Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures
Open accessAbstract
INTRODUCTION: Constipation is a common complaint in children and early intervention with oral laxatives may improve complete resolution of functional constipation. However, most treatment guidelines are based on reviews of the literature that do not incorporate a quality assessment of the studies. OBJECTIVE: To investigate and summarise the quantity and quality of the current evidence for the effect of laxatives and dietary measures on functional childhood constipation. METHODS: The Medline and Embase databases were searched to identify studies evaluating the effect of a medicamentous treatment or dietary intervention on functional constipation. Methodological quality was assessed using a validated list of criteria. Data were statistically pooled, and in case of clinical heterogeneity results were summarised according to a best evidence synthesis. RESULTS: Of the 736 studies found, 28 met the inclusion criteria. In total 10 studies were of high quality. The included studies were clinically and statistically heterogeneous in design. Most laxatives were not compared to placebo. Compared to all other laxatives, polyethylene glycol (PEG) achieved more treatment success (pooled relative risk (RR): 1.47; 95% CI 1.23 to 1.76). Lactulose was less than or equally effective in increasing the defecation frequency compared to all other laxatives investigated. There was no difference in effect on defecation frequency between fibre and placebo (weighted standardised mean difference 0.35 bowel movements per week in favour of fibre, 95% CI -0.04 to 0.74). CONCLUSION: Insufficient evidence exists supporting that laxative treatment is better than placebo in children with constipation. Compared to all other laxatives, PEG achieved more treatment success, but results on defecation frequency were conflicting. Based on the results of this review, we can give no recommendations to support one laxative over the other for childhood constipation.
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Current evidence is weak for using fiber to treat functional constipation in children.
“there is currently little evidence to support the use of fiber for pediatric FC. Multiple systematic reviews note the sparse data and high risk of bias among the current evidence base169–172.”
From The gut Microbiome in adult and pediatric functional gastrointestinal disorders (2019) · cites this paper as [169]
Several systematic reviews describe limited data and high bias risk in studies of fiber for pediatric functional constipation.
“Multiple systematic reviews note the sparse data and high risk of bias among the current evidence base169–172.”
From The gut Microbiome in adult and pediatric functional gastrointestinal disorders (2019) · cites this paper as [169]
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The gut Microbiome in adult and pediatric functional gastrointestinal disorders
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- Authors
- Pijpers, M. A. M., Tabbers, M. M., Benninga, M. A., & Berger, M. Y.
- Affiliations
- Erasmus MC (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Pijpers, M A M
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2008-09-18
- Volume
- 94
- Issue
- 2
- Pages
- 117-131
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2151296144
- Cited by
- 187
- References
- 56
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 61 · 2019: 2 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 9 · 2014: 10 · 2013: 16 · 2012: 11
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Intestinal Malrotation and Obstruction Disorders
- Keywords
- pediatric constipation, functional constipation, laxatives, polyethylene glycol, lactulose, dietary fiber, dietary intervention, stool frequency, treatment efficacy, quality of evidence, best evidence synthesis
- MeSH terms
- Adolescent, Child, Child, Preschool, Constipation, Humans, Infant, Infant, Newborn, Lactulose, Polyethylene Glycols, Quality Assurance, Health Care, Controlled Clinical Trials as Topic, Evidence-Based Medicine, Laxatives
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