis of the scores was performed before and after fecal disimpaction. Total colonic transit time was calculated in 59 radiographs with the use of radiopaque markers. The agreement between pairs of observers was assessed by the kappa coefficient and was good for the Barr (0.56, 0.59 and 0.69) and Leech scores (0.53, 0.58 and 0.61). The Blethyn score presented lower kappa coefficients (0.26, 0.32 and 0.36). In the comparison of methods, Leech and Barr showed a good correlation. After ...

Background and Purpose: Functional constipation (FC) is a gastrointestinal disorder that mainly affects the quality of life (QoL) of children under five years of age. This systematic review aims to compare the effectiveness of drug and behavioral therapies, their treatment outcomes, and preventive strategies for FC in children aged 0-5 years. Materials and Methods: This is a systematic review study based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed, Web of Science, CINAHL, EBSCO, and Cochrane CENTRAL for Englishlanguage studies published from 2014 to June 2025. Thirty one studies met the inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane risk-of-bias tool. Results: Polyethylene glycol (PEG) showed rapid symptom relief in most studies. In one study, the PEG group achieved 7.9 defecations per week versus 5.7 in the lactulose group (P=0.008). Adverse events were also fewer in the PEG group (15 vs 23, P=0.02). In another study, PEG 3350+electrolytes showed higher treatment efficiency (79.5%) compared to rectal enemas (58.3%) in children under two years of age. PEG at doses of 0.45-1.1 g/kg/day was safe and effective in children under 24 months of age, with lower side effects. Behavioral interventions, including toilet training and dietary changes, were effective in reducing recurrence and improving long-term bowel regularity. Their efficacy and impact on QoL can vary based on age, severity of constipation, and duration of treatment. Conclusion: The combined use of drug and behavioral therapies for FC in children aged 0-5 years is more effective and provides sustainable outcomes. This holistic treatment approach should consider age, constipation severity, and individual needs. To improve the efficacy of combined therapies, further high-quality RCTs are required to determine the most effective age-specific behavioral strategies and the best timing for their implementation.

Objectives: Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. Methods: A case---control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. Results: The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p = 0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p = 0.001). Among children with DS, females completed toilet training earlier (p = 0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with

Background and objectives: Functional constipation (FC) and the overweight/obesity (O/O) association are controversial. This study aims to investigate the prevalence of O/O, demographics, and clinical characteristics between children with O/O and normal BMIs, and establish whether O/O constitutes a clinical subgroup. Methods: Retrospective observational study of children/adolescents referred for evaluation of constipation. Inclusion criteria: age between 01-192 months; diagnosis of FC according to the Rome Criteria III-IV; Bristol Stool Form 1 or 2. Results: 450 FC children/adolescents were divided into three subgroups. In total, 34.4% had O/O. The proportion of overweight/obese children increased four times in the 61-192 subgroup (43.1%). Evaluation of subgroups: There was no significant difference in family factors, and there was a high presence of straining and painful defecation in the three subgroups. Evaluating O/O and normal BMI within each subgroup showed no significant difference for most variables. The statistical analysis of the comparisons of bowel movement characteristics between the O/O and normal BMI groups within each subgroup established that the normal BMI group had a higher presence of straining on defecation, blood in stools, and scybalous stools. In comparing BMI z scores, they were higher in the normal BMI group within the 25-60 subgroup than the 61-192 subgroup (p < 0.01). The proportion of overweight/obese children rises after five years old. There was no substantial difference in the clinical characteristics between overweight/obese and normal BMI children. However, the normal BMI group was more symptomatic than the O/O group. This study, therefore, does not document a distinct subgroup of O/O in FC, and probably

Functional constipation (FC) has a pooled world prevalence of 9.5%, a clear definition by Rome IV Criteria, and the NAPGHAN/ESPGHAN guidelines recommendation for management. With well-defined parameters, this commentary discusses the paths followed by the literature to implement different therapeutic modalities over time. The text will prioritize information based on systematic reviews, meta-analyses, or reviews. Recently, an Editorial exploring gastrointestinal diseases across the Lifespan linked constipation as a “vexing issue that, unfortunately, has the potential to impair Health-Related Quality of Life (HRQOL).” Indeed, The Rome Foundation recommended that HRQOL scores may assist in diagnosis, management, prognosis, and therapeutic decisions. Therefore, it can be helpful for clinicians, psychologists, and researchers and could be used to support health services that want to implement an HRQOL program. The final idea is to propose HRQOL as a secondary outcome for Pediatric FC mo...

Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC) , yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence , DGBI characteristics are primarily described in Caucasian populations . We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a crosssectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.

