Gordon Morris, Hathagoda Wathsala, Rajindrajith Shaman, Sinopoulou Vassiliki, Abdulshafea Mansour, Velasco Carlos, Tabbers Merit, Benninga Marc A
University of Central Lancashire, Preston, UK
Pediatrics, University of Colombo Faculty of Medicine, Colombo, Sri Lanka.
BMJ Paediatr Open. 2024 Dec 12;8(1):e003063. doi: 10.1136/bmjpo-2024-003063.
The Rome criteria define childhood functional constipation but do not address refractory constipation. Attempts to define refractory constipation lack consensus. The interchangeable use of 'refractory' and 'intractable' or 'therapy-resistant' constipation and lack of understanding of the therapeutic ceilings before this diagnosis complicates the definition.
To conduct an online cross-sectional study among medical professionals and researchers across a range of countries, to propose a consensus definition, terminology and duration of medically unresponsive constipation.
An expert-designed questionnaire was disseminated via Google Forms in a two-stage study over 2 months targeting paediatric gastroenterology professionals globally and Latin American clinicians with a translated version. The questionnaire had seven critical questions containing details needed to define medically unresponsive constipation. The study protocol was approved by the ethics review panel.
The survey involved 1079 participants: 87 from various countries in the first phase and 992 from Latin America in the second. There were 619 (57.3%) general paediatricians and 462 (43 %) paediatric gastroenterologists. The preferred term to indicate poorly responding constipation was 'therapy-resistant constipation' (47.8%), followed by 'refractory constipation' (43.6%). The majority of respondents (92.9%) agreed on considering a time frame for defining refractory constipation, with 37.7% suggesting 2-3 months. 467 (43.2%) recommended including failure despite maximum laxative therapy with two agents should be considered as previous therapy failure. Compliance with therapy was deemed essential for successful treatment by 91.1%, assessed through detailed history-taking (47.4%) or medical/pharmacy records (29.4%).
Based on the professional views collected in this study, we propose the term 'therapy-resistant constipation' and it can be defined as constipation that is not responding to a maximum dose of at least two laxatives of different classes for a minimum of 3 months with good compliance in a secondary or tertiary care facility.
罗马标准定义了儿童功能性便秘，但未涉及难治性便秘。目前对于难治性便秘的定义尚未达成共识。“难治性”与“顽固性”或“治疗抵抗性”便秘的交替使用，以及在做出该诊断之前对治疗上限缺乏了解，使得定义变得复杂。
在多个国家的医学专业人员和研究人员中开展一项在线横断面研究，以提出关于药物治疗无效便秘的共识定义、术语和时长。
在一项为期2个月的两阶段研究中，通过谷歌表单分发了一份由专家设计的问卷，目标是全球的儿科胃肠病学专业人员以及提供了翻译版本的拉丁美洲临床医生。问卷包含七个关键问题，涵盖了定义药物治疗无效便秘所需的详细信息。该研究方案已获得伦理审查小组的批准。
调查涉及1079名参与者：第一阶段来自不同国家的有87人，第二阶段来自拉丁美洲的有992人。其中有619名（57.3%）普通儿科医生和462名（43%）儿科胃肠病学家。表示便秘反应不佳的首选术语是“治疗抵抗性便秘”（47.8%），其次是“难治性便秘”（43.6%）。大多数受访者（92.9%）同意考虑为定义难治性便秘设定一个时间框架，37.7%的人建议为2至3个月。467人（43.2%）建议，尽管使用两种药物进行了最大剂量的泻药治疗但仍失败，应被视为既往治疗失败。91.1%的人认为治疗依从性对成功治疗至关重要，通过详细询问病史（47.4%）或医疗/药房记录（29.4%）进行评估。
基于本研究收集的专业意见，我们提出“治疗抵抗性便秘”这一术语，其可定义为在二级或三级医疗机构中，对至少两种不同类别的泻药最大剂量治疗至少3个月且依从性良好仍无反应的便秘。
