RESUMO
Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, commonly present with red flag signs and symptoms. A history and physical examination can diagnose functional constipation using the Rome IV diagnostic criteria. The first goal of managing constipation is to treat fecal impaction, and then maintenance therapy is used to prevent a recurrence. Polyethylene glycol is the first-line treatment for constipation. Second-line options include lactulose and enemas. Increasing dietary fiber and fluid intake above usual daily recommendations and adding probiotics provide no additional benefits for treating constipation. Frequent follow-up visits and referrals to a psychologist can assist in reaching some treatment goals. Clinicians should educate caregivers about the chronic course of functional constipation, frequent relapses, and the potential for prolonged therapy. Clinicians should acknowledge caregivers' specific challenges and the negative effects of constipation on the child's quality of life. Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy.
Assuntos
Impacção Fecal , Laxantes , Adolescente , Criança , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Impacção Fecal/complicações , Impacção Fecal/tratamento farmacológico , Humanos , Lactulose/uso terapêutico , Laxantes/uso terapêutico , Qualidade de VidaRESUMO
INTRODUCTION AND AIM: Functional abdominal pain (FAP) is one of the major gastrointestinal complaints in childhood. Studies have reported occult constipation (OC) as one of the leading causes of abdominal pain. Recent researches have proposed laxatives as potent therapeutic targets for abdominal pain in patients with OC. However, no study has compared effect of poly ethylene glycol (PEG) and lactulose on occult constipation. MATERIALS AND METHODS: 51 patients aged 4 to 18 years with abdominal pain who had OC (defined as fecal impaction in abdominal X ray) were studied. Demographic and clinical data including age, sex, body weight, height, abdominal pain duration, abdominal pain rate and fecal odor were registered. They were randomly assigned to receive PEG (1gr/kg) or Lactulose (1cc/kg) for at least two weeks. All patients were reevaluated by pain measurement scale after at least two weeks of treatment. RESULTS: It is indicated that the efficacy of PEG for reducing abdominal pain in OC was 48% while it was 37% for Lactulose. This study indicated that this efficacy is not affected significantly by sex and fecal odor, however this efficacy is influenced by age, body weight, abdominal pain duration and abdominal pain rate for both PEG and Lactulose. CONCLUSION: It could be concluded that PEG is a more efficient drug for treating abdominal pain in occult constipation than Lactulose and its optimum effect can be achieved in elder patients with more severe abdominal pain.
Assuntos
Dor Abdominal/tratamento farmacológico , Constipação Intestinal/tratamento farmacológico , Impacção Fecal/tratamento farmacológico , Lactulose/uso terapêutico , Laxantes/uso terapêutico , Polietilenoglicóis/uso terapêutico , Dor Abdominal/etiologia , Adolescente , Fatores Etários , Peso Corporal , Criança , Pré-Escolar , Constipação Intestinal/complicações , Impacção Fecal/complicações , Impacção Fecal/diagnóstico por imagem , Feminino , Humanos , Masculino , Medição da Dor/métodos , Fatores Sexuais , Fatores de TempoRESUMO
Fecal disimpaction in the hospital setting may be necessary for a constipated child's condition to improve. This study evaluated the efficiency of 2 disimpaction therapies: nasogastric GoLYTELY (polyethylene glycol-electrolyte solution) compared with oral magnesium citrate. Retrospective chart review of 103 children was conducted to determine the time from the start of the clinic cleanout until abdominal radiograph verification of successful stool evacuation. The children were in an age range of 1-18 years, with average age of 8 years. Forty-five were female and 59 were male. Forty-six (45%) children received nasogastric polyethylene glycol-electrolyte and 57 (55%) drank magnesium citrate. The children receiving nasogastric polyethylene glycol-electrolyte on average required 2.5 enemas, and the children receiving magnesium citrate required 3.0 enemas. The average time for a nasogastric polyethylene glycol-electrolyte cleanout was 5 hours 15 minutes (range: 3 hours 30 minutes to 7 hours) and 5 hours 30 minutes for magnesium citrate cleanout (range: 2 to 8 hours). Seven (15%) children who received nasogastric polyethylene glycol-electrolyte and 6 (10%) of those who drank magnesium citrate did not achieve clearance of stool on the second radiograph. Vomiting was an adverse effect of both medications, and 7 (12%) children were unable to drink the entire magnesium citrate dose. Both methods of disimpaction take the same amount of time. Magnesium citrate can be difficult to drink; however, it is less invasive and less costly than nasogastric polyethylene glycol-electrolyte.
