Vilanova-Sanchez Alejandra, Gasior Alessandra C, Toocheck Nicole, Weaver Laura, Wood Richard J, Reck Carlos A, Wagner Andrea, Hoover Erin, Gagnon Renae, Jaggers Jordon, Maloof Tassiana, Nash Onnalisa, Williams Charae, Levitt Marc A
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States.
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States.
J Pediatr Surg. 2018 Apr;53(4):722-727. doi: 10.1016/j.jpedsurg.2018.01.002. Epub 2018 Jan 31.
Senna is a stimulant laxative commonly used by pediatricians, pediatric gastroenterologists, and pediatric surgeons. Many clinicians avoid Senna for reasons such as tolerance or side effects but this has little scientific justification. We recently found several patients we were caring for developed perineal blistering during the course of Senna treatment. Because of this we chose to review the literature to identify side effects in children taking this medication as well as to analyze our Center's experience with Senna's secondary effects.
We performed a literature review (MEDLINE, PUBMED) using the keywords of Senna, sen, sennosides and children, and pediatric and functional (idiopathic) constipation. We looked for articles with information regarding perineal blisters related to Senna as well as other secondary effects of Senna laxatives in children when used on a long-term basis. We also reviewed the charts of our patients who had previously taken Senna or are currently taking Senna, looking for adverse reactions.
Eight articles in the literature reported perineal blisters after administration of Senna laxatives in 28 patients. Of those occurrences, 18 patients (64%) had accidental administration of Senna and 10 (36%) had Senna prescribed as a long term treatment. All of the blistering episodes were related to high dose, night-time accidents, or intense diarrhea with a long period of stool to skin contact. At our institution, from 2014 to 2017, we prescribed Senna and have recorded data to 640 patients. During the study period, 17 patients (2.2%) developed blisters during their treatment. Patients who developed blisters had higher doses 60mg/day; 60 [12-100] vs. 17.5 [1.7-150] (p<0.001). All of the blistering episodes were related to night-time accidents, with a long period of stool to skin contact. 83 (13%) patients presented minor side effects such as abdominal cramping, vomiting or diarrhea which resolved once the type of laxatives were changed or enemas were started. The doses of Senna was not significantly different in these patients 15mg/day [4.4-150] vs. 17.5mg/day [1.5-150]. There were no other long-term side effects from Senna found in the pediatric literature for long-term treatment besides abdominal cramping or diarrhea during the first weeks of administration. We found no evidence of tolerance to Senna in our review.
There is a paucity of information in the literature regarding side effects of sennosides as a long-term therapy, and to our knowledge, this is the first review of Senna side effects in children. Senna induced dermatitis is rare, but may occur when patients need a higher dose. All of the cases described had a long period of exposure of the skin to stool. Besides the perineal rash with blisters, we could find no other described major side effect with Senna administration in the pediatric population or evidence of the frequently mentioned concern of the development of tolerance to Senna. Pediatric caregivers should advise families of the rare side effect of skin blistering and educate them to change the diaper frequently in children who are not toilet- trained to reduce stool to skin exposure. We can conclude from this review that Senna is a safe treatment option for constipation in children.
IV.
番泻叶是儿科医生、儿科胃肠病学家和儿科外科医生常用的刺激性泻药。许多临床医生因耐受性或副作用等原因避免使用番泻叶，但这几乎没有科学依据。我们最近发现，我们所护理的几名患者在番泻叶治疗过程中出现了会阴水疱。因此，我们选择回顾文献，以确定服用此药的儿童的副作用，并分析我们中心使用番泻叶的继发效应的经验。
我们使用关键词番泻叶、番、番泻苷、儿童、儿科和功能性（特发性）便秘进行了文献综述（医学文献数据库、医学期刊数据库）。我们查找了有关与番泻叶相关的会阴水疱以及长期使用番泻叶泻药对儿童的其他继发效应的文章。我们还查阅了之前服用过番泻叶或正在服用番泻叶的患者的病历，以寻找不良反应。
文献中的八篇文章报道了28例患者服用番泻叶泻药后出现会阴水疱。在这些病例中，18例患者（64%）意外服用了番泻叶，10例（36%）被开了番泻叶作为长期治疗药物。所有水疱发作均与高剂量、夜间意外或严重腹泻以及长时间粪便与皮肤接触有关。在我们机构，2014年至2017年期间，我们开了番泻叶，并记录了640例患者的数据。在研究期间，17例患者（2.2%）在治疗过程中出现了水疱。出现水疱的患者剂量较高，60mg/天；60[12-100]对比17.5[1.7-150]（p<0.001）。所有水疱发作均与夜间意外有关，且粪便与皮肤接触时间较长。83例（13%）患者出现轻微副作用，如腹部绞痛、呕吐或腹泻，一旦改变泻药类型或开始灌肠，这些症状就会缓解。这些患者的番泻叶剂量无显著差异，15mg/天[4.4-150]对比17.5mg/天[1.5-150]。除了在给药的最初几周出现腹部绞痛或腹泻外，儿科文献中未发现番泻叶长期治疗的其他长期副作用。在我们的综述中，我们没有发现对番泻叶产生耐受性的证据。
关于番泻苷作为长期治疗的副作用，文献中信息匮乏，据我们所知，这是首次对儿童番泻叶副作用的综述。番泻叶引起的皮炎很少见，但在患者需要更高剂量时可能会发生。所有描述的病例都有皮肤长时间接触粪便的情况。除了伴有水疱的会阴皮疹外，我们在儿科人群中未发现其他与服用番泻叶相关的主要副作用描述，也没有发现经常提到的对番泻叶产生耐受性的担忧的证据。儿科护理人员应告知家属皮肤水疱这一罕见副作用，并教育他们在未接受如厕训练的儿童中频繁更换尿布，以减少粪便与皮肤的接触。从本次综述中我们可以得出结论：番泻叶是儿童便秘的一种安全治疗选择。
四级
