Jonker Charlotte A L, van Os Tirza M, Gorter Ramon R, Levitt Marc A, Benninga Marc A
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Children (Basel). 2025 Jun 28;12(7):857. doi: 10.3390/children12070857.
In this review, we summarize current insights into the treatment of functional constipation (FC) in children. Constipation is a global issue in the pediatric population, with a prevalence of approximately 9.5%. Initial management involves a combination of non-pharmacological and pharmacological interventions. However, a significant number of children continue to experience therapy-resistant FC despite optimal non-pharmacological and pharmacological treatments. While studies on novel pharmacological options in children are limited, adult trials have shown promising results. New agents such as lubiprostone, prucalopride, linaclotide, and plecanatide have demonstrated improved outcomes compared to placebo or conventional therapies, particularly in increasing spontaneous bowel movements. Neurostimulation presents an additional treatment modality. Posterior tibial nerve stimulation appears to be a promising new option, offering high treatment satisfaction and a favorable safety profile with a low rate of severe adverse events. For children who do not respond to optimal conservative therapy, the impact on quality of life can be substantial. In such cases, surgical interventions may be considered, including intrasphincteric botulinum toxin injections, antegrade continence enema surgery, and, in severe cases, colonic resection or a diverting ostomy. The choice of surgical treatment remains a subject of ongoing debate. Therapy-resistant FC in children is a complex and impactful condition. An individualized, stepwise approach is essential, with surgical options such as colonic resection reserved as a last resort.
在本综述中，我们总结了目前对儿童功能性便秘（FC）治疗的见解。便秘是儿科人群中的一个全球性问题，患病率约为9.5%。初始治疗包括非药物和药物干预相结合。然而，尽管进行了最佳的非药物和药物治疗，仍有相当数量的儿童持续经历难治性FC。虽然关于儿童新型药物选择的研究有限，但成人试验已显示出有前景的结果。鲁比前列酮、普芦卡必利、利那洛肽和普卡那肽等新药与安慰剂或传统疗法相比，已显示出更好的疗效，尤其是在增加自发排便方面。神经刺激是另一种治疗方式。胫后神经刺激似乎是一个有前景的新选择，具有较高的治疗满意度和良好的安全性，严重不良事件发生率低。对于对最佳保守治疗无反应的儿童，对生活质量的影响可能很大。在这种情况下，可考虑手术干预，包括括约肌内注射肉毒杆菌毒素、顺行性节制灌肠手术，以及在严重情况下进行结肠切除术或造口分流术。手术治疗的选择仍然是一个持续争论的话题。儿童难治性FC是一种复杂且有影响的病症。个性化的、逐步的方法至关重要，结肠切除术等手术选择应作为最后的手段。
