Fedele Flora, Fioretti Maria Teresa, Scarpato Elena, Martinelli Massimo, Strisciuglio Caterina, Miele Erasmo
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Ital J Pediatr. 2024 Apr 8;50(1):64. doi: 10.1186/s13052-024-01623-y.
Functional constipation is a common problem in childhood and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. No organic cause of the constipation can be found in approximately 95% of children, defining the "so-called" chronic functional constipation. Its prevalence has been reported to range from 0.7 to 29.6%, with a median of 12%. The diagnosis of functional constipation is exclusively clinical based on the pediatric diagnostic Rome criteria for functional gastrointestinal disorders and does not routinely require laboratory and/or radiological investigations. In case of alarm signs and symptoms that may suggest organic diseases, further investigations can be required. The therapeutic management is based on non-pharmacological and pharmacological approaches. Education, demystification of constipation and reward-based toilet training represent the cornerstones of nonpharmacological management. Disimpaction, maintenance treatment and weaning of medication are all elements of pharmacological treatment. Osmotic laxatives, mainly polyethylene glycol (PEG), are considered the first-choice laxative for both disimpaction and maintenance treatment. The aim of this review is to provide pediatric gastroenterologists with a practical tool to support the clinical and therapeutic management of children and adolescents affected by chronic functional constipation.
功能性便秘是儿童期常见问题，对受影响儿童及其照料者的社交、身体和情感功能有很大影响。在约95%的儿童中找不到便秘的器质性病因，这就定义了“所谓的”慢性功能性便秘。据报道，其患病率在0.7%至29.6%之间，中位数为12%。功能性便秘的诊断完全基于儿童功能性胃肠病的罗马诊断标准，通常不需要实验室和/或放射学检查。如果出现可能提示器质性疾病的警示症状，则可能需要进一步检查。治疗管理基于非药物和药物方法。教育、消除对便秘的神秘感以及基于奖励的如厕训练是非药物管理的基石。清除干结大便、维持治疗和药物撤减都是药物治疗的要素。渗透性泻药，主要是聚乙二醇（PEG），被认为是清除干结大便和维持治疗的首选泻药。本综述的目的是为儿科胃肠病学家提供一种实用工具，以支持对受慢性功能性便秘影响的儿童和青少年进行临床和治疗管理。
