University of Central Lancashire, Preston, UK.
University of Central Lancashire, Preston, UK
BMJ Paediatr Open. 2024 Jun 6;8(1):e002380. doi: 10.1136/bmjpo-2023-002380.
Therapy-resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements faecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy-resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures.
To conduct a systematic review determining how paediatric interventional studies define therapy-resistant constipation.
We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy-resistant constipation were identified. Data were extracted on criteria used for defining therapy-resistant constipation and reported using a meta-narrative approach highlighting areas of convergence and divergence in the findings.
A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least seven definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy-resistant constipation. Out of them, only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy-resistant constipation. The duration before being diagnosed as therapy-resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation while five adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children.
The current literature has no explicit definition for therapy-resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary and maybe even harmful, invasive diagnostic and therapeutic interventions.
治疗抵抗性便秘通常是一种令人沮丧的临床实体，其特征为尽管进行了强化治疗，但仍存在排便频率低、排便疼痛、粪便失禁和腹痛。在对儿童进行侵入性诊断和治疗程序之前，明确定义治疗抵抗性便秘非常重要。
进行系统评价，确定儿科介入研究如何定义治疗抵抗性便秘。
我们检索了 CENTRAL、MEDLINE、Embase、WHO ICTR 和 ClinicalTrials.gov。确定了包含治疗抵抗性便秘患者的研究。提取了用于定义治疗抵抗性便秘的标准，并使用元叙述方法报告数据，突出发现的趋同和分歧领域。
对 1553 篇摘要进行了重复筛选，共有 47 项研究纳入了综述。儿科文献中至少有七种定义用于定义医学抵抗性便秘。有 24 篇文章使用了“难治性”一词，21 篇文章使用了“难治性”一词来描述治疗抵抗性便秘。其中，只有 14 篇文章试图提供明确的定义，包括预设的时间和之前的治疗。有 10 项研究没有明确定义治疗抵抗性便秘。被诊断为治疗抵抗性便秘之前的时间从 1 个月到 2 年不等。7 项研究采用罗马标准（罗马 III 或罗马 IV）来描述便秘，5 项研究采用罗马 III 和欧洲北美儿科学会定义的儿童胃肠病、肝病和营养学会管理便秘指南。
目前的文献中没有儿童治疗抵抗性便秘的明确定义。需要制定详细的共识定义，以确保未来研究的一致性，并避免不必要的、甚至可能有害的侵入性诊断和治疗干预。
