Vadlapudi Srinivas Srinidhi, Poddar Ujjal, Srivastava Anshu, Sarma Moinak Sen
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
Dig Dis Sci. 2025 Apr 16. doi: 10.1007/s10620-025-09048-1.
BACKGROUND/AIMS: Functional constipation (FC) is the most common cause of childhood constipation. Children with FC and fecal impaction need to undergo disimpaction. Polyethylene glycol (PEG) is commonly used for disimpaction either in a hospital setting as a continuous lavage or in a home-based setting over 3-6 days. Randomized control trials comparing the two regimens are not available. The study objectives were to compare the efficacy, side effects, cost-effectiveness, and parental satisfaction of home- and hospital-based disimpaction.
Consecutive children attending our hospital (age: 1-18 years) and diagnosed to have FC as per ROME IV and requiring disimpaction were enrolled. Fecal impaction was established clinically (per-abdomen or per-rectal examination) or radiologically (X-ray abdomen- Barr criteria). Stratified block randomization was done. PEG was administered accordingly in a hospital-based or a home-based setting. The side effects, patient acceptability as per the treatment satisfaction questionnaire for medications (TSQM) and cost incurred were noted.
One hundred and fifteen children (hospital-based [n = 58], home-based [n = 57]) were enrolled. Successful disimpaction in hospital- and home-based disimpaction arm was 100% and 94.7%, respectively (p = 0.12). Vomiting (27.6% vs 5.3%, p = 0.001) and abdominal distension (31% vs 3.5%, p < 0.001) were higher in patients undergoing hospital-based disimpaction. Cost of treatment was higher in hospital-based disimpaction arm (INR 6,250 [2,228-15,585] vs INR 3,355 [850-18,350], p = < 0.001). Parental satisfaction was greater in home-based disimpaction.
Home-based disimpaction using PEG is as effective as hospital-based disimpaction. Disimpaction in a friendlier home environment, at a lower cost and with fewer side effects makes home-based disimpaction preferable in children.
背景/目的：功能性便秘（FC）是儿童便秘最常见的原因。患有FC和粪便嵌塞的儿童需要进行排便治疗。聚乙二醇（PEG）通常用于医院环境中的持续灌肠或在家中持续3 - 6天进行排便治疗。目前尚无比较这两种治疗方案的随机对照试验。本研究的目的是比较家庭式和医院式排便治疗的疗效、副作用、成本效益以及家长满意度。
连续纳入我院就诊的（年龄1 - 18岁）、根据罗马IV标准诊断为FC且需要进行排便治疗的儿童。通过临床检查（腹部或直肠检查）或影像学检查（腹部X线 - 巴尔标准）确定粪便嵌塞情况。采用分层区组随机化方法。相应地在医院或家庭环境中给予PEG。记录副作用、根据药物治疗满意度问卷（TSQM）得出的患者接受度以及所产生的费用。
共纳入115名儿童（医院式[n = 58]，家庭式[n = 57]）。医院式和家庭式排便治疗组的成功排便率分别为100%和94.7%（p = 0.12）。医院式排便治疗的患者呕吐发生率（27.6% vs 5.3%，p = 0.001）和腹胀发生率（31% vs 3.5%，p < 0.001）更高。医院式排便治疗组的治疗费用更高（6250印度卢比[2228 - 15585] vs 3355印度卢比[850 - 18350]，p = < 0.001）。家庭式排便治疗的家长满意度更高。
使用PEG进行家庭式排便治疗与医院式排便治疗效果相同。在更友好的家庭环境中进行排便治疗，成本更低且副作用更少，使得家庭式排便治疗对儿童更为可取。