Assuntos
Ácido Cítrico/administração & dosagem , Impacção Fecal/tratamento farmacológico , Intubação Gastrointestinal/métodos , Compostos Organometálicos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Administração Oral , Adolescente , Fatores Etários , Assistência Ambulatorial/métodos , Criança , Pré-Escolar , Estudos de Coortes , Eletrólitos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis. CASE PRESENTATION: An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia. CONCLUSION: Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.
Assuntos
Colite Isquêmica/complicações , Colite/complicações , Impacção Fecal/complicações , Acidose Láctica/complicações , Acidose Láctica/diagnóstico , Idoso de 80 Anos ou mais , Biópsia , Colite/diagnóstico , Colite/tratamento farmacológico , Colite Isquêmica/diagnóstico , Colite Isquêmica/tratamento farmacológico , Colonoscopia , Impacção Fecal/diagnóstico , Impacção Fecal/tratamento farmacológico , Humanos , Laxantes/uso terapêutico , Leucocitose/complicações , Leucocitose/diagnóstico , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Constipation is a common cause of pediatric abdominal pain and emergency department (ED) presentation. Despite the high prevalence, there is a dearth of clinical information and wide practice variation in childhood constipation management in the ED. The objective of the study was to assess the efficacy and safety of soap suds enema (SSE) in the therapy for fecal impaction in children with abdominal pain within the pediatric ED setting. The primary outcome was stool output following SSE. Secondary outcomes were adverse events, admissions, and return visits within 72âhours. METHODS: The present study is a retrospective cross-sectional study performed in the ED at a quaternary care children's hospital of patients seen during a 12-month period who received an SSE for fecal impaction. RESULTS: Five hundred twelve patients (53% girls, median age 7.8 years, range: 8 months-23 years) received SSE therapy during a 1-year period. Successful therapy (bowel movement) following SSE occurred in 419 (82%). Adverse events included abdominal pain in 24 (5%) and nausea/vomiting in 18 (4%). No SSE-related serious adverse events were identified. Following SSE, 405 (79%) were subsequently discharged, of which 15 (3.7%) returned to the ED for re-evaluation within 72âhours. CONCLUSIONS: SSE is an efficacious and safe therapeutic option for the acute treatment of childhood fecal impaction in the ED setting.
Assuntos
Tratamento de Emergência/estatística & dados numéricos , Enema , Impacção Fecal/tratamento farmacológico , Sabões/administração & dosagem , Dor Abdominal/etiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Impacção Fecal/complicações , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Texas , Adulto JovemRESUMO
UNLABELLED: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by variable associations of headaches, encephalopathy, seizures, vomiting, visual disturbance, and focal neurological signs. Neuroimaging shows cerebral edema of different patterns, classically involving the parieto-occipital white matter. PRES has been associated with several conditions predominantly hypertension, eclampsia, and immunosuppressive therapy. However, constipation has not been previously described in association with the development of PRES. In this report, we describe an 11-year-old child with history of severe functional constipation who developed PRES, as a consequence of renovascular hypertension from severe fecal impaction. Both hypertension and neurologic dysfunction resolved after resolution of fecal impaction. CONCLUSION: Severe functional constipation is a previously unrecognized cause of severe acute hypertension, resulting in life-threatening neurologic dysfunction. We highlight this unrecognized complication of severe functional constipation with fecal impaction that is potentially preventable if managed appropriately.