The diagnosis of functional constipation (FC) relies on patient-reported outcomes evaluated as criteria based on the clustering of symptoms. Although the ROME IV criteria for FC diagnosis is relevant for a multicultural population , how an individual's lifestyle, environment and culture may influence the pathophysiology of FC remains a gap in our knowledge. Building on insights into mechanisms underpinning disorders of gut-brain interactions (formerly functional gastrointestinal disorders) in the COMFORT Cohort , this study aimed to investigate the differences in gastrointestinal (GI) symptom scores among participants with FC in comparison to healthy controls between Chinese and non-Chinese New Zealanders. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal cohort study, which aimed to determine a comprehensive profile of characteristics and biological markers of FC between Chinese and non-Chinese New Zealanders. Chinese (classified according to maternal and paternal ethnicity) or non-Chinese (mixed ethnicities) adults living in Auckland classified as with or without FC based on ROME IV were enrolled. Monthly assessment (for 3 months) of GI symptoms, anthropometry, quality of life, diet, and biological samples were assessed monthly over March to June 2023. Demographics were obtained through a self-reported questionnaires and GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). This analysis is a cross-sectional assessment of patientreported outcomes of GI symptoms. Of 78 enrolled participants, 66 completed the study (male, n = 10; female, n = 56) and were distributed across: Chinese with FC (Ch-FC; n = 11), Chinese control (Ch-CON; n = 19), non-Chinese with FC (NCh-FC; n = 16), non-Chinese control (NCh-CON; n = 20). Mean (SD) age, body mass index, and waist circumference were 40 ± 9 years, 22.7 ± 2.5 kg/m 2 , and 78.0 ± 7.6 cm, respectively. Ethnicity did not impact SAGIS domain scores for GI symptoms (Ethnicity x FC severity interaction p>0.05). Yet, the constipation symptoms domain of the GSRS was scored differently depending on ethnicity and FC status (Ethnicity x FC interaction p<0.05). In post hoc comparison, NCh-FC tended to have higher GSRS constipation severity scores than Ch-FC (3.4 ± 1.0 versus 3.8 ± 0.8 /8, p<0.1) Although constipation symptom severity tended to be higher in NCh-FC, on the whole, ethnicity did not explain variation in this cohort. FC status was a more important predictor of GI symptoms scores. Future research will assess differences in symptom burden to explore ethnicity-specific characteristics of FC.

Bile acids are metabolites involved in nutrient absorption and signaling with levels influenced by dietary intake, metabolic processes, and the gut microbiome. We aimed to quantify 23 bile acids in fecal samples to ascertain if concentrations differed between healthy participants and those with functional gut disorders. Fecal bile acids were measured using liquid chromatography-mass spectrometry (LC-MS) in the COMFORT (The Christchurch IBS cohort to investigate mechanisms for gut relief and improved transit) cohort of 250 participants with Rome IV IBS (IBS-constipation (C), IBS-diarrhea (D), IBS-mixed (M)), functional gut disorders (functional constipation (FC), functional diarrhea (FD)) and healthy controls (FC n = 35, FD n = 13, IBS-C n = 24, IBS-D n = 52, IBS-M n = 29, and control n = 97). Dietary information was recorded to ascertain three-day dietary intake before fecal samples were collected. Fecal bile acid concentrations, predominantly primary bile acids, were significantly different between all functional gut disorder participants and healthy controls (CDCA p = 0.011, CA p = 0.003) and between constipation (FC + IBS-C) and diarrhea (FD + IBS-D) groups (CDCA p = 0.001, CA p = 0.0002). Comparison of bile acids between all functional groups showed four metabolites were significantly different, although analysis of combined groups (FC + IBS-C vs. FD + IBS-D) showed that 10 metabolites were significantly different. The bile acid profiles of FD individuals were similar to those with IBS-D, and likewise, those with FC were similar to IBS-C. Individuals with a diarrhea phenotype (FD + IBS-D) had higher concentrations of bile acids compared to those with constipation (FC + IBS-C). Bile acid metabolites distinguish between individuals with functional gut disorders and healthy controls but are similar in constipation (or diarrhea) whether classified as IBS or not.

Background: Constipation is a common problem among children. This study aimed to identify the factors related to the duration of chronic functional constipation. The study was conducted on 826 children with chronic functional constipation referring to a pediatric gastrointestinal (GI) clinic in Fars province. The inclusion criteria of the study were suffering from constipation not due to anatomical (Hirschsprung's disease and spinal disease) and organic reasons (non-functional constipation), not suffering from other systemic disorders (hypothyroidism and psychomotor retardation), not having the history of prior anal surgery, and not using drugs inducing constipation. The data were analyzed using a linear regression analysis. Results: This study was performed on 826 children with chronic functional constipation with the mean age of 4.98 + 2.74 years. Among the study children, 418 (50.6%) were boys. Based on the results of multivariate linear regression analysis, the duration of chronic constipation was related to children's age (B = 0.695 [P < 0.001]), intervals between defecations (B = 0.158 [P = 0.036]), age at the onset of defecation control (B = 0.15 [P = 0.050]), intervals of cereals consumption (B = 0.345 [P < 0.001]), and mother's education level (B = 0.283 [P = 0.001]). Accordingly, every year increase in children's age was accompanied by 8.5 months of constipation. In addition, every unit increase in the consumption of cereals during the week (every day, three days a week, once a week, and rarely) caused a four-month increase in chronic constipation. Conclusions: With increasing age, children need parental care to prevent the occurrence of chronic constipation. Moreover, increasing interest in video games has been accompanied by a decrease in physical activity, which requires more attention from parents.

