• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.44-54
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• 2008

Chronic functional constipation is a common problem in childhood, with soiling a significant issue. It presents a management problem for pediatrician, and parental concern is high. About 5% of pediatric patients is known to have constipation and/or encopresis which is the second most referred disease in pediatric gastroenterology clinic, accounting for up to 25% of all visits. The etiology of constipation was based on initiation factors including vicious cycle concept, genetic factors, psychological factors, dietary influences and histologic abnormalities of colon. Emphasis is placed on the evaluation and management options that are available to the treating pediatrician. Careful history taking is most important to diagnose functional constipation. In addition, diagnostic tests such as plain abdominal radiograph, colonic transit study, anorectal manometry, barium enema were helpful to diagnose the constipation. Childhood constipation can be very delicate to treat. It often requires prolonged supports by physicians and parents, demystification, medical treatment and especially with the child and parent's cooperation.

• The Journal of Internal Korean Medicine
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• v.33 no.2
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• pp.209-221
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• 2012

Objectives : The aim of this study was to investigate the relationship between the autonomic nervous system and the cold-heat pattern in patients with chronic constipation. Methods : Subjects with chronic constipation (n=30) and without chronic constipation (n=20) were recruited, interviewed and measured for heart rate variability (HRV). Chronic constipation was defined as functional constipation and Irritable Bowel Syndrome (IBS) with constipation based on Rome III criteria. We surveyed patients' general characteristics, categorized by cold-heat pattern, and took measurement of HRV for 5 minutes. Analysis was conducted among these three indices. Results : Women accounted for most of the subjects with chronic constipation (96.7%). In groups with or without constipation, the number of cold patterns was more than of heat patterns. The mean heart rate of subjects without chronic constipation was significantly higher than that of subjects with chronic constipation. No other statistical significance was noted among indices of HRV and cold-heat pattern. Conclusions : Through this study, there were few relationships between autonomic nervous system measured by HRV and cold-heat pattern in chronic constipation.

• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.355-362
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• 2005

Constipation is very common phenomenon during childhood that accounts approximately 3% of general pediatric outpatient visits and up to 25% of visit to the pediatric gastroenterologist. The diagnosis of functional constipation is based on the historical features and absence of physical abnormalities. Most infants and children with chronic constipation require no diagnostic tests. Constipation and subsequent fecal retention behavior often begins soon after experience of painful defecation. The effective management of childhood chronic constipation consist of education, prolonged support by physicians and parents, medications, and long term follow up.

• Journal of Korea Association of Health Promotion
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• v.3 no.1
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• pp.55-61
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• 2005

Functional constipation is regarded as a long-standing symptomatic manifestation of abnormal defecation expressed by either a reduced frequency of bowel movements and /or an altered act of evacuation. Patients with constipation can be treated with laxatives, diets and regular habits. Thorough evaluation of functional constipation is considered in those in whom conservative treatment with dietary advice and use of laxatives fails. Patients with normal colonic transit and normal anorectal function may only need reassurance, education and dietary advice with fiber supplementation. For constipated patients in whom such treatment modalities fail, laxatives including bulk-forming and osmotic agents may be used Although most laxatives, if used intermittently, are relatively safe, they must be chosen bearing in mind possible side effects, patient compliance and their action mechanisms. A subgroup of patients with slow transit through the colon ay be unresponsive to conventional laxatives, and, in these subjects, a trial with enteroprokinetics and sometimes stimulant laxatives should be attempted. This article presents our view of the assessment and pharmacologic treatment of functional constipation.

• Journal of Acupuncture Research
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• v.25 no.5
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• pp.127-137
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• 2008

Objectives : These days, herbal acupuncture therapy is widely applied to many diseases and symptoms by Korean medical doctors in Korea. The aim of this study was to demonstrate the effect of Carthami-Semen herbal acupuncture(CSHA) on chronic constipation. Methods : This single-blind placebo-controlled randomized parellel study enrolled 24 adults with chronic constipation. After one week's run-in period, they were randomly assigned to receive CSHA therapy, or placebo therapy for 4 weeks by 2 times per week. After completing 4 week's therapy, 2 week's follow-up period was continued. During study, defecation frequency, consistency and ease of evacuation were checked before study, every week and follow-up periods. Also, the VAS of constipation, quality of life(QoL) and heart rate variability(HRV : low frequency, high frequency) were checked 3 times totally. Finally, 21 subjects completed the protocol and 20 subjects were analyzed.(1 subject is excluded for analysis because of not following the protocol.) Results : In CSHA group, defecation frequency(continued after 1 week), consistency and ease of evacuation(at 1 week after and follow-up) were increased significantly. The VAS of constipation in CSHA group was significantly decreased. There was no significant change at QoL and HRV. Conclusions : CSHA therapy was effective in treating adults with chronic constipation. Study that have larger case number and longer follow up will be needed in the future.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.19 no.1
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• pp.38-43
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• 2016

