van den Berg Maartje M, Bongers Marloes E J, Voskuijl Wieger P, Benninga Marc A
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands.
Gastroenterology. 2009 Dec;137(6):1963-9. doi: 10.1053/j.gastro.2009.08.015. Epub 2009 Aug 21.
BACKGROUND & AIMS: Increased rectal compliance has been proposed to contribute to pediatric functional constipation (FC). We evaluated the clinical relevance of increased rectal compliance and assessed whether regular use of enemas improves rectal compliance in children with FC.
A prospective longitudinal study was conducted on children (8-18 years old) with FC. Pressure-controlled rectal distensions were performed at baseline and at 1 year. Rectal compliance was categorized into 3 groups: normal, moderately increased, or severely increased. Patients were randomly assigned to groups given conventional therapy or rectal enemas and conventional therapy. Clinical success was defined as >or=3 spontaneous defecations per week and fecal incontinence <1 per week.
Baseline measurements were performed in 101 children (11.0 +/- 2.1 years); rectal compliance was normal in 36%, moderately increased in 40%, and severely increased in 24%. Patients with severely increased rectal compliance had lower defecation frequency (P = .03), more fecal incontinence (P = .04), and more rectal fecal impaction (P < .001). After 1 year, success values were similar between groups: 42% normal, 41% moderately increased, and 40% with severely increased compliance. Barostat studies performed after 1 year in 80 children (37 conventional therapy and 43 rectal enemas in addition to conventional therapy) revealed that rectal compliance had not changed in either group and had not improved in successfully treated patients.
Constipated children with severely increased rectal compliance have severe symptoms. However, increased rectal compliance is not related to treatment failure. Regular use of enemas to avoid rectal fecal impaction does not improve rectal compliance in pediatric FC.
直肠顺应性增加被认为与小儿功能性便秘（FC）有关。我们评估了直肠顺应性增加的临床相关性，并评估了定期使用灌肠剂是否能改善FC患儿的直肠顺应性。
对FC患儿（8 - 18岁）进行了一项前瞻性纵向研究。在基线和1年后进行压力控制下的直肠扩张。直肠顺应性分为3组：正常、中度增加或重度增加。患者被随机分为接受传统治疗组或直肠灌肠加传统治疗组。临床成功定义为每周≥3次自主排便且每周大便失禁<1次。
对101名儿童（11.0±2.1岁）进行了基线测量；直肠顺应性正常者占36%，中度增加者占40%，重度增加者占24%。直肠顺应性重度增加的患者排便频率较低（P = 0.03），大便失禁较多（P = 0.04），直肠粪便嵌塞较多（P < 0.001）。1年后，各组的成功值相似：顺应性正常者为42%，中度增加者为41%，重度增加者为40%。1年后对80名儿童（37名接受传统治疗，43名接受直肠灌肠加传统治疗）进行的恒压器研究显示，两组的直肠顺应性均未改变，成功治疗的患者也未改善。
直肠顺应性重度增加的便秘患儿症状严重。然而，直肠顺应性增加与治疗失败无关。定期使用灌肠剂以避免直肠粪便嵌塞并不能改善小儿FC的直肠顺应性。