Background: Constipation is a common problem among children. This study aimed to identify the factors related to the duration of chronic functional constipation. The study was conducted on 826 children with chronic functional constipation referring to a pediatric gastrointestinal (GI) clinic in Fars province. The inclusion criteria of the study were suffering from constipation not due to anatomical (Hirschsprung's disease and spinal disease) and organic reasons (non-functional constipation), not suffering from other systemic disorders (hypothyroidism and psychomotor retardation), not having the history of prior anal surgery, and not using drugs inducing constipation. The data were analyzed using a linear regression analysis. Results: This study was performed on 826 children with chronic functional constipation with the mean age of 4.98 + 2.74 years. Among the study children, 418 (50.6%) were boys. Based on the results of multivariate linear regression analysis, the duration of chronic constipation was related to children's age (B = 0.695 [P < 0.001]), intervals between defecations (B = 0.158 [P = 0.036]), age at the onset of defecation control (B = 0.15 [P = 0.050]), intervals of cereals consumption (B = 0.345 [P < 0.001]), and mother's education level (B = 0.283 [P = 0.001]). Accordingly, every year increase in children's age was accompanied by 8.5 months of constipation. In addition, every unit increase in the consumption of cereals during the week (every day, three days a week, once a week, and rarely) caused a four-month increase in chronic constipation. Conclusions: With increasing age, children need parental care to prevent the occurrence of chronic constipation. Moreover, increasing interest in video games has been accompanied by a decrease in physical activity, which requires more attention from parents.

Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut‐Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom‐based sub‐classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD‐GERD), epigastric pain syndrome with irritable bowel syndrome (EPS‐IBS), postprandial distress syndrome with IBS (PDS‐IBS), and FD‐Constipation. We identified putative pathoph...

Introduction: Background: Constipation is a symptom, not a disease, every person in this world experiences constipation at some point in their real life. However, the prevalence of constipation in childhood is more but it is still under-appreciated in paediatric age group. Considering childhood constipation being one of the underappreciated and mismanaged health problems, the faculty members of paediatric surgery department, BSMMU approved a consensus of guideline of management of childhood constipation. It thus assists health care workers in the management of all of the children with constipation in all the level of care i.e. primary, secondary, and tertiary care. Methods: The faculty members of paediatric surgery department of BSMMU addressed the problem of constipation in infants and children who had no previously established medical condition. To develop the initial evidence-based guideline, articles on constipation published in English were found using Medline, Embase and Cochr...

Aim: Hirschsprung's Disease (HD) is a congenital bowel disorder resulting in functional dysmotility. Advancement in surgical techniques has improved outcomes but recent studies have identi ed problems having signi cant impact on patient's quality of life. The aim of this study is to analyze post-operative functional outcome after de nitive surgery for Hirschsprung's disease. Method:A retrospective study was conducted in the department of Pediatric Surgery, The Children's Hospital Lahore. The record of 64 patients was reviewed from the year 2009 -2019. Parents were interviewed on phone calls and a predesigned questionnaire was lled. Degree of constipation, incontinence and voluntary bowel movements was analyzed according to Krickenbeck Classi cation. Results: Median age at initial presentation was 11 days, with male to female ratio of 3.9:1. Most common presentation was delayed passage of meconium (38%). Diagnosis was made on biopsy in 70.3%, while contrast enema and biopsy in 29.7 %. Aganglionosis was limited to short segment in 81.3% & long segment in 14.5%. Decompressing enterostomy was made in 63% at mean age of 191 days. De nitive surgery included Duhamel pull through in 89.1%. The mean age at follow up was 10.6±4.19 years and alive patients are 95.4%. Post-operative enterocolitis was reported by 27%, while 35.5% reported fecal incontinence and 16.1% had complained of constipation. For voluntary bowel movements, 80% could hold bowel movement, among which 5% with feeling of urge and 15% had the capacity to verbalize. In 25 % of patients, fecal incontinence was a constant social problem and in 25% of these patients, constipation was resistant to diet and laxatives. Conclusion: On long term follow up; fecal incontinence was more worrisome affecting quality of life requiring help of bowel management program. Such patients need close follow up after de nitive procedure, so that they have normal stooling habits in their adulthood and lead a normal life.

Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three gro...

Aim: The present study is aimed to investigate the effect of red sugar on functional constipation in children compared to figs syrup. Background: Treatment of constipation in childhood improves gastrointestinal function in the future and regular bowel habit. Red sugar is an effective ingredient in the treatment of constipation. Figs syrup is the other common natural substance used to treat constipation in children. Conducted studies on these two substances and similar herbal substances have shown their beneficial effects, but in a conducted study, it is reported that the effect of fig syrup is less than the chemical material. Methods: This Randomized Controlled Trial (RCT) Study was done in 2016. First, by performing an examination and filling out the identifying form of the patient&#39;s health status, mothers respond to the designed questionnaire. 30 children with constipation were treated with the usual drug, fig syrup, and 30 other children received red sugar. After a 4-week tre...

