Constipation
Conditions
Keywords
Constipation, Maintenance treatment, Ultrasound of rectum
Brief summary
Constipation is a common problem among children. The majority of children suffering from constipation have no underlying disease. Although constipation has no basis in underlying disease, it often leads to a reduced quality of life of children who are on par with or worse than for children suffering from serious diseases such as cardiovascular and rheumatic diseases. Despite the high frequency of constipation among children, little is known about the causes and treatment of constipation. Treatment consists of symptomatic treatment with various laxatives. Movicol and Movicol junior has proven very effective and are therefore widely used in children as disimpaction and maintenance treatment. There is currently no research to prove the need for and length of maintenance treatment with laxative medications in children. The purpose is to examining the effectiveness of maintenance treatment with Movicol. Additional til study will examine how the anal diameter change during a course of treatment and the degree to which it can be used as an indicator of treatment efficacy. The study will test the following: • What is the effect of maintenance treatment with PEG compared to placebo? The results from this study are expected to form the basis for an evidence-based approach to the use of maintenance therapy and the use of ultrasound of the rectum in children with constipation.
Interventions
DRUGPolyethylene glycol 3350
Powder for solution. Each sachet contains 13.125 g of macrogol 3350. Disimpaction dosage consists of 1,5 g/kg, maintenance treatment are adjusted according til the Bristol stool chart. The drug can be taken at anytime of the day and can also be divided. Treatment duration up to ½ year.
OTHERPlacebo
Placebo will be manufactured and packaged as a powder to make it identical to the bags with the PEG 3350. The powder will comprise of a non-active substance, like a mild rehydration solution, which is a composition consisting of salt and sugar.
Sponsors
University of Southern Denmark
Kolding Sygehus
Line Modin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
2 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
* Children between 2 and 16 years and referral to our out patient clinic with either constipation or fecal incontinence. * Patients must fulfill the Rome III criteria of constipation, which mean they must have at least 2 of the following characteristics: fewer than 3 bowel movements weekly, more than 1 episode of fecal incontinence weekly, large stools in the rectum by digital rectal examination or palpable on abdominal examination, occasional passing of large stools, display of retentive posturing and withholding behavior, and painful defecation.
Exclusion criteria
* Children with known organic causes of constipation, including Hirsprung disease, spinal and anal congenital abnormalities, previous surgery on the colon, inflammatory bowel disease, allergy and metabolic or endocrine diseases. * Children receiving drugs known to affect bowel function during a 2 month period before initiation. * The healthy control group consists of children with no history of constipation (Rome III), urinary incontinence, urinary tract infections, fecal incontinence, laxative use or any other disease affecting the digestive system. * Children receiving medications known to affect bowel function are excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treatment Recovery | ½ year | Recovery is defined as the child having no symptoms of constipation according to the Rome III criteria. |
Secondary
| Measure | Time frame |
|---|---|
| Usage of Laxative | ½ year |
Countries
Denmark
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Active Maintenance Treatment Polyethylene glycol 3350: Powder for solution. Each sachet contains 13.125 g of macrogol 3350. Disimpaction dosage consists of 1,5 g/kg, maintenance treatment are adjusted according til the Bristol stool chart. The drug can be taken at anytime of the day and can also be divided. Treatment duration up to ½ year. | 49 |
| Placebo Maintenance Treatment Placebo: Placebo will be manufactured and packaged as a powder to make it identical to the bags with the PEG 3350. The powder will comprise of a non-active substance, like a mild rehydration solution, which is a composition consisting of salt and sugar. | 53 |
| Total | 102 |
Baseline characteristics
| Characteristic | Active Maintenance Treatment | Placebo Maintenance Treatment | Total |
|---|---|---|---|
| Age, Customized | 6.2 years | 6.1 years | 6.1 years |
| Region of Enrollment Denmark | 49 participants | 53 participants | 102 participants |
| Sex: Female, Male Female | 18 Participants | 27 Participants | 45 Participants |
| Sex: Female, Male Male | 31 Participants | 26 Participants | 57 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 25 / 49 | 32 / 53 |
| serious Total, serious adverse events | 1 / 49 | 0 / 53 |
Outcome results
Primary
Treatment Recovery
Recovery is defined as the child having no symptoms of constipation according to the Rome III criteria.
Time frame: ½ year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Active Maintenance Treatment | Treatment Recovery | 33 participants |
| Placebo Maintenance Treatment | Treatment Recovery | 19 participants |
p-value: 0.024Regression, Logistic
Secondary
Usage of Laxative
Time frame: ½ year