Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, Netherlands.
Pediatrics. 2010 Jul;126(1):e156-62. doi: 10.1542/peds.2009-1009. Epub 2010 Jun 7.
This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes.
In a Dutch tertiary hospital, children (5-18 years of age) who were diagnosed as having functional constipation were eligible for inclusion. After a 6-week treatment protocol, prospective follow-up evaluations were conducted at 6 and 12 months and annually thereafter. Good clinical outcomes were defined as > or =3 bowel movements per week for > or =4 weeks, with < or =2 fecal incontinence episodes per month, irrespective of laxative use.
A total of 401 children (260 boys; median age: 8 years [interquartile range: 6-9 years]) were included, with a median follow-up period of 11 years (interquartile range: 9-13 years). The dropout rate during follow-up was 15%. Good clinical outcomes were achieved by 80% of patients at 16 years of age. Thereafter, this proportion remained constant at 75%. Poor clinical outcomes at adult age were associated with: older age at onset (odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.02-1.30]; P = .04), longer delay between onset and first visit to our outpatient clinic (OR: 1.24 [95% CI: 1.10-1.40]; P = .001), and lower defecation frequency at study entry (OR: 0.92 [95% CI: 0.84-1.00]; P = .03).
One-fourth of children with functional constipation continued to experience symptoms at adult age. Certain risk factors for poor clinical outcomes in adulthood were identified. Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment.
本研究旨在探讨成年期功能性便秘患儿的长期预后，并确定与临床结局相关的预后因素。
在荷兰一家三级医院，符合功能性便秘诊断标准的 5-18 岁儿童符合纳入标准。经过 6 周的治疗方案后，在 6 个月、12 个月和此后每年进行前瞻性随访评估。良好的临床结局定义为每周>3 次大便，>4 周，每月<2 次粪便失禁，不论是否使用泻药。
共纳入 401 名儿童（260 名男孩；中位年龄：8 岁[四分位距：6-9 岁]），中位随访时间为 11 年（四分位距：9-13 年）。随访期间的失访率为 15%。16 岁时，80%的患者达到良好的临床结局。此后，这一比例一直保持在 75%。成年后临床结局较差与：发病年龄较大（优势比[OR]：1.15[95%置信区间[CI]：1.02-1.30]；P=.04），从发病到首次就诊于我们的门诊就诊的时间间隔较长（OR：1.24[95%CI：1.10-1.40]；P=.001），以及研究开始时排便频率较低（OR：0.92[95%CI：0.84-1.00]；P=.03）有关。
四分之一的功能性便秘患儿在成年后仍会出现症状。确定了一些成年后临床结局不良的危险因素。对于对一线治疗无反应的儿童，应考虑尽早转至专科诊所。
