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Dziechciarz P, Ruszczyński M, Horvath A. Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic Review. Pediatr Gastroenterol Hepatol Nutr 2022; 25:228-239. [PMID: 35611374 PMCID: PMC9110845 DOI: 10.5223/pghn.2022.25.3.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy. Methods Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction. Results Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose). Conclusion PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.
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Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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2
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Watanabe J, Kotani K. Polyethylene Glycol Versus Senna for Bowel Preparation for Colonoscopy in Children: Updated Evidence by a Systematic Review and Meta-Analysis. Cureus 2021; 13:e17813. [PMID: 34660023 PMCID: PMC8500257 DOI: 10.7759/cureus.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/11/2022] Open
Abstract
For colonoscopy, bowel preparation, especially that using polyethylene glycol (PEG) or senna, is performed among children with gastrointestinal disorders; however, it is not fully grounded in evidence. This study reviewed via meta-analyses the approaches to bowel preparation for colonoscopy in children. Electronic databases and trial registries were searched until April 2021. Quality assessment was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation method. In total, three randomized controlled trials (318 patients) were identified. PEG was observed as a preferred protocol of bowel preparation compared with senna (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.05-1.74; I2 = 15%). It was less painful than senna (RR 0.62, 95% CI 0.44-0.87; I2 = 0%). No serious adverse events were noted. Overall, the certainty of the evidence was low to moderate. PEG might be a preferred preparation agent for colonoscopy in children. Given the limited data, more studies are recommended.
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Affiliation(s)
- Jun Watanabe
- Community and Family Medicine, Jichi Medical University, Shimotsuke, JPN
| | - Kazuhiko Kotani
- Community and Family Medicine, Jichi Medical University, Shimotsuke, JPN
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3
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Fang S, Song Y, Liu Y, Wang L. Randomized clinical trial: efficacy and tolerability of two different split dose of low-volume polyethylene glycol electrolytes for bowel preparation before colonoscopy in hospitalized children. Pediatr Res 2021; 90:171-175. [PMID: 33106606 DOI: 10.1038/s41390-020-01216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/23/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Eighty milliliter per kilogram of polyethylene glycol (PEG) for bowel preparation (BP) has been recommended, but the amount of liquid orally without nasogastric intubation is difficult to achieve. This study is to compare the efficacy and tolerability of two different low-volume PEG electrolyte solutions for BP in children. METHODS The randomized, double-blind, controlled trial enrolled 150 children aged 6-18 years undergoing colonoscopy in our center. Patients were randomly assigned to receive 60 ml/kg (PEG-ELS 60) or 40 ml/kg (PEG-ELS 40) of PEG electrolytes (PEG-ELS) 4000. The Boston Bowel Preparation Scale was used for bowel cleansing evaluation. Primary end point was overall colon cleansing. Tolerability was also evaluated. RESULTS PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for both whole colon and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered the BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. CONCLUSIONS Low volume of PEG-ELS for BP has good efficacy in bowel cleansing. PEG-ELS with 40 ml/kg volume was not inferior to that of 60 ml/kg. IMPACT PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for whole and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. This study showed that low-volume PEG-ELS monotherapy was effective in bowel cleansing and explored a possibly feasible BP method for pediatrics in China that PEG-ELS 40 was comparable to PEG-ELS 60 regimen.
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Affiliation(s)
- Shengbo Fang
- Department of Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanqing Song
- Department of Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yufei Liu
- Department of Pediatric Gastroenterology Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Libo Wang
- Department of Pediatric Gastroenterology Unit, The First Hospital of Jilin University, Changchun, Jilin, China.
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Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
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Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
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The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy. Gastroenterol Res Pract 2020; 2019:3230654. [PMID: 31915433 PMCID: PMC6935457 DOI: 10.1155/2019/3230654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p = 0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p = 0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient's grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.