The purpose of this study was to identify the risk factors for recurrent abdominal pain (RAP) in children who presented with nonorganic acute abdominal pain. Methods: A retrospective, single study was conducted on 2-15-year-old children diagnosed with nonorganic acute abdominal pain at the pediatric outpatient department of Vajira Hospital, Nawamindradhiraj University, between January 2015 and December 2019. The potential risk factors were analyzed using univariate and multivariate analyses. Results: Of the 367 patients with nonorganic acute abdominal pain, 94 (25.6%) experienced RAP within three months. In this group with RAP, 76 patients (80.8%) were diagnosed with functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome, functional abdominal pain-not otherwise specified, and functional constipation. History of gastrointestinal infection (p=0.011), mental health problems (p=0.022), abdominal pain lasting ≥7 days (p<0.001), and change in stool frequency (p=0.001) were the independent risk factors associated with RAP in children with nonorganic acute abdominal pain; their odds ratios and 95% confidence intervals were 3.364 (1.314-8.162), 3.052 (1.172-7.949), 3.706 (1.847-7.435), and 2.649 (1.477-4.750), respectively. Conclusion: RAP is a common problem among children who first present with nonorganic acute abdominal pain. The identification of risk factors may provide proper management, especially follow-up plans for this group in the future.

Increasing evidence exists with respect to the relation between stressful life events and functional constipation (FC). We aimed to investigate the prevalence of FC in Palestinian refugee preschool children and to determine if stress and trauma exposure are risk factors of FC in these children. From November 2013 until May 2014, a cross-sectional survey was conducted in West Bank, Gaza and Jordan. Mothers of 862 Palestinian refugee children aged 7-48 months were interviewed on defecation pattern, socio-economic factors and the child's exposure to traumatic events. Twelve percent of the Palestinian refugee children fulfilled the criteria for FC. The prevalence of constipation was significantly lower in Gaza compared to Jordan (2% vs. 17%, p <0,001). Living in Gaza was associated with lower odds of FC (OR 0,08, 95% CI 0,03-0,20). Trauma exposure was associated with higher odds of FC (OR 1,19, 95% CI 1,06-1,35), however only a small number of children had been exposed to traumatic events. The overall prevalence of FC in Palestinian preschool children is comparable to prevalence rates among older children worldwide. In this age group stressful life events and trauma exposure seem not to play an important role in the development of FC.

Functional constipation (FC) has a pooled world prevalence of 9.5%, a clear definition by Rome IV Criteria, and the NAPGHAN/ESPGHAN guidelines recommendation for management. With well-defined parameters, this commentary discusses the paths followed by the literature to implement different therapeutic modalities over time. The text will prioritize information based on systematic reviews, meta-analyses, or reviews. Recently, an Editorial exploring gastrointestinal diseases across the Lifespan linked constipation as a “vexing issue that, unfortunately, has the potential to impair Health-Related Quality of Life (HRQOL).” Indeed, The Rome Foundation recommended that HRQOL scores may assist in diagnosis, management, prognosis, and therapeutic decisions. Therefore, it can be helpful for clinicians, psychologists, and researchers and could be used to support health services that want to implement an HRQOL program. The final idea is to propose HRQOL as a secondary outcome for Pediatric FC mo...

Objective: To evaluate the health-related quality of life in children with functional defecation disorders. Methods: One hundred children seen consecutively were enrolled and subdivided into three subsets according to the Roma II classification criteria: functional constipation (n = 57), functional fecal retention (n = 29) and nonretentive functional soiling (n = 14). The generic instrument Child Health Questionnaire -Parent Form 50 (CHQ-PF50 ® ), was used to measure quality of life and to assess the impact of these disorders from the point of view of parents. The instrument measures physical and psychosocial wellbeing in 15 health domains, each of which is graded on a scale from 0 to 100, with higher values indicating better health and greater wellbeing. Ten of these are then used to obtain two aggregated and summary scores: the physical and psychosocial scores. Results: No statistically significant differences were detected between subsets in terms of demographic or anthropometric characteristics. In 14 domains, children with defecation disorders scored lower than healthy children. When subsets were compared, statistically significant differences were detected between children with nonretentive functional soiling (lower scores) and those with functional constipation. Physical and psychosocial scores for the entire sample were lower than those for the group of healthy children used as controls. The CHQ-PF50 ® was considered adequate for demonstrating compromised quality of life in children with functional defecation disorders, as has been reported for other diseases, being a useful tool for making treatment decisions and for patient follow-up.