Assuntos
Constipação Intestinal/complicações , Hipertensão Renovascular/etiologia , Polietilenoglicóis/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/etiologia , Anti-Hipertensivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Catárticos/uso terapêutico , Criança , Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Impacção Fecal/complicações , Impacção Fecal/diagnóstico , Impacção Fecal/tratamento farmacológico , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/tratamento farmacológico , Intubação Gastrointestinal , Rim/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológicoRESUMO
OBJECTIVE: The objective of this study was to evaluate in an analytical and descriptive manner the evidence published so far on the use of polyethylene glycol (PEG), with or without electrolytes, in the management of functional constipation and the treatment of fecal impaction. METHODOLOGY: Search on MEDLINE, EMBASE and Cochrane databases until May 2016 of all publications adjusted to the following terms: constipation AND/OR fecal impaction AND (PEG OR polyethylene glycol OR macrogol OR movicol OR idralax OR miralax OR transipeg OR forlax OR golytely OR isocolan OR mulytely) NOT colonoscopy. Critical reading of selected articles (English or Spanish), sorting their description according to group age (adult/pediatric age) and within those, in accordance with study features (efficacy evaluation versus placebo, doses query, safety, comparison with other laxatives, observational studies and monographic review articles of polyethylene glycol or meta-analysis). RESULTS: Fifty-eight publications have been chosen for descriptive analysis; of them, 41 are clinical trials, eight are observational studies and nine are systematic reviews or meta-analysis. Twelve clinical trials evaluate PEG efficacy versus placebo, eight versus lactulose, six are dose studies, five compare polyethylene glycol with and without electrolytes, two compare its efficacy with respect to milk of magnesia, and the rest of the trials evaluate polyethylene glycol with enemas (two), psyllium (one), tegaserod (one), prucalopride (one), paraffin oil (one), fiber combinations (one) and Descurainia sophia (one). CONCLUSIONS: Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability. These preparations constitute the most efficacious osmotic laxatives (more than lactulose) and are the first-line treatment for functional constipation in the short and long-term. They are as efficacious as enemas in fecal impaction, avoid the need for hospital admission and are well tolerated by patients (mainly when administered without electrolytes).
Assuntos
Constipação Intestinal/tratamento farmacológico , Impacção Fecal/tratamento farmacológico , Laxantes/uso terapêutico , Polietilenoglicóis/uso terapêutico , Adulto , Criança , HumanosRESUMO
BACKGROUND & AIMS: Prucalopride is a selective, high-affinity agonist of the 5-hydroxytryptamine (serotonin) receptor 4 that enhances motility in the gastrointestinal tract. We performed a multicenter, randomized, placebo-controlled, double-blind, phase 3 trial to evaluate the efficacy and safety of prucalopride in children (6 months to 18 years old) with functional constipation. METHODS: Children with functional constipation, based on the Rome III criteria, were given prucalopride (children ≤ 50 kg were given a 0.04 mg/kg oral solution; children >50 kg were given a 2-mg tablet) or placebo once daily for 8 weeks. The primary efficacy end point was the proportion of children with toileting skills who had a mean of ≥ 3 spontaneous bowel movements/week and ≤ 1 episode of fecal incontinence/2 weeks, from study weeks 5-8 (responders). Adverse events, clinical laboratory values, and electrocardiograms were monitored. RESULTS: Efficacy and safety were assessed in 213 children (106 prucalopride, 107 placebo). Twenty-five percent were younger than 4 years old, 50% were 4-11 years old, and 25% were 12-18 years old; 55.4% were girls. At screening, 62.3% of patients in the prucalopride group and 55.1% in the placebo group had a history of fecal incontinence; 60.4% and 55.1% in the prucalopride and placebo groups, respectively, had a mean of ≤ 1 spontaneous bowel movements/week. The proportion of responders was similar between groups (prucalopride, 17.0% and placebo, 17.8%). There were no statistically significant differences in the primary efficacy end point when patients were stratified by sex, age group, or country. The incidence of treatment-emergent adverse events was similar in the prucalopride (69.8%) and placebo (60.7%) groups. CONCLUSIONS: Prucalopride, although generally well tolerated, was not more effective than placebo in children with functional constipation. ClinicalTrials.gov Number: NCT01330381.
