Murdoch Children's Research Institute, Urology Department, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Expert Rev Gastroenterol Hepatol. 2020 Mar;14(3):163-174. doi: 10.1080/17474124.2020.1733974.
: Constipation occurs in many children and can become chronic. Many grow out of it but for one third, it continues into adulthood. For most patients, there is no identifiable organic disorder and it is classified as functional constipation.: In 2016, treatment of childhood constipation was extensively reviewed by Rome IV. This review covers meta-analyses and evidence for treatment of paediatric constipation since 2016 and new emerging treatments.: Since 2016, meta-analyses conclude 1) fibre should be included in a normal diet, but further supplementation does not improve constipation; 2) probiotics may increase stool frequency in children, but evidence from larger RCTs is needed; 3) comparing laxatives, polyethylene glycol (PEG) is superior to placebo, lactulose and milk of magnesia, and 4) appendix stomas are effective and should be considered before surgery. Emerging areas of study include food intolerance, electrical stimulation and faecal microbiota transplant. For research, outcome measures need standardising to allow comparison between studies and allow meta-analyses. To assist this, validated GI instruments have been developed by Rome IV and PedsQl.
便秘在许多儿童中都会发生，并可能成为慢性疾病。许多儿童会随着年龄增长而自愈，但仍有三分之一的儿童会持续到成年。对于大多数患者来说，没有可识别的器质性疾病，因此被归类为功能性便秘。2016 年，罗马 IV 对儿童便秘的治疗进行了广泛的综述。这篇综述涵盖了自 2016 年以来针对儿童便秘的治疗的荟萃分析和证据，以及新出现的治疗方法。自 2016 年以来，荟萃分析的结论为：1）膳食纤维应包含在正常饮食中，但进一步补充并不能改善便秘；2）益生菌可能会增加儿童的粪便频率，但需要更大规模 RCT 的证据；3）比较泻药，聚乙二醇（PEG）优于安慰剂、乳果糖和镁乳；4）阑尾造口术是有效的，在手术前应考虑。新出现的研究领域包括食物不耐受、电刺激和粪便微生物群移植。对于研究，需要对结果衡量标准进行标准化，以便在研究之间进行比较并允许进行荟萃分析。为此，罗马 IV 和 PedsQl 开发了经过验证的胃肠道仪器。