Objectives: Evaluate the effect of combinations of green banana biomass and laxatives in children and adolescents with chronic constipation. Methods: This was a randomized study of 80 children and adolescents with functional constipation according to the Rome IV Criteria, who were divided into five groups: (1) green banana biomass alone; (2) green banana biomass plus PEG 3350 with electrolytes; (3) green banana biomass plus sodium picosulfate; (4) PEG 3350 with electrolytes alone; and (5) sodium picosulfate alone. Primary outcome measure was the reduction of the proportion of patients with Bristol Stool Form Scale ratings 1 or 2. Secondary outcome measures were: increase of the proportion of >3 bowel movements/week and reduction of the proportion of fecal incontinence, straining on defecation, painful defecation, blood in stool, abdominal pain, and decreased laxative doses. Results: On consumption of green banana biomass alone, a statistically significant reduction was observed in the proportion of children with Bristol Stool Form Scale rating 1 or 2, straining on defecation, painful defecation, and abdominal pain. Conversely, no reduction was observed in fecal incontinence episodes/week, blood in stool, and no increase was observed in the proportion of children with >3 bowel movements/week. The percentage of children who required ଝ Please cite this article as: Cassettari VM, Machado NC, Lourenc ¸ão PL, Carvalho MA, Ortolan EV. Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study.

Purpose: To assess and compares sociodemographic, clinical, anthropometric, and treatment characteristics in two subgroups of children with FC: 1) with onset in the first 12 months old and 2) with onset after 13 months old. Methods: Observational, retrospective cohort study, including consecutive cases of children/adolescents for initial evaluation of constipation. Data were collected in a pre-designed standard protocol, and the parents answered all the questions during the first visit. Inclusion criteria: age between 01 month to 15 years of age, with a diagnosis of FC defined according to the Rome Criteria III and Rome IV criteria. Exclusion criteria: constipation of organic etiology; other chronic health problems such as neurological, genetic, mental/psychiatric disorders or growth and development disorders. The stool form was evaluated according to Bristol Stool Form Scale. Two experienced pediatric gastroenterologists determined the patients&#39; final diagnoses of FC. Approval ...

Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut‐Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom‐based sub‐classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD‐GERD), epigastric pain syndrome with irritable bowel syndrome (EPS‐IBS), postprandial distress syndrome with IBS (PDS‐IBS), and FD‐Constipation. We identified putative pathoph...

There is a growing interest for the use of probiotics for chronic constipation. A recent randomized controlled trial (RCT) showed a positive effect of Lactobacillus reuteri (L. reuteri) on bowel movement frequency in infants with chronic constipation. The aim of the present study was to evaluate the effects of L. reuteri in adult patients with functional constipation. A double-blind, placebo RCT was conducted in 40 adults (18M/22F, 35+/-15 years) affected by functional constipation according to the Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri (DSM 17938), or matching placebo for 4 weeks. The increase of bowel movements/week was the primary outcome, while the improvement of stool consistency was the secondary outcome. At week 4, the mean increase in bowel movements/week was 2.6 (SD +/-1.14, 95% CI:1.6-3.6) in the L. reuteri group and 1.0 (SD+/-1. 95% CI:0.12-1.88) in the placebo group (p=0.046). At the end of the treatment, the mean bo...

Objective: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. Methods: A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. Results: At admission, colonic dysmotility was found in 71.9% (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6% (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

The aim of this study was to assess the prevalence of functional constipation and its relationship with the food intake, overweight status, and physical activity of children. METHODS: This cross-sectional study included students from two public schools in the municipality of Osasco, which is located in the metropolitan area of São Paulo. Functional constipation was diagnosed if the clinical manifestations of the Rome IV criteria were present for more than 2 months. A 24-h recall survey was used to determine the daily food intake. Weight, height, abdominal circumference, and bioelectrical impedance were used to evaluate the weight status. Active commuting to school and physical activity scores were assessed using a questionnaire that has been validated in Brazil. RESULTS: A total of 452 children, aged 6-12 years, were evaluated. Functional constipation was observed in 22.3% of participants. A greater abdominal circumference was associated with functional constipation in girls (p=0.036) in the bivariate analysis but not in the logistic regression model. Boys with functional constipation consumed higher quantities of fats (p=0.041). There was no statistically significant relationship between functional constipation and overweight status (44.6 and 34.5% of children with and without constipation, respectively; p=0.083) and active commuting to school (48.5 and 56.7% of children with and without constipation, respectively; p=0.179). CONCLUSION: Functional constipation was associated with a greater abdominal circumference in girls in the bivariate analysis, however, without association in the logistic regression model. Boys with functional constipation consumed higher quantities of fat. No association was found between functional constipation, overweight status, and physical activity.

Background: The Fatigue Rate Index (FRI) is a parameter in anorectal manometry (ARM) to assess sustained voluntary contraction, considering the squeeze pressure and fatigability of the external anal sphincter. It is used in adults to detect fecal incontinence even in patients who present normal squeeze pressures. The FRI in adult patients with functional constipation is similar to controls. Objective: The aim of this study was to evaluate the feasibility and values of FRI in children in relation to the values previously established in adults and comparing children with functional constipation and retentive fecal incontinence to children without retentive fecal incontinence. Methods: This retrospective study evaluated 105 ARM performed from Jan 2014 to Apr 2015. 42 patients were selected (were able to perform a voluntary contraction and had no co-morbidities other than functional constipation). 14 (33.3%) of those collaborated in sustaining contraction for 40 seconds (s), allowing th...