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6
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Hawley P, MacKenzie H, Gobbo M. PEG vs. sennosides for opioid-induced constipation in cancer care. Support Care Cancer 2019; 28:1775-1782. [PMID: 31321524 DOI: 10.1007/s00520-019-04944-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/17/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE This randomized double-blind, double-dummy, 2-treatment, 2-period crossover study aimed to compare the efficacy and tolerability of polyethylene glycol (PEG) and sennosides in ambulatory cancer patients with opioid-induced constipation. METHODS Outpatients ≥ 18 years old with cancer, at risk of or already experiencing opioid-induced constipation, were randomly assigned to begin a standard bowel protocol of escalating doses of sennosides or PEG, plus a dummy preparation. After 3 weeks, the patients switched to the alternate active product and dummy preparation. Constipation was assessed using the revised Victoria Bowel Performance Scale (rBPS) at the end of each of the 2 consecutive 21-day study periods for the number of days with a satisfactory bowel movement, the time in days to goal rBPS (G), and the treatment preference of each patient. RESULTS Seventy patients were recruited, with 42 completing their first treatment period and 28 completing both treatment periods. For the typical patient, the expected number of days with a satisfactory bowel movement per days of treatment was found to be 1.21 times higher on PEG than on sennosides in a particular period (95% credible interval 0.96 to 1.55). Patients taking PEG were 1.47 times more likely to reach a rBPS of G before patients taking sennosides in the first period (95% confidence interval 0.74 to 2.94). There was no evidence of a difference in patient preference between laxatives. CONCLUSION Our study found weak evidence that PEG is superior to sennosides with respect to overall effectiveness in cancer patients with opioid-induced constipation.
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Affiliation(s)
- Philippa Hawley
- Pain and Symptom Management/Palliative Care, British Columbia Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada. .,University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Hannah MacKenzie
- University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Monica Gobbo
- Pain and Symptom Management/Palliative Care, British Columbia Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
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7
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Alikiaii B, Majedi MA, Hashemi ST, Kiani M. Comparing the Efficacy of Two Drugs Senalin and Bisacodyl in Treatment of Constipation in Intensive Care Units' Patients. Adv Biomed Res 2019; 8:17. [PMID: 30993087 PMCID: PMC6425743 DOI: 10.4103/abr.abr_165_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Constipation is an intestinal syndrome that can be created alone or in the context of another disease in patients admitted to intensive care units (ICUs). Given the role of sennosides in increasing the transfer rate of materials from the large intestine, we aimed to compare the effect of senalin with bisacodyl on the treatment of constipation in patients admitted to ICUs. Materials and Methods In this randomized, double-blind study, 70 patients admitted to the ICU were divided into two groups. The senalin recipient group received senalin with a dose of 500 mg daily for 3 days. The bisacodyl recipient group received bisacodyl with a dose of 10 mg daily for 3 days. Results The mean of defecation frequency during the 2nd day of treatment of constipation was significantly higher in the group receiving bisacodyl than in the senalin group (P < 0.01). There was no significant difference between the two groups in terms of fecal consistency in any of the study days (P < 0.05). The prevalence of complications in the 3rd day of treatment was significantly higher in bisacodyl group than in the senalin group (P = 0.04). Conclusion Given the lack of difference in the efficacy of two drugs, fecal consistency, daily defecation frequency and fewer complications of senalin compared to bisacodyl, it s eems that this drug can be used as an appropriate treatment for constipation in patients admitted to ICUs.
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Affiliation(s)
- Babak Alikiaii
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Azad Majedi
- Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Seyed Taghi Hashemi
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kiani
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Lamanna A, Dughetti LD, Jordan-Ely JA, Dobson KM, Dynan M, Foo A, Kooiman LMP, Murakami N, Fiuza K, Foroughi S, Leal M, Vidmar S, Catto-Smith AG, Hutson JM, Southwell BR. Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate. JGH OPEN 2018; 2:144-151. [PMID: 30483580 PMCID: PMC6207039 DOI: 10.1002/jgh3.12062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/23/2018] [Indexed: 01/05/2023]
Abstract
Background and Aim Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. Methods Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X-ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X-rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2-8 sachets (14.7 g/sachet) on days 1-2, reducing to 2-6 sachets on day 3. The SPS dose was 15-20 drops on days 2-3. Results Eighty-nine children (4-18 years) produced a large volume of soft stool (median/inter-quartile-range: 2.2/1.6-3.1 L) over 7 days. Stool volume on X-rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change. Conclusions A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.
