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Comparing Treatments for Intractable Functional Constipation

June 4, 2020
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Two procedures are both successful but have different effects on specific symptoms.

Constipation is a common problem in children. While a majority of kids respond to traditional treatments, including behavioral interventions and laxatives, a sizable number continue to have problems with intractable constipation that can lead to fecal incontinence.

For these children, treatment options include minimally invasive surgical procedures such as antegrade continence enemas (ACE) and sacral nerve stimulation (SNS). However, there is little data comparing these procedures and guidelines for their use are lacking, leading to variation in treatment practices between centers.

In a new study, researchers from Nationwide Children’s compared the efficacy and safety of ACE and SNS in children with intractable functional constipation. The objective was to compare the two treatments to help clinicians better decide on the best option for each specific patient.

The research team, led by Peter Lu, MD, MS, an attending pediatric gastroenterologist at Nationwide Children’s, found that both ACE and SNS led to durable improvement of functional constipation in children, although the two treatments had different effects on specific symptoms.

“It was clear from our data that SNS works really well for stool accidents, even though it did not make a huge difference for other factors, like bowel movement frequency and abdominal pain,” says Dr. Lu, who is also Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine. “ACE helped with stool accidents, though not to the same degree as SNS, but was better for making bowel movements more regular and decreasing abdominal pain.”

Dr. Lu and his colleagues say this study is the first step toward being able to decide on an ideal treatment option for each child based on his or her symptoms.

“Our takeaway from this study is that if the child’s main symptom is fecal incontinence, and especially if they have urinary symptoms too, SNS may be a good option,” says Dr. Lu. “Whereas if the fecal incontinence is secondary to not being able to go and having a lot of pain, maybe ACE would be the better option.”

Since this study was retrospective, Dr. Lu says that larger, randomized, prospective studies are needed to gather even more evidence for the optimal uses of these two treatments. Future studies could also examine other treatment options that are considered for these patients, such as surgically removing part of the colon.

“Ongoing constipation and stool accidents are common and have a huge impact on a child’s self-esteem and quality of life,” says Dr. Lu.

“This research is only possible when you have a multidisciplinary team like the one here at Nationwide, made up of people from gastroenterology, surgery, and urology who are passionate about these problems and understand the impact it can have on kids. This is a group of kids who have in some ways been neglected because these are embarrassing problems for a lot of children, and they deserve our attention and care.”

 

Reference:

Vriesman MH, Wang L, Park C, Diefenbach KA, Levitt MA, Wood RJ, Alpert SA, Benninga MA, Vaz K, Yacob D, Di Lorenzo C, Lu P. Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence. Neurogastroenterology and Motility. 2020;e13809. 

 

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