Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Factors Contributing to Treatment Outcome of Functional Constipation in Children

소아 기능성 변비의 치료에 영향을 미치는 인자

  • Kim, Hyung-Seok (Department of Pediatrics, School of Medicine, Pusan National University) ;
  • Hong, You-Rha (Department of Pediatrics, School of Medicine, Kosin University) ;
  • We, Ju-Hee (Department of Pediatrics, School of Medicine, Pusan National University) ;
  • Park, Jae-Hong (Department of Pediatrics, School of Medicine, Pusan National University)
  • 김형석 (부산대학교 의학전문대학원 소아과학교실) ;
  • 홍유라 (고신대학교 의과대학 소아과학교실) ;
  • 위주희 (부산대학교 의학전문대학원 소아과학교실) ;
  • 박재홍 (부산대학교 의학전문대학원 소아과학교실)
  • Received : 2010.02.19
  • Accepted : 2010.03.08
  • Published : 2010.03.30
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Abstract

Purpose: The aim of this study was to evaluate the clinical features and factors contributing to treatment outcome for chronic functional constipation in children. Methods: We analyzed the medical records of patients with constipation, who visited the inpatient or outpatient clinic of the Department of Pediatrics of Pusan National University Hospital, between January 1998 and December 2007. The clinical features, outcomes, and factors affecting the treatment response according to the main drug (lactulose vs. PEG 4000) were analyzed retrospectively. Results: Two hundred forty children (142 males and 98 females) were enrolled in this study. The mean age was 51.2${\pm}$37.9 months. The duration of symptoms was 32.6${\pm}$33.7 months. The accompanying symptoms were as follows: encopresis, 91 (30.4%); abdominal pain, 76 (31.6%); and blood-tinged stool, 37 (15.4%). The treatment response was achieved earlier in females (p<0.001), patients with accompanying symptoms (p<0.05), and patients treated with PEG 4000 (p=0.001). The duration of symptoms (p<0.05) and stool frequency before treatment (p<0.05) were related to a delayed treatment response. Relapse occurred in 7 children, all of whom were treated successfully later. Conclusion: Factors contributing to treatment response are female gender, accompanying symptoms, duration of symptoms, and stool frequency before treatment. PEG 4000 is superior to lactulose in response time and taken into consideration as a primary drug for the treatment of functional constipation of children. Early treatment and sufficient treatment time may also be important factors to achieve an early response and prevent relapse.

목 적: 소아에서 기능성 변비는 흔히 볼 수 있는 질환이지만 임상적 경과 및 치료 반응에 대한 대단위 연구가 없는 실정이다. 이 질환의 임상적 특징과 치료에 영향을 미치는 인자들을 알아보고자 본 연구를 시행하였다. 방 법: 1998년 1월부터 2007년 12월까지 부산대학교 병원 소아과에서 변비로 치료를 받았던 500명 중 Iowa 기준에 따라 기능성 변비로 1개월 이상 치료를 받고 경과관찰이 가능하였던 240명의 환자를 대상으로 후향적조사를 하였다. 변비의 주 치료제로 락툴로스를 복용한 군(145명)과 PEG (polyethylene glycol)를 복용한 군(95명)으로 나누었다. 환자에 따라 magnesium hydroxide, psyllium, bisacodyl, domperidone, 고장성 인산염 관장액등을 병용하였다. 치료 반응은 약물 투여 후 이틀에 1회 이상 통증이 없이 배변을 하는 시점으로 하였고, 치료 반응이 3개월 이상 유지되면 약물을 감량하였다. 결 과: 1) 남자 142명(59.2%), 여자 98명(40.8%)이었고, 발병 시 연령은 18.7${\pm}$21.5개월, 진단 시 연령은 51.2${\pm}$37.9개월이었다. 발병 시 연령은 1세 이하가 94명(39.2%)으로 가장 많았다. 2) 증상 지속 기간은 32.6${\pm}$33.7개월, 치료 전 배변 빈도는 1회/4.8일이었다. 3) 동반 증상은 유분증 91명(30.4%), 복통 76명(31.6%), 혈변37명(15.4%), 식욕저하 23명(9.6%), 복부팽만 18명(7.5%), 구토 14명(5.8%)이었다. 4) 배변 빈도가 락툴로스 투여군 1회/4.6일로 PEG 투여군 1회/5.2일에 비해 짧았던 것을 제외하고 두 군 간에 차이는 없었다. 5) 치료 반응은 여자에서(p<0.001), 동반증상이 있었을 때(p<0.05), PEG 투여군에서(p=0.001) 의미 있게 빨랐으며, 치료 전 증상 지속 기간이 길수록(p<0.05), 배변 빈도가 적을수록(p<0.05) 늦었다. 6) 총 치료 기간은 성별, 증상 발생 나이, 증상 지속 기간, 배변 빈도, 동반 증상, 유분증 유무, 타병원에서의 치료, 민간 요법 시행, 치료 약물의 종류와 무관하였다. 7) 7명(락툴로스군 6명, PEG군 1명)에서 치료 후 재발이 있었으나, 2명을 제외하고 재치료로 완치되었다. 결 론: 여자, 치료 전 증상 지속 기간 및 배변 빈도가 치료 반응에 중요한 인자였고, PEG가 락툴로스에 비해 치료 반응 시간이 짧았기 때문에 1차 치료 약제로 고려해 볼 수 있겠다. 총 치료 기간에 영향을 미치는 요인은 없었으나, 조기 치료가 치료 반응 및 치료 기간을 단축할 수 있으리라 판단된다.