Objectives: To assess the prevalence of functional constipation and its association with overweight, physical activity and the estimation of fat and fiber intake in adolescents. Methods: In all, 386 adolescents aged 14-19 years from the city of Macei o (Alagoas, Northeast Brazil) were included in this study. Participants responded to standardized questionnaires that assessed bowel habits, physical activity and the estimation of fat and dietary fiber intake. Functional constipation was defined according to the Rome criteria. Weight and height were measured using standard methods. Body mass index (BMI) was used to evaluate whether a participant was overweight. Results: The prevalence of constipation was 24.9%. The median BMI was higher in female adolescents with constipation (22.6) compared with female adolescents without constipation (20.0; p ¼ .001). Physical inactivity (fewer than 300 min of physical activity per week) was more frequent in females (62.7%; 126/201) than in males (42.2%; 78/185; p ¼ .000). No association was observed between physical inactivity and functional constipation. Excessive intake of fat in the diet was found in 45.3% (175/ 386) of participants, while poor dietary fiber intake was found in 84.2% (325/386) of participants. No association was found between a fat-rich diet and constipation. Low dietary fiber intake was associated with constipation in female adolescents (odds ratio ¼ 3.42, 95% confidence interval: 1.08 and 12.06). Conclusions: The prevalence of constipation was high among this group of adolescents. Constipation was not associated with physical inactivity but was associated with a low dietary fiber intake and higher BMI values in female adolescents.

OBJETIVOS: Estimar o consumo de fibra alimentar e de macronutrientes por crianças com constipação crônica funcional atendidas em ambulatório especializado. CASUÍSTICA E MÉTODOS: O estudo caso-controle foi desenvolvido no Hospital de Pediatria da Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil. Foram analisadas 54 crianças na faixa etária de 2 a 12 anos com constipação crônica funcional, pareadas por sexo e faixa etária com 50 crianças sem constipação (grupo-controle). A avaliação do consumo alimentar foi feita através do registro alimentar de 3 dias e a análise e adequação das dietas foram realizadas por programa informatizado. RESULTADOS: Em 59,3% dos casos a constipação teve início nos dois primeiros anos de vida. Não houve diferença quanto ao sexo no grupo com constipação, nem associação entre constipação e desnutrição nas crianças estudadas. A quantidade de alimentos ingerida por crianças com constipação foi menor quando comparada à do grupo-controle. O consumo mé...

Background and Objectives: Posterior compartment prolapse is associated with constipation and obstructed defecation syndrome. However, there is still a lack of consensus on the optimal treatment for this condition. We aim to investigate functional, anatomical, and quality-of-life outcomes of native tissue transvaginal repair of isolated symptomatic rectocele. Materials and Methods: We retrospective analyzed patients who underwent transvaginal native tissue repair for stage ≥ II and symptomatic posterior vaginal wall prolapse between January 2018 and June 2021. Anatomical and functional outcomes were evaluated. Wexner constipation score was used to assess bowel symptoms, while the Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. Results: Twenty-eight patients were included in the analysis. The median age was 64.5 years, and half of them underwent a previous hysterectomy for benign reasons. The median follow-up time was 33.5 months. A significant anatomical improvement in the posterior compartment was noticed compared with preoperative assessment (p < 0.001 for Ap and Bp), with only two (7.1%) anatomical recurrences. Additionally, obstructed defecation symptoms decreased significantly compared to baseline (p < 0.001), as well as vaginal bulging, with no new-onset cases of fecal incontinence or de novo dyspareunia. PGI-I resulted in 89.2% of patients being satisfied (PGI-I ≥ 2), with a median score of 1.5. Conclusions: Transvaginal native tissue repair for isolated posterior prolapse is safe and effective in managing bowel symptoms, with excellent anatomical and functional outcomes and satisfactory improvement in patients' quality of life.

Objective-To determine if constipation predominant IBS (IBS-C) is associated with changes in intestinal barrier and secretory function. Design-19 IBS-C patients and 18 healthy volunteers (all females) underwent saccharide excretion assay (0.1 g 13 C mannitol and 1 g lactulose), measurements of duodenal and colonic mucosal barrier (transmucosal resistance (TMR), macromolecular and E. coli Bio-Particle translocation), mucosal secretion (basal and ACh evoked short circuit current, Isc), in vivo duodenal mucosal impedance, circulating endotoxins and colonic tight junction gene expression. Results-There were no differences in the in vivo measurements of barrier function between IBS-C and healthy: cumulative excretion of 13 C mannitol (0-2 hr mean (SEM); IBS-C: 12.1 (0.9) mg vs healthy: 13.2 (0.8) mg) and lactulose (8-24 hr; IBS-C: 0.9 (0.5) mg vs healthy: 0.5 (0.2) mg); duodenal impedance IBS-C: 729 (65) Ω vs healthy: 706 (43) Ω; plasma mean endotoxin activity level IBS-C: 0.36 (0.03) vs healthy: 0.35 (0.02); and in colonic mRNA expression of occludin, ZO 1-3, and claudins 1-12, 14-19. Ex vivo findings were consistent, with no group differences: duodenal TMR (IBS-C: 28.2 (1.9) Ω * cm 2 vs healthy: 29.8 (1.9) Ω * cm 2 ) and colonic TMR (IBS-C: 19.1 (1.1) Ω * cm 2 vs healthy: 17.6 (1.7) Ω * cm 2 ); FITC Dextran (4 kDa) and E. coli Bio-Particle flux. Colonic basal Isc was similar, however, duodenal basal Isc was lower in IBS-C (43.5 (4.5) µA * cm 2 ) vs healthy (56.9 (4.9) µA * cm 2 ), p=0.05. ACh evoked ΔIsc was similar.

