Bekkali Noor-L-Houda, van den Berg Maartje-Maria, Dijkgraaf Marcel G W, van Wijk Michiel P, Bongers Marloes E J, Liem Olivia, Benninga Marc A
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, Netherlands.
Pediatrics. 2009 Dec;124(6):e1108-15. doi: 10.1542/peds.2009-0022.
We hypothesized that enemas and polyethylene glycol (PEG) would be equally effective in treating rectal fecal impaction (RFI) but enemas would be less well tolerated and colonic transit time (CTT) would improve during disimpaction.
Children (4-16 years) with functional constipation and RFI participated. One week before disimpaction, a rectal examination was performed, symptoms of constipation were recorded, and the first CTT measurement was started. If RFI was determined, then patients were assigned randomly to receive enemas once daily or PEG (1.5 g/kg per day) for 6 consecutive days. During this period, the second CTT measurement was started and a child's behavior questionnaire was administered. Successful rectal disimpaction, defecation and fecal incontinence frequencies, occurrence of abdominal pain and watery stools, CTTs (before and after disimpaction), and behavior scores were assessed.
Ninety-five patients were eligible, of whom 90 participated (male, n = 60; mean age: 7.5 +/- 2.8 years). Forty-six patients received enemas and 44 PEG, with 5 dropouts in each group. Successful disimpaction was achieved with enemas (80%) and PEG (68%; P = .28). Fecal incontinence and watery stools were reported more frequently with PEG (P < .01), but defecation frequency (P = .64), abdominal pain (P = .33), and behavior scores were comparable between groups. CTT normalized equally (P = .85) in the 2 groups.
Enemas and PEG were equally effective in treating RFI in children. Compared with enemas, PEG caused more fecal incontinence, with comparable behavior scores. The treatments should be considered equally as first-line therapy for RFI.
我们假设灌肠剂和聚乙二醇（PEG）在治疗直肠粪便嵌塞（RFI）方面同样有效，但灌肠剂的耐受性较差，且在解除嵌塞过程中结肠运输时间（CTT）会改善。
纳入患有功能性便秘和RFI的儿童（4 - 16岁）。在解除嵌塞前一周，进行直肠检查，记录便秘症状，并开始首次CTT测量。若确定为RFI，则将患者随机分配，连续6天每日接受一次灌肠剂或PEG（1.5 g/kg/天）治疗。在此期间，开始第二次CTT测量，并发放儿童行为问卷。评估直肠嵌塞解除是否成功、排便和大便失禁频率、腹痛和水样便的发生情况、CTT（解除嵌塞前后）以及行为评分。
95例患者符合条件，其中90例参与研究（男性60例；平均年龄：7.5±2.8岁）。46例患者接受灌肠剂治疗，44例接受PEG治疗，每组各有5例退出。灌肠剂组（80%）和PEG组（68%）成功解除嵌塞（P = 0.28）。PEG组报告的大便失禁和水样便更为频繁（P < 0.01），但两组间排便频率（P = 0.64）、腹痛（P = 0.33）和行为评分相当。两组CTT均同等程度恢复正常（P = 0.85）。
灌肠剂和PEG在治疗儿童RFI方面同样有效。与灌肠剂相比，PEG导致更多大便失禁，行为评分相当。这两种治疗方法应同样被视为RFI的一线治疗方案。
