Widodo Ariani, Hegar Badriul, Vandenplas Yvan
Department of Child Health, Universitas Indonesia, Jakarta 10430, Indonesia.
Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Larbeeeklan, Brussels 1090, Belgium.
World J Clin Pediatr. 2018 Feb 8;7(1):56-61. doi: 10.5409/wjcp.v7.i1.56.
To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.
A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.
Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements (according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools (83%), blood in the stools (36%), fecal incontinence (33%), and/or difficulty in defecating (47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly (according to 68%) The preferred nonpharmacologic treatment are high-fiber diet (96%), increased fluid intake (90%), toilet training (74%), and abdominal massage (49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used (87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment (85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians (69%) expect a positive response during the first week with a mean (± SD) of 4.1 (± 2.56) d. Most participants (86%) treat during one month or even less. And the majority (67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.
These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.
评估印度尼西亚各地普通儿科医生对儿童便秘诊断和治疗的了解情况。
向印度尼西亚各地多家教学医院和政府医院的普通儿科医生发放了一份综合问卷。
从印度尼西亚20个城市的100名儿科医生处获取了数据，他们的平均临床实践经验为78.34±18.00个月。当6个月以上儿童出现排便频率降低（87%的参与者认为），平均每3.59±1.0天排便一次，大便干结（83%），便血（36%），大便失禁（33%）和/或排便困难（47%）时，会怀疑儿童便秘。只有26名儿科医生将药物治疗作为首选治疗方法，而绝大多数医生更喜欢非药物治疗，大多数（68%）首选的非药物治疗方法是高纤维饮食（96%）、增加液体摄入量（90%）、排便训练（74%）和腹部按摩（49%）。非药物治疗的持续时间限制在1至2周。70%推荐排便训练的儿科医生只能提及该技术的一些要素，只有15%能够全面且正确地解释。乳果糖是最常用的药物干预措施（87%的参与者），用柠檬酸钠、月桂醇硫酸酯钠和山梨醇进行直肠治疗是最常用的直肠治疗方法（85%）。只有51%的医生会为粪便嵌塞开直肠治疗的处方。大多数儿科医生（69%）期望在第一周出现阳性反应，平均（±标准差）为4.1（±2.56）天。大多数参与者（86%）治疗一个月或更短时间。大多数（67%）医生在大便频率和/或性状恢复正常或患者不再有症状时停止治疗。
这些数据为印度尼西亚儿童便秘的诊断和管理提供了见解。尽管普通儿科医生了解便秘诊断和管理的一些重要方面，但总体知识有限。应努力改善现有指南的传播。这些发现突出并证实了将现有指南信息传播给普通儿科医生存在困难。
