Bu Ling-Nan, Chang Mei-Hwei, Ni Yen-Hsuan, Chen Huey-Ling, Cheng Chia-Chi
Department of Pediatrics, Keelung Hospital, Department of Health, the Executive Yuan, Keelung, Taiwan.
Pediatr Int. 2007 Aug;49(4):485-90. doi: 10.1111/j.1442-200X.2007.02397.x.
The purpose of the present paper was to evaluate the efficacy of probiotics (Lactobacillus casei rhamnosus, Lcr35) for treating children with chronic constipation and to compare its effect with magnesium oxide (MgO) and placebo.
This double-blind placebo-controlled, randomized study enrolled 45 children under 10 years old with chronic constipation. They were randomly assigned to receive Lcr35 (8 x 10(8) c.f.u./day; n = 18), MgO (50 mg/kg/day; n = 18), or placebo (n = 9) orally twice daily for 4 weeks. Lactulose use (1 mL/kg per day) was allowed when no stool passage for 3 days was noted. Glycerin enema was used only when no defecation was noted for >5 days or abdominal pain was suffered due to stool impaction. Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora. Comparisons of the frequency of defecation, consistency of stool and the use of lactulose or enema during the period of treatment were made among the three groups.
The patients who received MgO or probiotics had a higher defecation frequency (P = 0.03), higher percentage of treatment success (P = 0.01), less use of glycerin enema (P = 0.04) and less hard stool (P = 0.01) than the placebo group. There was no significant difference between MgO and probiotic groups in the aforementioned comparisons. The first effect of MgO (second week) on constipation was slightly earlier than that of probiotic (second to third week). Abdominal pain occurred less frequently in the probiotic group than in both the MgO and the placebo groups (P = 0.03). There was no statistically significant difference among the three groups in the use of lactulose, episodes of fecal soiling, and change of appetite. No adverse effect was noted in probiotic and placebo groups. Only one patient in the MgO group suffered from mild diarrhea.
Lcr35 was effective in treating children with chronic constipation. There is no statistically significant difference in efficacy between MgO and Lcr35, but less abdominal pain occurred when using Lcr35. Study with larger case number and longer follow up is needed in the future.
本文旨在评估益生菌（鼠李糖乳杆菌，Lcr35）治疗儿童慢性便秘的疗效，并将其与氧化镁（MgO）和安慰剂进行效果比较。
这项双盲、安慰剂对照的随机研究纳入了45名10岁以下的慢性便秘儿童。他们被随机分配口服Lcr35（8×10⁸ c.f.u./天；n = 18）、MgO（50 mg/kg/天；n = 18）或安慰剂（n = 9），每日两次，共4周。当3天未排便时允许使用乳果糖（1 mL/kg/天）。仅当超过5天未排便或因粪便嵌塞出现腹痛时使用甘油灌肠。治疗前后进行粪便细菌培养以评估肠道菌群的变化。对三组治疗期间的排便频率、粪便稠度以及乳果糖或灌肠剂的使用情况进行比较。
与安慰剂组相比，接受MgO或益生菌治疗的患者排便频率更高（P = 0.03），治疗成功率更高（P = 0.01），甘油灌肠剂使用更少（P = 0.04），硬便更少（P = 0.01）。在上述比较中，MgO组和益生菌组之间无显著差异。MgO（第二周）对便秘的首次起效略早于益生菌（第二至三周）。益生菌组腹痛发生频率低于MgO组和安慰剂组（P = 0.03）。三组在乳果糖使用、大便失禁发作和食欲变化方面无统计学显著差异。益生菌组和安慰剂组未观察到不良反应。MgO组仅有1例患者出现轻度腹泻。
Lcr35治疗儿童慢性便秘有效。MgO和Lcr35在疗效上无统计学显著差异，但使用Lcr35时腹痛较少。未来需要进行更大样本量和更长随访时间的研究。