Assuntos
Benzofuranos/administração & dosagem , Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Impacção Fecal/tratamento farmacológico , Agonistas do Receptor 5-HT4 de Serotonina/administração & dosagem , Adolescente , Benzofuranos/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Agonistas do Receptor 5-HT4 de Serotonina/efeitos adversos , Falha de TratamentoRESUMO
AIM: Constipation is a common cause of admission to hospital for disimpaction, as oral laxatives are often inadequate. High-dose oral laxative protocols are used for complete bowel clearance prior to colonoscopy, but have not been reported for treating faecal impaction. The aim of this study was to assess the effectiveness of a high-dose oral protocol using polyethylene glycol with electrolytes (PEG + E) (Movicol Rx) combined with sodium picosulphate (SP) (Dulcolax SP Rx) in faecal impaction in children presenting to a suburban clinic. METHODS: Forty-four children presented with acute/chronic faecal impaction were given six to eight sachets of PEG + E were given on day 1, with decreasing doses on subsequent 3 days, while 15-20 SP drops were given on days 2 and 3. Compliance with medication was achieved using a simple method of motivation, with the child drinking the laxatives in a race. On day 4, PEG + E was reduced to one sachet and SP to 10 drops as an ongoing maintenance dose. Defecation, soiling, diet and water intake was monitored daily for 7 days in a diary. RESULTS: Forty-four children (aged 2-17 years) seen over 8 months were reviewed retrospectively. Children began defecating within 10-12 h reaching a maximum volume of stool/day (four cups) on day 2. All patients were disimpacted successfully and in the week following disimpaction there was no reported faecal soiling or complications. CONCLUSIONS: A high-dose oral protocol combining PEG + E sachets and SP drops successfully and safely disimpacted a cohort of children with acute/chronic constipation presenting to a suburban continence clinic. This protocol appears to be useful to control faecal disimpaction in an outpatient setting, thereby avoiding hospital admission.
Assuntos
Citratos/uso terapêutico , Constipação Intestinal/tratamento farmacológico , Eletrólitos/uso terapêutico , Impacção Fecal/tratamento farmacológico , Laxantes/uso terapêutico , Compostos Organometálicos/uso terapêutico , Picolinas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Administração Oral , Adolescente , Catárticos/uso terapêutico , Criança , Pré-Escolar , Citratos/administração & dosagem , Combinação de Medicamentos , Quimioterapia Combinada , Eletrólitos/administração & dosagem , Feminino , Humanos , Laxantes/administração & dosagem , Masculino , Compostos Organometálicos/administração & dosagem , Picolinas/administração & dosagem , Polietilenoglicóis/administração & dosagem , Solventes/uso terapêutico , Serviços de Saúde Suburbana , Resultado do TratamentoRESUMO
INTRODUCTION: Chronic constipation is a frequent symptom encountered in the daily clinical practice. The treatment of this condition mainly relies on the use of laxatives. However, patients' satisfaction with this approach is limited, and alternative measures are often added to the treatment. Among these, particularly frequent worldwide is the use of enemas, even though literature data on its scientific validity are scarce. AREAS COVERED: In this article, by an extensive online search of Medline (through PubMed), Scopus, Cochrane CENTRAL, EMBASE, and the Science Citation Index, the available literature data on the use of enemas in adult patients with chronic constipation, also in the perspective of available guidelines on treatment of this pathological condition, were analyzed. EXPERT OPINION: Although the use of enemas remains a frequently employed method and it is considered as useful by many physicians as an adjunctive support for the treatment of chronic constipation in adults, this practice is not substantiated by rigorous scientific data, and some studies are available only for specific instances (fecal impaction, transanal irrigation). Thus, waiting for more robust scientific data, enemas treatment should be carried out on an individual patient's basis, according to the experience of the caring physicians.
