A Randomized Controlled Trial of Enemas in Combination With Oral Laxative Therapy for Children With Chronic Constipation
A Randomized Controlled Trial of Enemas in Combination With Oral Laxative Therapy for Children With Chronic Constipation
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DOI：
10.1016/j.cgh.2009.06.018
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发表时间：
2009-10-01
影响因子：
12.6
通讯作者：
Benninga, Marc A.
中科院分区：
文献类型：
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作者：
Bongers, Marloes E. J.;van den Berg, Maartje M.;Benninga, Marc A.
背景和目的：经过5年的强化口服泻药使用，高达30%的便秘儿童仍然有不成功的结果。对口服泻药难治的儿童可以通过定期灌肠进行直肠排泄。这项随机对照试验比较了直肠灌肠（干预）和常规治疗（口服泻药，对照）对严重便秘儿童的效果。方法：在荷兰的一家三级医院，100名8-18岁的功能性便秘至少2年的儿童被随机分配到干预组或对照组。对照组接受教育、行为策略和口服泻药。干预组在对照组基础上给予3次直肠灌肠/周，每3个月减少1次。结果测量是12、26、39和52周的排便和大便失禁频率和总体成功。总体成功定义为每周排便3次或更多，每周少于1次大便失禁，无论是否使用泻药。结果：两组患者排便频率均恢复正常，但干预组在26周和52周时排便频率明显高于对照组（分别为5.6 vs 3.9/周，P = 0.02和5.3 vs 3.9/周，P = 0.02）。两组之间在减少大便失禁发作（P = 0.49）和总成功率（P = 0.67）方面无显著差异。治疗1年后，干预组的总成功率为47.1%，对照组为36.1%。结论：与单独口服泻药相比，灌肠作为严重便秘儿童的维持治疗没有额外的效果。
BACKGROUND & AIMS: After 5 years of intensive oral laxative use, up to 30% of constipated children still have an unsuccessful outcome. Children refractory to oral laxatives might benefit from regular rectal evacuation by enemas. This randomized controlled trial compared the effects of additional treatment with rectal enemas (intervention) with conventional treatment alone (oral laxatives, control) in severely constipated children. METHODS: In a tertiary hospital in the Netherlands, 100 children, aged 8-18 years, with functional constipation for at least 2 years were randomly assigned to intervention or control groups. The control group received education, behavioral strategies, and oral laxatives. The intervention group was also given 3 rectal enemas/week, reduced by I enema/week every 3 months. Outcome measures were defecation and fecal incontinence frequency and overall success at 12, 26, 39, and 52 weeks. Overall success was defined as 3 or more defecations/week and less than 1 fecal incontinence episode/week, irrespective of laxative use. RESULTS: Defecation frequency normalized in both groups but was significantly higher in the intervention group compared with controls at 26 and 52 weeks (5.6 vs 3.9/week, P = .02, and 5.3 vs 3.9/week, P = .02, respectively). There were no significant differences between groups in reduction of fecal incontinence episodes (P = .49) and overall success rates (P = .67). After 1 year of treatment, the overall success rate was 47.1% in the intervention group versus 36.1% in the control group. CONCLUSIONS: There is no additional effect of enemas compared with oral laxatives alone as maintenance therapy for severely constipated children.