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Affiliation(s)
- Anthony Lamanna
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Lauren D Dughetti
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Julie A Jordan-Ely
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Kyla M Dobson
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Megan Dynan
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Adeline Foo
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Louise M P Kooiman
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,University of Groningen Groningen The Netherlands
| | - Naomi Murakami
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,RMIT University Bundoora Victoria Australia.,Universidade Federal Fluminense (UFF) Niterói Rio de Janeiro Brazil
| | - Kaic Fiuza
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,University of South Australia Adelaide South Australia Australia.,Universidade Federal Fluminense (UFF) Niterói Rio de Janeiro Brazil
| | - Siavash Foroughi
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Systems Biology and Personalised Medicine Division The Walter and Eliza Hall Institute of Medical Research Melbourne Victoria Australia
| | - Marcelo Leal
- Gastroenterology and Clinical Nutrition Royal Children's Hospital Parkville Victoria Australia
| | - Suzanna Vidmar
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Clinical Epidemiology & Biostatistics Unit Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Anthony G Catto-Smith
- Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Gastroenterology and Clinical Nutrition Royal Children's Hospital Parkville Victoria Australia.,Gastroenterology Department Lady Cilento Children's Hospital Brisbane Queensland Australia
| | - John M Hutson
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Department of Urology Royal Children's Hospital Melbourne Victoria Australia
| | - Bridget R Southwell
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Department of Urology Royal Children's Hospital Melbourne Victoria Australia
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9
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Vilanova-Sanchez A, Gasior AC, Toocheck N, Weaver L, Wood RJ, Reck CA, Wagner A, Hoover E, Gagnon R, Jaggers J, Maloof T, Nash O, Williams C, Levitt MA. Are Senna based laxatives safe when used as long term treatment for constipation in children? J Pediatr Surg 2018; 53:722-727. [PMID: 29429768 DOI: 10.1016/j.jpedsurg.2018.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/21/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Senna is a stimulant laxative commonly used by pediatricians, pediatric gastroenterologists, and pediatric surgeons. Many clinicians avoid Senna for reasons such as tolerance or side effects but this has little scientific justification. We recently found several patients we were caring for developed perineal blistering during the course of Senna treatment. Because of this we chose to review the literature to identify side effects in children taking this medication as well as to analyze our Center's experience with Senna's secondary effects. METHODS We performed a literature review (MEDLINE, PUBMED) using the keywords of Senna, sen, sennosides and children, and pediatric and functional (idiopathic) constipation. We looked for articles with information regarding perineal blisters related to Senna as well as other secondary effects of Senna laxatives in children when used on a long-term basis. We also reviewed the charts of our patients who had previously taken Senna or are currently taking Senna, looking for adverse reactions. RESULTS Eight articles in the literature reported perineal blisters after administration of Senna laxatives in 28 patients. Of those occurrences, 18 patients (64%) had accidental administration of Senna and 10 (36%) had Senna prescribed as a long term treatment. All of the blistering episodes were related to high dose, night-time accidents, or intense diarrhea with a long period of stool to skin contact. At our institution, from 2014 to 2017, we prescribed Senna and have recorded data to 640 patients. During the study period, 17 patients (2.2%) developed blisters during their treatment. Patients who developed blisters had higher doses 60mg/day; 60 [12-100] vs. 17.5 [1.7-150] (p<0.001). All of the blistering episodes were related to night-time accidents, with a long period of stool to skin contact. 83 (13%) patients presented minor side effects such as abdominal cramping, vomiting or diarrhea which resolved once the type of laxatives were changed or enemas were started. The doses of Senna was not significantly different in these patients 15mg/day [4.4-150] vs. 17.5mg/day [1.5-150]. There were no other long-term side effects from Senna found in the pediatric literature for long-term treatment besides abdominal cramping or diarrhea during the first weeks of administration. We found no evidence of tolerance to Senna in our review. CONCLUSION There is a paucity of information in the literature regarding side effects of sennosides as a long-term therapy, and to our knowledge, this is the first review of Senna side effects in children. Senna induced dermatitis is rare, but may occur when patients need a higher dose. All of the cases described had a long period of exposure of the skin to stool. Besides the perineal rash with blisters, we could find no other described major side effect with Senna administration in the pediatric population or evidence of the frequently mentioned concern of the development of tolerance to Senna. Pediatric caregivers should advise families of the rare side effect of skin blistering and educate them to change the diaper frequently in children who are not toilet- trained to reduce stool to skin exposure. We can conclude from this review that Senna is a safe treatment option for constipation in children. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alejandra Vilanova-Sanchez
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States.