Assuntos
Constipação Intestinal , Impacção Fecal , Humanos , Adulto , Constipação Intestinal/terapia , Constipação Intestinal/tratamento farmacológico , Laxantes/uso terapêutico , Impacção Fecal/tratamento farmacológico , Enema/métodos , Satisfação do PacienteRESUMO
BACKGROUND: PEG-based laxatives are considered today the gold standard for the treatment of constipation in children. PEG formulations differ in terms of composition of inactive ingredients which may have an impact on acceptance, compliance and adherence to treatment. We therefore compared the efficacy, tolerability, acceptance and compliance of a new PEG-only formulation compared to a reference PEG-electrolyte (PEG-EL) formulation in resolving faecal impaction and in the treatment of chronic constipation. METHODS: Children aged 2-16 years with functional chronic constipation for at least 2 months were randomized to receive PEG-only 0.7 g/kg/day in 2 divided doses or 6.9 g PEG-EL 1-4 sachets according to age for 4 weeks. Children with faecal impaction were randomized to receive PEG-only 1.5/g/kg in 2 divided doses until resolution or for 6 days or PEG-EL with an initial dose of 4 sachets and increasing 2 sachets a day until resolution or for 7 days. RESULTS: Ninety-six children were randomized into the study. Five patients withdrew consent before starting treatment. Three children discontinued treatment for refusal due to bad taste of the product (1 PEG-only, 2 PEG-EL); 1 (PEG-EL) for an adverse effect (abdominal pain). Intent-to-treat analysis was carried out in 49 children in the PEG-only group and 42 in the PEG-EL group.No significant differences were observed between the two treatment groups at baseline.Adequate relief of constipation in terms of normalized frequency and painless defecation of soft stools was achieved in all patients in both groups. The number of stools/week was 9.2 ± 3.2 (mean ± SD) in the PEG-only group and 7.8 ± 2.4 in the PEG-EL group (p = 0.025); the number of days with stool was 22.4 ± 5.1 in the PEG-only group and 19.6 ± 7.2 in the PEG-EL group (p = 0.034).In the PEG-only group faecaloma resolution was observed in 5 children on the second day and in 2 children on the third day, while in the PEG-EL group it was observed in 2 children on the second day, in 3 children on the third day and in 1 child on the fifth day.Only 2 patients reported mild treatment-related adverse events: 1 child in the PEG-only group had diarrhoea and vomiting and 1 child in the PEG-EL group had abdominal pain requiring treatment discontinuation. The PEG-only preparation was better tolerated as shown by the lower frequency of nausea than in the PEG-EL group.In the PEG-only group, 96% of patients did not demonstrate any difficulties associated with treatment, as compared with 52% of patients in the PEG-EL group (p < 0.001). Also, the PEG-only formulation taste was better than that of PEG-EL (p < 0.001). The difference between the percentage of subjects who took > 80% of the prescribed dose was in favour of the PEG-only group (98% vs. 88%), though it did not reach a conventional statistical level (p = 0.062). CONCLUSION: PEG-only was better tolerated and accepted than PEG-EL in children with chronic constipation. At the higher PEG doses recommended by the manufactures children in the PEG-only group had higher and more regular soft stool frequency than PEG-EL.
Assuntos
Constipação Intestinal/tratamento farmacológico , Eletrólitos/uso terapêutico , Impacção Fecal/tratamento farmacológico , Laxantes/uso terapêutico , Polietilenoglicóis/uso terapêutico , Adolescente , Criança , Pré-Escolar , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Laxantes/efeitos adversos , Masculino , Polietilenoglicóis/efeitos adversosRESUMO
BACKGROUND: Antipsychotic are the cornerstone in the treatment of schizophrenia. They also have a number of side-effects. Constipation is thought to be common, and a potential serious side-effect, which has received little attention in recent literature. METHOD: We performed a retrospective study in consecutively admitted patients, between 2007 and 2009 and treated with antipsychotic medication, linking different electronic patient data to evaluate the prevalence and severity of constipation in patients with schizophrenia under routine treatment conditions. RESULTS: Over a period of 22 months 36.3% of patients (99) received at least once a pharmacological treatment for constipation. On average medication for constipation was prescribed for 273 days. Severe cases (N = 50), non-responsive to initial treatment, got a plain x-ray of the abdomen. In 68.4% fecal impaction was found. CONCLUSION: A high prevalence of constipation, often severe and needing medical interventions, was confirmed during the study period. Early detection, monitoring over treatment and early intervention of constipation could prevent serious consequences such as ileus.
Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Esquizofrenia/tratamento farmacológico , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aripiprazol , Clozapina/efeitos adversos , Clozapina/uso terapêutico , Constipação Intestinal/tratamento farmacológico , Enema , Impacção Fecal/induzido quimicamente , Impacção Fecal/tratamento farmacológico , Impacção Fecal/epidemiologia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Lactulose/uso terapêutico , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Piperazinas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Prevalência , Quinolonas/efeitos adversos , Quinolonas/uso terapêutico , Estudos Retrospectivos , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Constipation is a common clinical problem. Lactulose and Polyethylene Glycol (PEG) are both commonly used osmotic laxatives that have been shown to be effective and safe treatments for chronic constipation. However, there is no definitive data as to which provides the best treatment. OBJECTIVES: To identify and review all relevant data in order to determine whether Lactulose or Polyethylene Glycol is more effective at treating chronic constipation and faecal impaction. SEARCH STRATEGY: We searched the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of lactulose and polyethylene glycol in the management of faecal impaction and chronic constipation. SELECTION CRITERIA: Studies were included if they were randomised controlled trials which compared lactulose with polyethylene glycol in the management of chronic constipation. DATA COLLECTION AND ANALYSIS: Data on study methods, participants, interventions used and outcomes measured was extracted from each study. Data was entered into the Cochrane Review Manager software (RevMan 5.0) and analysed using Cochrane MetaView. MAIN RESULTS: In the present meta-analysis, we considered for the first time all ten randomised controlled trials so far performed. The findings of our work indicate that Polyethylene glycol is better than lactulose in outcomes of stool frequency per week, form of stool, relief of abdominal pain and the need for additional products. On subgroup analysis, this is seen in both adults and children, except for relief of abdominal pain. AUTHORS' CONCLUSIONS: Polyethylene Glycol should be used in preference to Lactulose in the treatment of Chronic Constipation.
Assuntos
Constipação Intestinal/tratamento farmacológico , Impacção Fecal/tratamento farmacológico , Lactulose/uso terapêutico , Laxantes/uso terapêutico , Polietilenoglicóis/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
We observed a patient with incomplete, cervical paraplegia and opioid-induced constipation who developed a resistance to laxatives after 15 years of treatment. The constipation-induced reduction in the patient's quality of life was improved using 12 mg methylnaltrexone, a peripheral mu-opioid receptor antagonist, administered subcutaneously twice a week.
Assuntos
Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Naltrexona/análogos & derivados , Antagonistas de Entorpecentes/uso terapêutico , Entorpecentes/efeitos adversos , Paraplegia/complicações , Idoso , Vértebras Cervicais/cirurgia , Impacção Fecal/induzido quimicamente , Impacção Fecal/tratamento farmacológico , Humanos , Injeções Subcutâneas , Masculino , Naltrexona/efeitos adversos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/efeitos adversos , Entorpecentes/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Compostos de Amônio Quaternário/efeitos adversos , Compostos de Amônio Quaternário/uso terapêutico , Compressão da Medula Espinal/cirurgiaRESUMO
Abdominal free air upon X-ray examination implies a medical emergency, but there is an extensive differential diagnosis that should be considered. Fecaloma is one of the possible imitators of free abdominal air. Fecaloma is a complication of chronic constipation, in which a large fecal mass impacts the bowel, imitating a tumor mass. This phenomenon is not uncommon in the elderly, and requires prompt recognition and immediate medical treatment. A 29-year-old woman, known to suffer from mental retardation, was admitted due to frequent vomiting and diarrhea following constipation a few days prior to her admission. The patient was treated in her institution by an enema, with partial decompression, that was followed by recurrent vomiting and fever. Physical examination upon admittance revealed a distended abdomen without peritoneal signs. An abdominal X-ray series demonstrated a distended large bowel with an abundance of fecal contents, and suspected free air in the abdominal cavity. Due to these findings, an abdominal CT was performed, which demonstrated a huge fecaloma involving the descending and sigmoid colon. The patient was treated non-operatively with: IV fluids, oral laxatives, frequent enemas and manual stool disimpaction. Following this treatment the patient's condition improved dramatically. Fecaloma is a situation that requires prompt recognition and treatment. The diagnosis of fecaloma is a clinical challenge. In addition to signs, symptoms and physical examination, which may be non-specific, the use of X-rays, CT and US may aid in the diagnosis. The treatment in most cases consists primarily of hydration, laxatives, enemas and manual disimpaction. If there is no improvement, one should consider endoscopic treatment, or surgery which may entail a partial or total colectomy.
