Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Pediatr Gastroenterol Nutr. 2010 Mar;50(3):256-68. doi: 10.1097/MPG.0b013e3181afcdc3.
Knowledge regarding prognosis and factors influencing the clinical course of functional constipation in children is important to enable general practitioners and paediatricians to give accurate patient information, to compare treatment strategies, and identify children with high risk for unfavourable outcome. The objective of the study was to investigate and summarize the quantity and quality of evidence on prognosis of childhood constipation with and without treatment and its predictive factors.
An extensive literature search in MEDLINE and Embase was performed to identify prospective follow-up studies evaluating the prognosis or prognostic determinants of functional constipation. Methodological quality was assessed using a standardised list. Results on prognosis of constipation were statistically pooled, and the influence of prognostic factors was summarised in a best evidence synthesis.
The search strategy resulted in a total of 2882 abstracts. Only 14 publications met our inclusion criteria, of which 21% scored high methodological quality. Included studies showed large heterogeneity in study populations and outcome measures. Without regard to these differences, 49.3% +/- 11.8% of all of the children followed for 6 to 12 months were found to recover and taken off laxatives. The percentage of children who were free from complaints, regardless of laxative use, after 6 to 12 months was 60.6% +/- 19.2%. There is substantial evidence that defecation frequency and a positive family history are not associated with recovery from constipation.
The few studies published on prognosis of childhood functional constipation and predictive factors showed large heterogeneity and poor methodological quality. Overall, 60.6% of children are found to be free from symptoms after 6 to 12 months. Recovery rate showed no relation with defecation frequency or positive family history. Based on the present literature, we are unable to identify a group of children with high risk for poor prognosis.
了解儿童功能性便秘的预后及影响临床病程的因素，对于普通医生和儿科医生为患者提供准确信息、比较治疗策略以及识别预后不良风险较高的儿童至关重要。本研究旨在调查和总结功能性便秘有或无治疗的预后及其预测因素的数量和质量证据。
在 MEDLINE 和 Embase 中进行了广泛的文献检索，以确定评估功能性便秘预后或预后决定因素的前瞻性随访研究。使用标准化清单评估方法学质量。对便秘的预后结果进行统计学汇总，并在最佳证据综合中总结预后因素的影响。
检索策略共产生了 2882 篇摘要。只有 14 篇出版物符合我们的纳入标准，其中 21%的研究具有较高的方法学质量。纳入的研究在研究人群和结局测量方面存在很大的异质性。尽管存在这些差异，但在随访 6 至 12 个月的所有儿童中，仍有 49.3% +/- 11.8%被发现痊愈并停用泻药。在随访 6 至 12 个月后，无论是否使用泻药，无抱怨症状的儿童比例为 60.6% +/- 19.2%。有大量证据表明，排便频率和阳性家族史与便秘的恢复无关。
已发表的关于儿童功能性便秘预后和预测因素的少数研究显示出较大的异质性和较差的方法学质量。总体而言，60.6%的儿童在随访 6 至 12 个月后症状消失。恢复率与排便频率或阳性家族史无关。根据目前的文献，我们无法确定一组预后不良风险较高的儿童。