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Nicole Toocheck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Andrea Wagner
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Erin Hoover
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Renae Gagnon
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jordon Jaggers
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Onnalisa Nash
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Charae Williams
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, United States
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10
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Younes M, Aggett P, Aguilar F, Crebelli R, Filipič M, Frutos MJ, Galtier P, Gott D, Gundert-Remy U, Kuhnle GG, Lambré C, Leblanc JC, Lillegaard IT, Moldeus P, Mortensen A, Oskarsson A, Stankovic I, Waalkens-Berendsen I, Woutersen RA, Andrade RJ, Fortes C, Mosesso P, Restani P, Pizzo F, Smeraldi C, Papaioannou A, Wright M. Safety of hydroxyanthracene derivatives for use in food. EFSA J 2018; 16:e05090. [PMID: 32625659 PMCID: PMC7009633 DOI: 10.2903/j.efsa.2018.5090] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Panel on Food Additives and Nutrient Sources added to Food (ANS) was asked to deliver a scientific opinion on the safety of hydroxyanthracene derivatives and to provide advice on a daily intake that does not give rise to concerns about harmful effects to health. Hydroxyanthracene derivatives are a class of chemical substances naturally occurring in different botanical species and used in food to improve bowel function. The ANS Panel reviewed the available scientific data on a possible relationship between hydroxyanthracene derivatives exposure and genotoxic and carcinogenic effects. On the basis of the data currently available, the Panel noted that emodin, aloe-emodin and the structurally related substance danthron have shown evidence of in vitro genotoxicity. Aloe extracts have also been shown to be genotoxic in vitro possibly due to the presence of hydroxyanthracene derivatives in the extract. Furthermore, aloe-emodin was shown to be genotoxic in vivo and the whole-leaf aloe extract and the structural analogue danthron were shown to be carcinogenic. Epidemiological data suggested an increased risk for colorectal cancer associated with the general use of laxatives, several of which contain hydroxyanthracene derivatives. Considering the possible presence of aloe-emodin and emodin in extracts, the Panel concluded that hydroxyanthracene derivatives should be considered as genotoxic and carcinogenic unless there are specific data to the contrary, such as for rhein, and that there is a safety concern for extracts containing hydroxyanthracene derivatives although uncertainty persists. The Panel was unable to provide advice on a daily intake of hydroxyanthracene derivatives that does not give rise to concerns about harmful effects to health.
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Khorasanynejad R, Norouzi A, Roshandel G, Besharat S. Bowel Preparation for a Better Colonoscopy Using Polyethylene Glycol or C-lax: A Double Blind Randomized Clinical Trial. Middle East J Dig Dis 2017; 9:212-217. [PMID: 29255579 PMCID: PMC5726334 DOI: 10.15171/mejdd.2017.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND
Ideal bowel preparation regimen for a suitable colonoscopy should be safe, and well tolerated,
and should rapidly clear gastrointestinal tract. Soluble polyethylene glycol (PEG) is the most common
cleansing drug and Senna or C-Lax (Cassia angustifolia Vahl) is an alternative herbal one.
