Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, H7-250, PO Box 22700, 1100 DD Amsterdam, Netherlands.
Pediatrics. 2011 Oct;128(4):753-61. doi: 10.1542/peds.2011-0179. Epub 2011 Sep 26.
To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine.
We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently.
We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone.
There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation.
总结非药物治疗儿童便秘的证据，并评估报告研究的质量，包括纤维、液体、身体运动、益生元、益生菌、行为疗法、多学科治疗和替代医学形式。
我们系统地搜索了 3 个主要的电子数据库和现有综述的参考文献列表。我们纳入了报告非药物治疗的系统评价和随机对照试验（RCT）。两名评审员独立评估方法学质量。
我们纳入了 9 项研究，共 640 名儿童。由于研究之间存在很大的异质性，因此无法进行荟萃分析。我们没有发现关于身体运动、多学科治疗或替代医学的 RCT。一些证据表明，纤维补充剂可能比安慰剂更有效地改善粪便的频率和一致性，并减轻腹痛。与正常液体摄入相比，我们没有发现水摄入增加的证据，也没有证据表明高渗液治疗更有效地增加粪便频率或减少排便困难。我们没有证据推荐使用益生元或益生菌。含泻药的行为疗法并不比单独使用泻药更有效。
有一些证据表明纤维补充剂比安慰剂更有效。对于液体补充剂、益生元、益生菌或行为干预，没有发现任何效果的证据。对于功能性便秘儿童的非药物治疗，缺乏高质量的精心设计的 RCT。
