Tran DL, Sintusek P. Functional constipation in children: What physicians should know. World J Gastroenterol 2023; 29(8): 1261-1288 [PMID: 36925458 DOI: 10.3748/wjg.v29.i8.1261]
Corresponding Author of This Article
Palittiya Sintusek, MD, PhD, Doctor, Lecturer, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Thai Red Cross, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan Subdistrict, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 28, 2023; 29(8): 1261-1288 Published online Feb 28, 2023. doi: 10.3748/wjg.v29.i8.1261
Functional constipation in children: What physicians should know
Duc Long Tran, Palittiya Sintusek
Duc Long Tran, Thailand and Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Bangkok, Thailand
Duc Long Tran, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City 9000, Viet Nam
Palittiya Sintusek, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Thai Red Cross, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Sintusek P and Tran DL contributed to conception of the study; Tran DL drafted the manuscript; Sintusek P and Tran DL wrote the manuscript; Sintusek P made critical revisions related to the intellectual content of the manuscript; and all authors read and approved the final version of the manuscript.
Supported byThailand and Thailand Science Research and Innovation Fund Chulalongkorn University, No. HEA663000047.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, PhD, Doctor, Lecturer, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Thai Red Cross, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan Subdistrict, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: October 28, 2022 Peer-review started: October 28, 2022 First decision: November 14, 2022 Revised: December 5, 2022 Accepted: February 16, 2023 Article in press: February 16, 2023 Published online: February 28, 2023
Abstract
Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.
Core Tip: Functional constipation (FC) is a typical symptom of functional gastrointestinal disorders in children and its prevalence is high worldwide. Since the pathophysiology of FC in children is associated with stool withholding behavior, successful toilet training in combination with osmotic laxatives is crucial for the treatment childhood FC. Additionally, promising and innovative drugs can also aid in treatment success.
