Bolia Rishi, Safe Mark, Southwell Bridget R, King Sebastian K, Oliver Mark R
Division of Paediatric Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India.
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2020 Nov;56(11):1708-1718. doi: 10.1111/jpc.14720.
Constipation is a common problem in childhood. The most common type of constipation is functional, accounting for 90-95% of all cases. The aim of this review is to provide clinical scenarios with treatment using evidence-based information, and management strategies and a clinical algorithm to guide the management of constipation in children. Recent guidelines and online information sites are detailed. Clinical red flags and organic causes of constipation are included. Four clinical scenarios are presented: case (1) 4-month-old child with constipation since birth and likely Hirschsprung disease; case (2) 6-month-old infant with infant dyschezia; case (3) 4-year old with functional constipation; and; case (4) 9-year old with treatment resistant constipation. Children with functional constipation need a thorough history and physical exam to rule out the presence of any 'red flags' but do not require laboratory investigations. Management includes education and demystification, disimpaction followed by maintenance therapy with oral laxatives, dietary counselling and toilet training. Treatment options differ between infants and children. Disimpaction and maintenance regimens for common laxatives are presented. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. The radionuclide intestinal transit study (scintigraphy) is a useful modality for evaluation and planning of management in treatment-resistant children. Treatment options for treatment-resistant patients are presented. High-level evidence (meta-analyses) for pharmalogical and non-pharmalogical treatment modalities are reviewed and an algorithm for assessment and treatment are presented.
便秘是儿童期的常见问题。最常见的便秘类型是功能性便秘，占所有病例的90 - 95%。本综述的目的是利用循证信息提供临床病例及治疗方法、管理策略和临床算法，以指导儿童便秘的管理。详细介绍了近期的指南和在线信息网站。还包括便秘的临床警示信号和器质性病因。文中呈现了四个临床病例：病例（1）自出生起就便秘的4个月大儿童，可能患有先天性巨结肠症；病例（2）患有婴儿排便困难的6个月大婴儿；病例（3）患有功能性便秘的4岁儿童；以及病例（4）患有难治性便秘的9岁儿童。功能性便秘患儿需要进行全面的病史询问和体格检查以排除任何“警示信号”，但无需实验室检查。管理措施包括教育和消除疑虑、使用口服泻药进行通便治疗后进行维持治疗、饮食咨询和排便训练。婴儿和儿童的治疗方案有所不同。介绍了常用泻药的通便和维持治疗方案。治疗失败或怀疑有器质性疾病时，患者应转诊进行进一步评估。放射性核素肠道通过研究（闪烁扫描）是评估和规划难治性儿童治疗的有用方法。介绍了难治性患者的治疗方案。回顾了药物和非药物治疗方式的高级别证据（荟萃分析），并给出了评估和治疗算法。
