Pediatrician's knowledge on the approach of functional constipation / Conhecimento do pediatra sobre o manejo da constipação intestinal funcional

Abstract Objective: To evaluate the pediatrician's knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation. Methods: A descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013. Results: The majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated. Conclusions: Our results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.

Resumo Objetivo: Identificar o conhecimento do pediatra quanto ao manejo diagnóstico e terapêutico da criança com constipação intestinal funcional. Métodos: Estudo transversal descritivo com amostra constituída de médicos (n=297) entrevistados no 36º Congresso Brasileiro de Pediatria de 2013. Foi usado um questionário autoadministrado referente a um caso clínico hipotético de constipação intestinal. Resultados: Foi observada maior proporção de pediatras do sexo feminino, média de 44,1 anos, tempo de formação médio de 18,8 anos, 56,9% portadores de título de especialista pela Sociedade Brasileira de Pediatria. Exames complementares foram solicitados por 40,4%, a radiografia abdominal foi o mais requisitado (19,5%), seguido por enema opaco (10,4%), exames laboratoriais (9,8%), ultrassonografia de abdome (6,7%), colonoscopia (2,4%), manometria e biópsia (ambas 1,7%). Para o manejo foi sugerida a prescrição de lactulose (26,6%), óleo mineral (17,5%), polietilenoglicol (14,5%), suplemento de fibras (9,1%) e leite de magnésia (5,4%). Orientação alimentar (84,8%), desimpactação fecal (17,2%) e treinamento de toalete (19,5%) também foram indicadas. Conclusões: Evidencia-se uma discordância entre o manejo sugerido pelos pediatras e a conduta preconizada pela literatura disponível atualmente, uma vez que foram solicitados exames complementares desnecessários e não foi recomendada a orientação terapêutica considerada de primeira linha.

Pediatrician's knowledge on the approach of functional constipation. / Conhecimento do pediatra sobre o manejo da constipação intestinal funcional.

OBJECTIVE: To evaluate the pediatrician's knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation. METHODS: A descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013. RESULTS: The majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated. CONCLUSIONS: Our results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.