Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Comparison of polyethylene glycol 4000 and lactulose for treatment of chronic functional constipation in children

소아의 만성 기능성 변비 치료에 polyethylene clycol 4000과 락툴로스의 효과 비교

  • Uhm, Ji Hyun (Department of Pediatrics, College of Medicine, Eulji University)
  • 엄지현 (을지의과대학교 노원을지병원 소아과)
  • Received : 2007.06.04
  • Accepted : 2007.07.13
  • Published : 2007.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : The aim of this study was to compare 2 laxatives, namely, polyethylene glycol 4000 without electrolytes and lactulose, evaluating the efficacy and safety for the treatment of constipation in children. Methods : Fifty-six children with chronic functional constipation were randomly assigned to receive polyethylene glycol 4000 (24 patients) or lactulose (32 patients). Patients or their parents reported defecation frequency, stool consistency, abdominal pain, stool incontinence and side effects after 1, 3, 6 and 12 months of treatment. Percentage of recovered patients were compared with each group. Results : Defecation frequency, abdominal pain and stool incontinence were improved in each group. At 12 months of follow up, 60% of patients treated with polyethylene glycol and 57.7% of patients treated with lactulose were considered as recovered. Conclusion : In this study, both polyethylene glycol and lactulose were equally effective and safe in the long-term treatment of constipation in children. There were no significant differences in recovery rates between 2 groups.

목 적 : 만성 기능성 변비 환아의 치료에서 PEG 4000과 락툴로스의 임상적 효용성에 대해 비교 분석 하였다. 방 법 : 2004년 9월부터 2007년 2월까지 노원 을지병원 소아과에 만성 반복성 복통이나 배변 장애를 주소로 내원하여 만성 기능성 변비로 치료받고 1년간 외래 추적이 가능했던 환아 56명을 대상으로 하였다. 전해질이 함유되지 않은 PEG 4000을 투여한 24명의 환아와 락툴로스를 투여한 32명의 환아들을 대상으로 치료 시작시와 치료 1개월, 3개월, 6개월, 1년 후에 각 약물의 효과와 부작용에 대해 비교 분석하였다. 결 과 : 두 군 모두 배변 횟수가 치료전에 비해 유의하게 증가하였고(P<0.05), 복통 또한 치료 전에 비해 유의한 감소가 있었다(P<0.05). 치료를 시작한 시점에서 12개월이 되었을 때 변비와 유분증으로부터의 회복은 PEG 투여군에서는 12례(60%)에서, 락툴로스 투여군에서는 15례(57.7%)에서 있었으며 두 군 간에 유의한 차이는 없었다. 결 론 : 유소아 만성 변비에서 PEG 4000과 락툴로스는 장기적 유지 요법으로 안전하고 효과적인 약물이며 변비와 유분증으로부터의 회복에 두 군간에 유의한 차이는 없었다.

Keywords

References

  1. Pashankar D, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediar Gastroenterol Nutr 2001;139: 428-32
  2. Attar A, Lemann M, Ferguson A, Halphen M, Boutron MC, Flourie B, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44:226-30 https://doi.org/10.1136/gut.44.2.226
  3. Benninga MA, Voskuijl WP, Taminiau JA. Childhood constipation: is there new light in the tunnel? J Pediatr Gastroenterol Nutr 2004;39:448-64 https://doi.org/10.1097/00005176-200411000-00002
  4. Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1999;28:612-26
  5. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9 https://doi.org/10.1007/BF02234645
  6. Loening-Baucke V, Krishna R, Pashankar DS. Polyethylene glycol 3350 without electrolytes for the treatment of functional constipation in infants and toddlers. J Pediatr Gastroenterol Nutr 2004;39:536-9 https://doi.org/10.1097/00005176-200411000-00016
  7. Canning DA. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Urol 2003;170:327
  8. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr 2002;34:372-7 https://doi.org/10.1097/00005176-200204000-00011
  9. Loening-Baucke V, Pashankar DS. A randomized, prospective, comparison study of Polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. J pediatr 2006;118:528-35 https://doi.org/10.1542/peds.2006-0220
  10. Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. Dose response of PEG 3350 for treatment of childhood fecal impaction. J Pediatr 2002;141: 410-4 https://doi.org/10.1067/mpd.2002.126603
  11. 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 https://doi.org/10.1097/01.mpg.0000181188.01887.78
  12. Hudziak H, Bronowicki JP, Frank P, Dubos-Berogin C, Bigard MA. Low dose of Polyethylene glycol 4000: digestive effects. Randomazed double-blind study in healthy subjects. Gastroenterol Clin Biol 1996;20:418-23
  13. Dupont C, Leluyer B, Amar F, Kalach N, Benhamou PH, Mouterde O, et al. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr 2006;42: 178-85 https://doi.org/10.1097/01.mpg.0000189349.17549.a9
  14. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, et al. Childhood functional gastrointestinal disorders. Gut 1999;45(Suppl 2):60-8
  15. Voskuijl WP, Heijmans J, Heijmans HS, Taminiau JA, Benninga MA. Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. J Pediatr 2004;145:213-7 https://doi.org/10.1016/j.jpeds.2004.04.050
  16. Loening-Baucke V. Factors responsible for persistence of childhood constipation. J Pediatr Gastroenterol Nutr 1987;6: 915-22 https://doi.org/10.1097/00005176-198711000-00016
  17. Chung KS. Chronic constipation in children. Korean J Pediatr 2004;47(3 suppl):631S-42S
  18. de Lorijn F, van Wijk MP, Reitsma JB, van Ginkel R, Taminiau JA, Benninga MA. Prognosis of constipation: clinical factors and colonic transit time. Arch Dis Child 2004;89:723-7 https://doi.org/10.1136/adc.2003.040220
  19. Lewis G, Rudolph CD. Practical approach to defecation disorders in children. Pediatr Ann 1997;26:260-8 https://doi.org/10.3928/0090-4481-19970401-10
  20. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr 2002;41:225-9 https://doi.org/10.1177/000992280204100405
  21. Voskuijl W, de Lorijn F, Verwijs W, Hogeman P, Heijmans J, Makel 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 https://doi.org/10.1136/gut.2004.043620
  22. 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 https://doi.org/10.1097/01.mpg.0000228097.58960.e6
  23. van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 2003;125: 357-63 https://doi.org/10.1016/S0016-5085(03)00888-6
  24. Loening-Baucke V. Factors determining outcome in children with chronic constipation and faecal soiling. Gut 1989;30:999-1006 https://doi.org/10.1136/gut.30.7.999
  25. DiPalma JA, DeRidder PH, Orlando RC, Kolts BE, Cleveland MB. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000;95:446-50 https://doi.org/10.1111/j.1572-0241.2000.01765.x