This study was designed to compare the efficacy of PEG and C-lax in bowel preparation.
METHODS
In this randomized double blind trial (registry number in IRCT.ir: IRCT201601161264N7),
320 patients were randomly assigned in PEG or C-lax groups. PEG solution was prepared from
5×70 gr sachets in 20×250cc water (250 ml every 15 minutes), prescribed 24h before the colonoscopy.
In the other group 3×60 ml C-lax syrup glasses (each containing 90 mg senozid B) was given
in two divided doses (1.5 glasses of 250cc every 12 hours), 24h before the colonoscopy. Ottawa
score was used to evaluate the quality of bowel preparation. Chi-square test, Student t test, MannWhitney
test and multivariate analysis were used to analyze the data.
RESULTS
Of these patients with the mean (SD) age of 50 (15.16) years, 162 (50.8%) were men. Mean
(SD) Ottawa score was 2.57 (0.2) and 3.15 (0.31) in the PEG and C-lax group, respectively (p
value = 0.81). Multivariate analysis showed that less opium consumption (p < 0.001) and higher
educational level (p =0.005) were associated with better bowel preparation.
CONCLUSION
C-Lax is non-inferior to PEG solution in cleansing colon. The quality of bowel preparation was
lower in opium consumers and better in those with higher educational level.
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Affiliation(s)
- Rose Khorasanynejad
- Assistant of cardiology, Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Norouzi
- Gastroentrologist, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gholamreza Roshandel
- Epidemiologist, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sima Besharat
- PhD of Biomedicine, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
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Gordon M, Karlsen F, Isaji S, Teck GO. Bowel preparation for elective procedures in children: a systematic review and meta-analysis. BMJ Paediatr Open 2017; 1:e000118. [PMID: 29637141 PMCID: PMC5862165 DOI: 10.1136/bmjpo-2017-000118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Reviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people. DESIGN A Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool. PATIENTS Young people requiring bowel preparation for any elective procedure, as defined by the primary studies. INTERVENTIONS RCTs comparing bowel preparation with placebo or other interventions. MAIN OUTCOME MEASURES Adequacy of bowel preparation, tolerability and adverse events. RESULTS The search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)). CONCLUSIONS The evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy.
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Affiliation(s)
- Morris Gordon
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.,Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Fiona Karlsen
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Sahira Isaji
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Guan-Ong Teck
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
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13
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Fan XP, Zhu Q, Zhou YJ, Ma T, Xia CX, Huang HL. Comparative Study of Three Regimens of Bowel Preparation Before Transabdominal Ultrasonography of the Colon. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2140-2145. [PMID: 27181688 DOI: 10.1016/j.ultrasmedbio.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 06/05/2023]
Abstract
The objective of the study was to compare the efficacy of three bowel preparation regimens for transabdominal colon ultrasonography. A total of 192 consecutive patients were given one of three regimens (senna, magnesium sulfate or polyethylene glycol electrolyte powder) before ultrasonographic examinations. The cleaning grade (I = emptying; II = filled or filled + empty; III = I or II with some retention; and IV = retention [grades I and II were termed "qualified"]) and cleaning range (A = all seven colon sections were qualified; B = four to six sections were qualified; C = three or less sections were qualified) were evaluated retrospectively. Senna was found more effective than polyethylene glycol in terms of cleaning grade (p < 0.001), qualified rate (p < 0.001) and cleaning range (p = 0.003). Senna was better than magnesium sulfate in cleaning grade (p < 0.001). Our results suggest that senna seems to be the preferred regimen for bowel preparation before transabdominal colonic ultrasonography.