Chronic constipation is a common problem with multiple etiologies that has a substantial negative impact on the patient's quality of life. Mechanical reasons for this, such as dolichocolon or dolichosigmoid, often makes conventional treatment with medication and laxatives unsuccessful, turning the situation frustrating for patients and doctors. Surgical resolution in well evaluated patients with dolichocolon and slow transit time, has proven to be a good option if medical treatment has failed. The objective of this paper is to report the results of a series of five patients with severe chronic constipation secondary to dolichosigmoid resolved by laparoscopic sigmoidectomy.

Background. Inconsistent data exist about the role of probiotics in the treatment of constipated children. The aim of this study was to investigate the effectiveness of probiotics in childhood constipation.Materials and Methods. In this placebo controlled trial, fifty-six children aged 4–12 years with constipation received randomly lactulose plus Protexin or lactulose plus placebo daily for four weeks. Stool frequency and consistency, abdominal pain, fecal incontinence, and weight gain were studied at the beginning, after the first week, and at the end of the 4th week in both groups.Results. Forty-eight patients completed the study. At the end of the fourth week, the frequency and consistency of defecation improved significantly (P=0.042andP=0.049, resp.). At the end of the first week, fecal incontinence and abdominal pain improved significantly in intervention group (P=0.030andP=0.017, resp.) but, at the end of the fourth week, this difference was not significant (P=0.125andP=0.161...

Functional constipation is one of the most common gastrointestinal symptoms across the globe. Its high prevalence rate, economic burden, and adverse implications on the quality of life make constipation a major public health issue. Though various treatment options are available for the management of constipation, evidence for their efficacy and safety are limited. An open-label, prospective, interventional, and exploratory clinical trial was carried out to evaluate the efficacy and safety of "TLPL/AY/01/2008" in 34 patients suffering from functional constipation. "TLPL/AY/01/2008" is an Ayurvedic proprietary polyherbal formulation in powder form, containing Isabgol husk, Senna extract, and Triphala extract. Administration of "TLPL/AY/01/2008" for 14 days showed a significant increase in mean weekly bowel movements from 10.19 ± 05.64 to 18.29 ± 05.72 (P<0.05). The mean average time spent on toilet for bowel evacuation reduced significantly from 11.02 ± 05.43 minutes (baseline value) to 08.70 ± 04.72 minutes on day 14 (P<0.05). Mean stool form score assessed on Bristol stool form scale was improved from 02.97 ± 00.48 (baseline value) to 04.61 ± 00.84 (P<0.05) on day 14. A significant improvement (P<0.05) was also noted in straining during defecation, sensation of incomplete evacuation, sensation of anorectal blockage, and other associated symptoms of functional constipation. The significant improvement in most of the above symptoms was endured for a post-treatment observatory period of one week. All the study patients showed an excellent tolerability to the study drug. These findings suggest that "TLPL/AY/01/2008" is an effective, safe, and nonhabit-forming herbal laxative formulation for the management of constipation. Comparative clinical studies with larger sample size would be able to confirm the above findings.

Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut‐Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom‐based sub‐classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD‐GERD), epigastric pain syndrome with irritable bowel syndrome (EPS‐IBS), postprandial distress syndrome with IBS (PDS‐IBS), and FD‐Constipation. We identified putative pathoph...

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Purpose Constipation is a frequent complaint of patients with functional bowel disorders. The present study aimed to evaluate the relationship between the perceived constipation severity with demographics, clinical, physiological, and psychological parameters in constipated patients. Patients and Methods Four hundred seven constipated patients were included and had clinical, physiological, and psychological evaluation. The self-reported severity of constipation was analyzed using stepwise linear regression in the total population and within each clinical group. The patients were mainly of female gender (81%) and were 47.4 ± 16.5 years old. They complained of IBS (65%), and 62% had defecation disorders. The depression scale was abnormal in 200 patients (49%). The relationships of the constipation severity varied according to the Rome IV phenotype. In all phenotypes, it was positively associated with bloating severity, and negatively with Bristol stool form. In IBS patients, perceived constipation severity was also associated with abdominal pain severity. Conclusion Our data support the hypothesis that perceived constipation severity is associated with clinical and physiological factors but not demographics and psychological factors. Besides, the relationships of perceived constipation severity with these factors vary according to clinical phenotypes.

