Need for Rectal Biopsy for Childhood Constipation Predicts Severity of Illness and Need for Laxatives.

Abstract

OBJECTIVES:

This study aimed to examine the long-term clinical outcomes of children with severe constipation, as defined by need for rectal biopsy (RB), and to determine which baseline characteristics were predictors of successful outcome.

METHODS:

Children with severe constipation who underwent RB for evaluation of Hirschsprung disease at a tertiary medical center were eligible. A cohort of children with constipation without a history of RB served as controls (matched 2:1 by sex and age). Retrospective chart review of clinic visits was performed at baseline, 3, 6, 12, 18, and 24 months. Successful clinical outcomes were defined as ≥3 bowel movements weekly for ≥4 weeks, with ≤2 fecal incontinence episodes monthly, irrespective of laxative use.

RESULTS:

A total of 175 RB children (90 boys, mean age: 6.7 years) were matched to 350 controls. Mean duration of constipation symptoms before intake in the RB group was significantly longer compared with controls (3.7 vs 0.4 years, P < 0.001). By 24 months, the cumulative percentage of children achieving at least 1 period of successful outcome was significantly higher in the control group compared with RB population (73% vs 24%, P < 0.001). Multivariate analysis revealed that younger age (P = 0.001, odds ratio 0.87) and shorter duration of constipation before RB (P = 0.03, odds ratio 0.45) were significant predictors of successful outcome.

CONCLUSIONS:

Only one-quarter of patients with severe constipation achieved successful outcome during 2-year follow-up. Younger age and shorter duration of constipation at time of biopsy were predictors of successful outcomes, emphasizing the importance of early diagnosis and initiation of treatment in this population.

• Authors: Khoa Tran, Kyle Staller, Eric Macklin, Allan Goldstein, Jaime Belkind-Gerson, Braden Kuo
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 62 Issue 6 Pg. 834-9 (06 2016) ISSN: 1536-4801 [Electronic] United States
• PMID: 26551318 (Publication Type: Journal Article)

Chemical References

• Laxatives

Topics

• Adolescent
• Biopsy (methods)
• Child
• Child, Preschool
• Constipation (diagnosis, drug therapy)
• Female
• Hirschsprung Disease (diagnosis)
• Humans
• Infant
• Laxatives (therapeutic use)
• Male
• Rectum (pathology)
• Retrospective Studies
• Severity of Illness Index
• Young Adult