Purpose: Each ethnic group has a unique life style, including diets. Life style affects bowel movement. The aim of this study is to describe the results of colon transit time (CTT) tests in Korean children who had chronic functional constipation based on highly refined data. Methods: One hundred ninety (86 males) out of 415 children who performed a CTT test under the diagnosis of chronic constipation according to Rome III criteria at Konkuk University Medical Center from January 2006 through March 2015 were enrolled in this study. Two hundreds twenty-five children were excluded on the basis of CTT test result, defecation diary, and clinical setting. Shapiro-Wilk and Mann-Whitney U, and chi-square tests were used for statistical analysis. Results: The median value and interquartile range (IQR) of CTT was 54 (37.5) hours in Encopresis group, and those in non-encopresis group was 40.2 (27.9) hours (p<0.001). The frequency of subtype between non-encopresis group and encopresis was statistically significant (p=0.002). The non-encopresis group (n=154, 81.1%) was divided into normal transit subgroup (n=84, 54.5%; median value and IQR of CTT=26.4 [9.6] hours), outlet obstruction subgroup (n=18, 11.7%; 62.4 [15.6] hours), and slow transit subgroup (n=52, 33.8%; 54.6 [21.0] hours]. The encopresis group (n=36, 18.9%) was divided into normal transit subgroup (n=8, 22.2%; median value and IQR of CTT=32.4 [9.9] hours), outlet obstruction subgroup (n=8, 22.2%; 67.8 [34.8] hours), and slow transit subgroup (n=20, 55.6%; 59.4 [62.7] hours). Conclusion: This study provided the basic pattern and value of the CTT test in Korean children with chronic constipation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.111-117
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• 2009

Constipation is one of the most common symptoms that a child visits pediatrician. The general approach to the child with functional constipation includes the following steps; disimpaction, maintenance and withdrawal of medication. There are many drugs which can be applied to children; osmotic agents (lactulose, sorbitol, magnesium hydroxide/citrate, polyethylene glycol with/without electrolytes, sodium phosphate, glycerin), stimulants (senna, bisacodyl, caster oil), lubricant (mineral oil), bulking agent (psyllium, cellulose, glucomannan). At each stage of treatment, one or some of these drug can be applied to the purpose. The author tries to summarize recent studies on drugs for constipation in child, and finally introduces new dugs for constipation which is under investigation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.2
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• pp.200-209
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• 2006

Purpose: The purpose of this study was to evaluate the long term outcome and the factors contributing to treatment outcome for chronic functional constipation in children. Methods: Sixty three children were enrolled who had chronic functional constipation and could be followed by telephone contact. They were treated at the Bucheon Soonchunhyang Hospital for more than 1 month and observed from March 2001 to June 2005. We analyzed the clinical features, symptoms and signs, as well as the course and results of treatment. Results: The male to female ratio was 35 (55.6%) : 28 (44.4%). The mean age at the onset of symptoms and diagnosis was $21.1{\pm}23.5$ (1.9~84.0) months and $47.1{\pm}34.2$ (6.9~138.0) months, respectively. The mean defecation frequency before treatment was $3.2{\pm}2.3$ (0.5~10.0) times per week. The symptoms associated with constipation were as follows: soiling 34 (54.0%) which was more common in males than females, large stools in 30 (47.6%), decreased bowel movements less than three times a week in 20 (31.7%), straining during defecation in 19 (30.2%) and retentive posturing 19 (30.2%). The mean duration of follow-up was $34.2{\pm}14.6$ (3.6~60.0) months and 44 (69.8%) patients had their symptoms resolve ("success") and 19 (30.2%) were not resloved ("fail") from the constipation. The time for recovery from soiling, straining during defecation and retentive posturing after treatment was $4.3{\pm}2.4$ (1.0~36.0), $5.0{\pm}1.4$ (0.8~36.0) and $5.0{\pm}3.1$ (1.0~36.0) months, respectively. A relapse of the constipation occurred in 15 (23.8%) patients, 9 (60%) boys and 6 (40%) girls. The time to relapse after cessation of treatment was $2.9{\pm}1.9$ (1.0~6.0) months and the only risk factor associated with relapse was the initial duration of treatment. Conclusion: Most of the patients had resolution of symptoms within five months after treatment; relapse occurred within three months after the interruption of treatment. The duration of treatment was important for recovery and for the prevention of relapse in the constipated children. Thus a long term maintenance of therapy and follow-up is necessary for chronic functional constipation in children.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.752-756
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• 2007

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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.2
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• pp.238-243
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• 2021

Caudal regression syndrome (CRS) is a rare neural tube defect that affects the terminal spinal segment, manifesting as neurological deficits and structural anomalies in the lower body. We report a case of a 31-month-old boy presenting with constipation who had long been considered to have functional constipation but was finally confirmed to have CRS. Small, flat buttocks with bilateral buttock dimples and a short intergluteal cleft were identified on close examination. Plain radiographs of the abdomen, retrospectively reviewed, revealed the absence of the distal sacrum and the coccyx. During the 5-year follow-up period, we could find his long-term clinical course showing bowel and bladder dysfunction without progressive neurologic deficits. We present this case to highlight the fact that a precise physical examination, along with a close evaluation of plain radiographs encompassing the sacrum, is necessary with a strong suspicion of spinal dysraphism when confronting a child with chronic constipation despite the absence of neurologic deficits or gross structural anomalies.