Background The Rome III criteria classify patients complaining of constipation into two main groups: patients with functional constipation (FC) and patients with constipation predominant irritable bowel syndrome (IBS-C). The purpose of this study was to identify differences in the intensity of symptoms and total and segmental colonic transit time in these two types of patients. Methods We performed a prospective evaluation of 337 outpatients consecutively referred for chronic constipation and classified according to the Rome III criteria as FC or IBS-C. They were asked to report symptom intensity, on a 10-point Likert scale, for diarrhea, constipation, bloating and abdominal pain. Stool form was reported using the Bristol scale, and colonic transit time was measured by using multiple-ingestion single-marker single-film technique. Statistical analysis was completed by a discriminant analysis. Results Female gender and obstructed defecation was more frequent in IBS-C patients than in FC patients. IBS-C patients reported greater symptom intensity than FC patients, but stool form, and total and segmental colonic transit time were not different between the two groups. Multivariate logistic regression showed that only two parameters, bloating and abdominal pain, were related to the IBS-C or to the FC phenotype, and discriminant analysis showed that these two parameters were sufficient to give a correct classification of 71% of the patients. Conclusions Our study suggests that self-evaluation of abdominal pain and bloating is more helpful than colonic transit time in classifying patient as IBS-C or FC.

Introduction: Studies on colonic motor function in pediatric patients with constipation have revealed some dysfunctional patterns of colonic transit. We aimed to evaluate the times and patterns of colon transit time to diagnose and categorize of colon abnormalities. Materials and methods: This descriptive, cross-sectional study was performed at Dr. Sheikh Pediatrics Hospital of Mashhad University of Medical Sciences, Mashhad, Iran during 2013-2019. Sixty-four children with chronic constipation that were referred to the radiology department were enrolled in the study. Segmental and total colon transit times (CTT) were calculated by using plastic markers and Metcalf Protocol. Results: Among 68 children with constipation (aged between 2 and 18 years), about half of patients had normal segmental and total CTT. Of 55 patients with a normal total CTT, 20 (36%) had a prolonged segmental CTT. The normal upper limit for right, left, rectosigmoid and total CTT respectively 20, 20, 30, and 60 ...

A well-known functional gastrointestinal disorder called functional dyspepsia (FD) is defined by dyspeptic symptoms without any structural abnormalities. In alternative intervention, electrolyzed alkaline-reduced water (EARW) consumption is regarded as a treatment modality for gastrointestinal symptoms despite its mechanism not yet fully understood. The present clinical study aimed to investigate the effects of EARW on gastrointestinal symptoms of patients with FD. Forty-eight participants with FD were screened, and 42 were enrolled. Participants were randomly allocated to the EARW (n = 21) and purified water (PW) (n = 21) groups. The EARW group ingested EARW (10 mL/kg body weight/day) for 6 weeks. The gastrointestinal symptom rating scale (GSRS), functional dyspepsia-related quality of life (FD-QoL), the Korean version of the Nepean Dyspepsia Index (NDI-K) were used as primary outcome measures at baseline and at 6 weeks, and inflammatory markers were measured as the secondary outco...

Background and Objectives: Chronic functional constipation is a prevalent and symptom-based disorder of the gastrointestinal tract. Constipation takes several different forms among patients. The Wexner Constipation Scoring System (WCSS) was developed to present a uniform tool for the assessment of chronic functional constipation. The purpose of this study was to provide the Persian version of WCSS and assess its validity and reliability. Methods: WCSS was translated into Farsi. After being linguistically validated, the Persian version of the WCSS was administered to a sample of 76 patients with chronic functional constipation. Reliability tests were used to evaluate the internal consistency (the Cronbach alpha) and reproducibility (Intraclass Coefficient Correlation [ICC]) of the tool. The validation studies were conducted to assess the convergent validity (Correlated with the Patient Assessment of Constipation Symptom [PAC-SYM]) and Concurrent Validity (Correlated with Patient Asse...

Background: Functional constipation is a common and annoying gastrointestinal disorder among children worldwide in which the intestinal microbiota composition plays a fundamental role. This study aimed to compare the quantity of main intestinal Lactobacillus species in constipated children and healthy controls. Materials and Methods: Fecal samples were collected from 40 children fulfilling Rome IV criteria for functional constipation and 40 healthy volunteers. Quantitative real-time polymerase chain reaction (qPCR) method with species-specific primers was used to investigate seven main Lactobacillus species in fecal samples. Results: Lactobacillus strains of the patient group were different from the healthy controls, main differences being noticeable decrease in the population quantity of Lactobacillus reuteri (mean 10 2.61 CFU/gram feces) and lower abundance of Lactobacillus fermentum (p<0.0001). Conclusion: Lactobacillus species might be quantitatively altered in childhood functional constipation. Our findings on the different species of Lactobacillus population showed significantly decreased quantity in the patient group compared with the healthy subjects.