Keywords

References

  1. Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005;146:359-63. https://doi.org/10.1016/j.jpeds.2004.10.046
  2. Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child 2007;92:486-9. https://doi.org/10.1136/adc.2006.098335
  3. 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;29:612-26. https://doi.org/10.1097/00005176-199911000-00029
  4. Borowitz SM, Cox DJ, Tam A, Ritterband LM, Sutphen JL, Penberthy JK. Precipitants of constipation during early childhood. J Am Board Fam Pract 2003;16:213-8. https://doi.org/10.3122/jabfm.16.3.213
  5. 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
  6. 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
  7. Lee JH, Lee R, Bae SH. Efficacy and safety of electrolytes-free polyethylene glycol (PEG) 4000 for disimpaction in children with chronic functional constipation. Korean J Pediatr 2008;51:391-5. https://doi.org/10.3345/kjp.2008.51.4.391
  8. Uhm JH. Comparison of polyethylene glycol 4000 and lactulose for treatment of chronic functional constipation in children. Korean J Pediatr 2007;50:752-6. https://doi.org/10.3345/kjp.2007.50.8.752
  9. Ahn YJ, Park JO. Clinical outcome and long term follow-up of chronic functional constipation in children. Korean J Pediatr Gastroenterol Nutr 2006;9:200-9.
  10. 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
  11. Kot TV, Pettit-Young NA. Lactulose in the management of constipation: a current review. Ann Pharmacother 1992;26:1277-82. https://doi.org/10.1177/106002809202601017
  12. Wang BX, Wang MG, Jiang MZ, Xu CD, Shao CH, Jia LY, et al. Forlax in the treatment of childhood constipation: a randomized, controlled, multicenter clinical study. Zhongguo Dang Dai Er Ke Za Zhi 2007;9:429-32.
  13. Thomson MA, Jenkins HR, Bisset WM, Heuschkel R, Kalra DS, Green MR, et al. Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study. Arch Dis Child 2007;92:996-1000. https://doi.org/10.1136/adc.2006.115493
  14. Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethylene 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
  15. 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, randomized, controlled, multicenter trial. Gut 2004;53:1590-4. https://doi.org/10.1136/gut.2004.043620
  16. 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. https://doi.org/10.1177/000992280204100405
  17. 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. Pediatrics 2006;118:528-35. https://doi.org/10.1542/peds.2006-0220
  18. Abi-Hanna A, Lake AM. Constipation and encopresis in childhood. Pediatr Rev 1998;19:23-30.
  19. Seo JW. Constipation and encopresis in children. J Korean Med Assoc 2001;44:59-68. https://doi.org/10.5124/jkma.2001.44.1.59
  20. Kim JY. Constipation in children. Korean J Pediatr 2005;48:355-62.
  21. van Ginkel R, Reitsma JB, Büller 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
  22. Sutphen JL, Borowitz SM, Hutchison RL, Cox DJ. Long-term follow-up of medically treated childhood constipation. Clin Pediatr (Phila) 1995;34:576-80. https://doi.org/10.1177/000992289503401102
  23. Staiano A, Andreotti MR, Greco L, Basile P, Auricchio S. Long-term follow-up of children with chronic idiopathic constipation. Dig Dis Sci 1994;39:561-4. https://doi.org/10.1007/BF02088343