Rajindrajith Shaman, Devanarayana Niranga M, Lakmini Chamila, Subasinghe Vindya, de Silva D G Harendra, Benninga Marc A
*Faculty of Medicine, Department of Paediatrics †Faculty of Medicine, Department of Physiology, University of Kelaniya, Ragama, Sri Lanka ‡Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
J Pediatr Gastroenterol Nutr. 2014 Apr;58(4):486-90. doi: 10.1097/MPG.0000000000000249.
Child abuse leads to multiple physical and psychosomatic sequelae. The aim of the present study was to evaluate the association between child abuse and constipation among schoolchildren.
Children 13 to 18 years of age were selected from 4 semiurban schools in Gampaha District, Sri Lanka. A self-administered questionnaire was used for data collection. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse, and somatisation were collected. Constipation was diagnosed using Rome III criteria.
A total of 1792 children were included in the analysis (boys 975 [54.4%], mean age 14.4 years, standard deviation [SD] 1.3 years). One hundred thirty-eight (7.7%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional, and sexual abuse were, respectively, 438 (24.4%), 396 (22.1%), and 51 (2.8%). The prevalence of constipation was significantly higher in those exposed to sexual (5.8% vs 2.6% P = 0.03), emotional (40.9% vs 20.8%, P < 0.0001), and physical abuse (41.6% vs 23.2%, P < 0.0001). Mean somatisation score was higher in the total group of abused children with constipation (mean 18.6, SD 12.5) compared with those without (mean 13.9, SD 12.3; P = 0.027). Children with a history of abuse did not seek health care more often than children without this history. Patient-perceived severity of bowel symptoms was higher in children with physical abuse (23.7 vs 19.7 P = 0.001) and emotional abuse (25.4 vs 19.3 P < 0.0001).
Childhood constipation shows a significant association with physical, sexual, and emotional abuse. Children with constipation complain of more somatic symptoms and bowel symptoms when they are exposed to abuse.
虐待儿童会导致多种身体和身心后遗症。本研究的目的是评估学童中虐待儿童与便秘之间的关联。
从斯里兰卡甘帕哈区的4所半城市学校中选取13至18岁的儿童。使用自填式问卷进行数据收集。收集有关社会人口学因素、胃肠道症状、虐待儿童情况和躯体化的信息。采用罗马Ⅲ标准诊断便秘。
共有1792名儿童纳入分析（男孩975名[54.4%]，平均年龄14.4岁，标准差[SD]1.3岁）。138名（7.7%）符合便秘的罗马Ⅲ标准。遭受身体虐待、情感虐待和性虐待的儿童数量分别为438名（24.4%）、396名（22.1%）和51名（2.8%）。遭受性虐待（5.8%对2.6%，P = 0.03）、情感虐待（40.9%对20.8%，P < 0.0001）和身体虐待（41.6%对23.2%，P < 0.0001）的儿童便秘患病率显著更高。与未患便秘的受虐待儿童总体（平均18.6，SD 12.5）相比，患便秘的受虐待儿童总体的平均躯体化得分更高（平均13.9，SD 12.3；P = 0.027）。有虐待史的儿童寻求医疗保健的频率并不比无此病史的儿童更高。身体虐待儿童（23.7对19.7，P = 0.001）和情感虐待儿童（25.4对19.3，P < 0.0001）对肠道症状的自我感知严重程度更高。
儿童便秘与身体、性和情感虐待存在显著关联。便秘儿童在遭受虐待时会抱怨更多的躯体症状和肠道症状。
