Clinical Question: Is polyethylene ...

Clinical Question: Is polyethylene glycol (PEG) 3350 or lactulose a better treatment for children with functional constipation?

Setting: Outpatient (specialty)

inquiry Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: In this reflection investigators compared two osmotic laxatives, lactulose and PEG 3350 in children six month to 15 years of age who met sum of two units of the following four criteria: (1) fewer than three bowel motions per week; (2) encopresis more than one time a week; (3) large amounts of stool (enough to trammel the toilet) every one to four weeks; and (4) palpable abdominal or rectal mass. Children with an organic cause for constipation, of that kind as Hirschsprung's disease, were excluded

Before randomization, all children underwent an untreated one-week run-in period, during which symptoms were recorded and use of oral laxatives was not allowed. They received single enema per day for three days at the cessation of the week to clear any stool in the rectum Children six month to six years of age were randomly assigned to receive 6 g of lactulose or 295 g of PEG 3350 through day; children six to 15 years of age received 12 g of lactulose or 59 g of PEG 3350 for day. After one week, treatment power was assessed. The dosage was increased at one dose per day if symptoms persisted or was divide [i]or[/i] sever in half if the child was having diarrhea. A stimulant laxative also was given if the symptoms had not improved from baseline.

Patients were evaluated again at sum of two units four, and eight weeks, at which time the dosage could be adjusted. The primary result evaluated using per-protocol analysis, was treatment succes at eight weeks, defined as at least three bowel manner of movings per week and encopresis no more than one time every two weeks. Although per-protocol analysis is les robust than intention-to-treat analysis, in this case and nothing else four of 50 patients in the PEG 3350 cluster and five of 50 patients in the lactulose arrange withdrew prematurely, making bias unlikely.

At the close of the eight-week study, the frequent occurrence of stools increased similarly in the couple groups from fewer than three to approximately seven by means of week. The frequency of encopresis decreased from more than one time per day at intake to approximately three times through week in both groups. The [i]finale[/i] point of treatment success was achieved more frequently in the PEG 3350 cluster (56 versus 29 percent; P = 02; number straited to treat = four). Treatment was fortunate more often in girls, in children with les than single in kind year of symptoms before enrollment and in those with les encopresis at enrollment PEG 3350 was somewhat better tolerated than lactulose in regard to side validitys such as abdominal pain, pain at defecation, and straining at defecation, further children disliked the taste of PEG 3350 more than the taste of lactulose.

Bottom Line: PEG 3350 and lactulose increase stool frequent occurrence and decrease encopresis in children with functional constipation. Overall treatment succes (using a somewhat arbitrary measure defined by means of the researchers) was more likely in the PEG 3350 cluster and, other than its taste, PEG 3350 was somewhat better tolerated than lactulose. (Level of Evidence: lb)

meditation Reference: Voskuijl W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controll multicentre trial. eviscerate November 2004;53:1590-4.

Used with permission from Ebell M PEG 3350 better than lactulose for functional constipation in kids. Accessed online March 1 2005 at: http://wwwlnfoPOEMscom

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group