Assuntos
Impacção Fecal/diagnóstico , Adulto , Ar , Enema , Impacção Fecal/diagnóstico por imagem , Impacção Fecal/tratamento farmacológico , Impacção Fecal/terapia , Feminino , Hidratação , Humanos , Deficiência Intelectual/complicações , Intestino Grosso/diagnóstico por imagem , Laxantes/uso terapêutico , Radiografia AbdominalRESUMO
BACKGROUND/AIM: Faecal impaction (FI) is a common cause of lower gastrointestinal tract obstruction. Gastrografin is a water-soluble radiologic contrast agent that may be orally or rectally administered, with proved therapeutic benefits in adhesive small bowel obstruction. Enemas have long been advocated as the best treatment for FI. The purpose of this study was to demonstrate that enteral administration of gastrografin might be more effective than enema in FI treatment inducing intestinal obstruction. METHODS: A double-blinded, controlled and randomized trial was conducted. Participants received 100 mL of gastrografin (gastrografin group) through nasointestinal tube or enemas (enema group) once daily for six consecutive days. Successful faecal disimpaction, FI time to resolution, Bristol Stool Scale, constipation severity, symptom assessment and adverse events were evaluated. RESULTS: A total of 124 patients were eligible, but only 83 were enrolled to this trial (mean age: 44 ± 15.8 years). Forty-two patients received enemas, and 41 patients received gastrografin, with six dropouts in each group. Successful disimpaction was achieved with enemas (69.44%) and gastrografin (88.57%; P = 0.034), mean duration of impaction was strikingly different between the two groups (67.13 versus 31.67, respectively; P < 0.01). Constipation severity and symptom assessment were significantly reduced in the gastrografin group. CONCLUSION: Gastrografin given through nasointestinal tube was more effective than enema in the treatment of FI inducing colon obstruction. Gastrografin might be taken into consideration as an effective and safe therapeutic option for FI.
Assuntos
Constipação Intestinal/complicações , Diatrizoato de Meglumina/uso terapêutico , Impacção Fecal/tratamento farmacológico , Impacção Fecal/etiologia , Adolescente , Adulto , Idoso , Método Duplo-Cego , Enema , Impacção Fecal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid - small bowel atresia and developed severe faecal impaction in the post - operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.
Assuntos
Acetilcisteína/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas , Fibrose Cística , Enema , Sequestradores de Radicais Livres/efeitos adversos , Acetilcisteína/administração & dosagem , Impacção Fecal/tratamento farmacológico , Sequestradores de Radicais Livres/administração & dosagem , Humanos , Íleus/tratamento farmacológico , Recém-Nascido , Mecônio/efeitos dos fármacosRESUMO
We describe a case of an 18-year-old man who suffers from cystic fibrosis and developed distal intestinal obstruction syndrome while being treated as an inpatient. Following failed medical management, we proceeded to laparotomy where the small bowel was decompressed with retrograde milking into the stomach, leaving a section of impacted stool in the distal ileum. N-acetylcysteine was injected into the bowel lumen proximal to the obstruction. This resulted in dissolution of the stool without the need for enterotomy and is, to our knowledge, the first successful example of this technique in the literature.
Assuntos
Acetilcisteína/administração & dosagem , Impacção Fecal/tratamento farmacológico , Obstrução Intestinal/tratamento farmacológico , Intestino Delgado/cirurgia , Solventes/administração & dosagem , Adolescente , Fibrose Cística/complicações , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Impacção Fecal/diagnóstico por imagem , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To determine short- and long-term outcomes, including recurrence rates, for horses with cecal impaction treated medically or surgically. DESIGN: Retrospective case series. ANIMALS: 114 horses. PROCEDURES: Medical records were reviewed for information on signalment, history, clinical findings, treatment (medical vs surgical), and short-term outcome. Information on longterm outcome was obtained through a mail survey and telephone interview with owners. RESULTS: 54 horses were treated medically, 49 horses were treated surgically, and 11 horses were euthanized after initial examination without further treatment. Horses treated surgically were significantly more likely to have signs of moderate or severe pain than were horses treated medically. Forty-four of the 54 (81%) horses treated medically were discharged from the hospital. Twelve of the 49 horses treated surgically were euthanized at surgery because of cecal rupture. Thirty-five of the 37 (95%) horses that were allowed to recover from surgery were discharged from the hospital. In 34 horses treated surgically, typhlotomy without a bypass procedure was performed. Long-term (>or= 1 year) follow-up information was available for 19 horses treated medically and 28 horses treated surgically. Eighteen (95%) and 25 (89%) of the horses, respectively, were alive at least 1 year after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that medical and surgical treatment were both associated with favorable outcomes in horses with cecal impactions. In this population, typhlotomy alone without cecal bypass was associated with a low recurrence rate. The long-term prognosis for horses that were discharged from the hospital was good.