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Affiliation(s)
- Xiu-Ping Fan
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Ya-Jing Zhou
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Teng Ma
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chun-Xia Xia
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui-Lian Huang
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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14
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Miquel I, Arancibia ME, Alliende F, Ríos G, Rodríguez L, Lucero Y, Saelzer E. [Intestinal cleaning for colonoscopy in children: effectiveness, adherence and adverse effects of schemes differentiated by age]. ACTA ACUST UNITED AC 2016; 88:216-222. [PMID: 27425772 DOI: 10.1016/j.rchipe.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
Adequate intestinal cleanliness is crucial to achieve optimal colonoscopy performance. Several bowel preparation (BP) schemes have been proposed, but there is still no consensus as regards which is the most suitable in paediatric patients. OBJECTIVE To describe the effectiveness, adherence, and adverse effects of BP protocols differentiated by age group in paediatric patients subjected to colonoscopy. PATIENTS AND METHOD Prospective, study that included patients < 18 years subjected to colonoscopy. BP protocols differentiated by age group were indicated as follows: < 6 m (glycerine suppository); 6 m-3y 11 m (poly-ethylene-glycol (PEG 3350 without electrolytes); 4y-9y 11 m (PEG 3350 without electrolytes + bisacodyl); 10 y-18 y (PEG 3350 with electrolytes). Demographic, clinical information, adherence and adverse effects were registered. Effectiveness was determined using a validated scale (Boston modified) during colonoscopy. RESULTS A total of 159 patients were included, of which 87 (55%) were males, and with a median age of 4 years (range 1 m-17 years). Seventy eight percent of patients achieved successful BP. The higher effectiveness was observed in the groups of < 6 m (96%) and 10-18 y (91%). Constipation was significantly more frequent (29%) in the 4 yo-9 yo 11 m in which lower effectiveness was observed (69%). Good adherence was observed in 87% of patients. Adverse effects were observed in a third of patients, although they were mild and did not lead to the suspension of the BP. CONCLUSIONS Satisfactory results were achieved with the BP schemes used, with a successful BP being obtained in 4 out of 5 patients. Results were different between groups, which is probably related to previous bowel transit and indicated medication.
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Affiliation(s)
- Isabel Miquel
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Gloria Ríos
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Lorena Rodríguez
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Yalda Lucero
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Eric Saelzer
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
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15
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Berger T, Classen M, Engelhardt H, Keller KM, Laass MW, Melchior R, Posovszky C, Rodeck B, Schaper K, Behrens R. Bowel preparation in pediatric colonoscopy: results of an open observational study. Endosc Int Open 2016; 4:E820-7. [PMID: 27556104 PMCID: PMC4993869 DOI: 10.1055/s-0042-107789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/25/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The goal of this study was to analyze the bowel cleansing methods currently used for pediatric colonoscopy in terms of effectiveness, tolerance and safety. PATIENTS AND METHODS Data from 768 colonoscopies reported by 28 centers were registered in an online database for further analysis. Binary logistic regression was used to determine how preparation methods affected the cleaning effect (Aronchick score) and the rate of adverse events (Aes) and complications. RESULTS The most frequently reported cleansing agents were sodium picosulphate (54.2 %) and polyethylene-glycol (41.3 %) in various combinations. The cleaning effect was good to excellent in 72.6 % of patients. AEs during the preparation period occurred in 21.5 % of patients. Complications during endoscopy were reported in 12.1 % and were mostly mild. The different agents had no influence on the cleaning effect. In contrast the risk of AEs during preparation was significantly increased when polyethylene-glycol was used (odds ratio (OR) 2.112, P = 0.002) but reduced with the use of sodium picosulphate (OR 0.380, P < 0.001). In particular, the risk of needing a nasogastric tube to complete clean-out was about 10-fold higher when polyethylene-glycol was used. CONCLUSIONS A large variety of regimens are used for bowel preparation in children. We found a good overall cleaning result independent of the agents used. Cleansing agents, on the other hand, had a significant influence on tolerance and safety.
