Treatment of childhood constipation by primary care physicians: Efficacy and predictors of outcome
Treatment of childhood constipation by primary care physicians: Efficacy and predictors of outcome
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DOI：
10.1542/peds.2004-0537
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发表时间：
2005-04-01
期刊：
影响因子：
8
通讯作者：
Sutphen, J
中科院分区：
文献类型：
--
作者：
Borowitz, SM;Cox, DJ;Sutphen, J
Objective.儿童便秘占到普通儿科诊所就诊人数的3%，占到儿科胃肠病学家就诊人数的30%。大多数经历便秘的儿童及其照顾者寻求医疗护理，都是由儿科医生或家庭医生等初级保健医生看到的。人们对初级保健医生如何治疗儿童便秘或其治疗的成功知之甚少。通过这项研究，我们前瞻性地研究了初级保健医生为首次出现便秘的儿童开出的治疗方法以及这些治疗方法的有效性。共有119名2至7岁（平均年龄：44.1 ± 13.6个月）的儿童首次参加了这项研究，他们接受了26名不同的初级保健医生（15名儿科医生和11名家庭医生）的治疗。在开始治疗前2周，父母完成了他们孩子的排便习惯的每日日记，并在治疗后2个月再次进行。处方治疗是通过审查主治医生的办公室记录来确定的。治疗2个月后，119名儿童中有44名（37%）仍然便秘。在大多数情况下（87%），医生开了某种形式的泻药或大便软化剂。最常用的泻药是氢氧化镁（77%）、番泻叶糖浆（23%）、矿物油（8%）和乳果糖（8%）。在几乎所有的情况下，都推荐了特定的固定剂量的泻药;只有5%的情况下，父母被明确指示调整泻药的剂量以获得预期的效果。在大约一半的病例中，医生建议进行某种饮食干预。在大约三分之一的案件的办公室记录中提到了某种形式的行为干预;然而，在大多数情况下，提供的细节很少。在45%的病例中，医生使用口服泻药、灌肠剂或栓剂进行缓解，然后每天服用泻药。在35%的情况下，医生每天开泻药，没有任何解除程序。在其余的患者中，医生仅规定改变饮食（5%），使用间歇性泻药（9%）或不治疗（7%）。治疗的成功与儿童的治疗积极性相对应。具体来说，接受某种形式的结肠排空，然后每天进行泻药治疗的儿童比那些治疗不那么积极的儿童更有可能对治疗产生反应。初级保健医生往往对儿童便秘治疗不足。经过2个月的治疗，近40%的便秘儿童仍然有症状。
Objective. Childhood constipation accounts for 3% of visits to general pediatric clinics and as many as 30% of visits to pediatric gastroenterologists. The majority of children who experience constipation and whose caregivers seek medical care are seen by primary care physicians such as pediatricians or family physicians. Little is known about how primary care physicians treat childhood constipation or the success of their treatments. With this study, we prospectively examined which treatments primary care physicians prescribe to children who present for the first time with constipation and how effective those treatments are.Methods. A total of 119 children who were between 2 and 7 years of age ( mean: 44.1 +/- 13.6 months) and presented to 26 different primary care physicians ( 15 pediatricians and 11 family physicians) for the treatment of constipation for the first time participated in this study. Parents completed daily diaries of their child's bowel habits for 2 weeks before starting treatment recommended by their primary care physician and again 2 months after treatment. The prescribed treatment was identified by reviewing office records of the treating physicians.Results. After 2 months of treatment, 44 (37%) of 119 children remained constipated. In the majority (87%) of cases, physicians prescribed some form of laxative or stool softener. The most commonly prescribed laxatives were magnesium hydroxide (77%), senna syrup (23%), mineral oil (8%), and lactulose ( 8%). In nearly all cases, a specific fixed dose of laxative was recommended; in only 5% of cases were parents instructed clearly to adjust the dose of laxative up or down to get the desired effect. In approximately half of the cases, physicians recommended some sort of dietary intervention. Some form of behavioral intervention was mentioned in the office records of approximately one third of cases; however, in most cases, little detail was provided. In 45% of cases, physicians prescribed disimpaction using oral cathartics, enemas, or suppositories followed by daily laxatives. In 35% of cases, physicians prescribed daily laxatives without any disimpaction procedure. In the remainder, physicians prescribed only dietary changes ( 5%), the use of intermittent laxatives (9%), or no therapy (7%). Treatment success corresponded to how aggressively the child was treated. Specifically, children who underwent some form of colonic evacuation followed by daily laxative therapy were more likely to have responded to treatment than were those who were treated less aggressively.Conclusion. Primary care physicians tend to undertreat childhood constipation. After 2 months of treatment, nearly 40% of constipated children remain symptomatic.