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Affiliation(s)
- Thomas Berger
- Vestische Kinder- und Jugendklinik Datteln, University of Witten-Herdecke, Datteln, Germany,Corresponding author Thomas Berger, MD Vestische Kinder- und Jugendklinik DattelnUniversität Witten-HerdeckeDr. Friedrich-Steiner-Str. 5D-45711 DattelnGermany+49(0)2363-975255
| | - Martin Classen
- Department of Child and Adolescent Medicine, Klinikum Links der Weser, Bremen, Germany
| | | | - Klaus-Michael Keller
- Division of Child and Adolescent Medicine, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Martin W. Laass
- Department of Child and Adolescent Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | | | - Katharina Schaper
- Institute of Medical Biometry and Epidemiology, University of Witten-Herdecke, Witten, Germany
| | - Rolf Behrens
- Department of Newborn, Child and Adolescent Medicine, Klinikum Nürnberg, Nürnberg, Germany
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16
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Abstract
OBJECTIVES The purpose of this randomised study was to compare the quality of bowel cleansing using either polyethylene glycol (PEG) or sodium picosulphate (NaPico) (primary outcome) in relation to the tolerability and acceptance of these laxatives among children and their caregivers (secondary outcome). METHODS The study was a randomised controlled trial that was conducted as an investigator-blinded study within the Department of Paediatrics of Skåne University Hospital in Malmö, Sweden. A total of 72 children (10-18 years of age) were randomly placed into 1 of 2 groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Score was used to evaluate the quality of bowel cleansing. A total of 2 different questionnaires were used to evaluate both the acceptability and tolerability of the laxatives. RESULTS In total, 71 children completed the bowel cleansing. Of these 71 cleanses, 67 protocols were analysed according to the Ottawa Bowel Preparation Quality Score. No significant difference in bowel cleansing quality was detected between the 2 groups. Rates of acceptability and tolerability were significantly higher in the NaPico group than in the PEG group. CONCLUSIONS In the present study, both laxatives were found to be satisfactory in terms of aiding the performance of an uncomplicated and successful colonoscopy. NaPico was, however, more tolerable to the children than PEG, and both, the children and their caregivers, were more accepting of NaPico than of PEG. Consequently, NaPico can be recommended as the option for bowel cleansing in children ages 10 years and older.
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17
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Park R, Mikami S, LeClair J, Bollom A, Lembo C, Sethi S, Lembo A, Jones M, Cheng V, Friedlander E, Nurko S. Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009. Neurogastroenterol Motil 2015; 27:684-92. [PMID: 25809794 PMCID: PMC5549670 DOI: 10.1111/nmo.12542] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the USA. The aim of this study was to evaluate the inpatient admission rate, length of stay (LoS), and associated costs related to FGIDs from 1997 to 2009. METHODS We analyzed the Kids' Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0-564.09), abdominal pain (ICD-9 codes: 789.0-789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code: 346.80 and 346.81) dyspepsia (ICD-9 code: 536.8), or fecal incontinence (ICD-codes: 787.6-787.63) was the primary discharge diagnosis from 1997 to 2009. The KID is the largest publicly available all-payer inpatient database in the USA, containing data from 2 to 3 million pediatric hospital stays yearly. KEY RESULTS From 1997 to 2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the LoS remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10-14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5-9 year age group. IBS discharge was most common for the 15-17 year age group. CONCLUSIONS & INFERENCES Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the USA from 1997 to 2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated.
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Affiliation(s)
- Richard Park
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sage Mikami
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jack LeClair
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andrea Bollom
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Cara Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Saurabh Sethi
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anthony Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mike Jones
- Macquarie University, Sydney, New South Wales, Australia
| | - Vivian Cheng
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Elizabeth Friedlander
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
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18
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Parra-Blanco A, Ruiz A, Alvarez-Lobos M, Amorós A, Gana JC, Ibáñez P, Ono A, Fujii T. Achieving the best bowel preparation for colonoscopy. World J Gastroenterol 2014; 20:17709-17726. [PMID: 25548470 PMCID: PMC4273122 DOI: 10.3748/wjg.v20.i47.17709] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/20/2014] [Accepted: 11/08/2014] [Indexed: 02/06/2023] Open
Abstract
Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.
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