Treatments for intractable constipation in childhood

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the efficacy and safety of treatments used for intractable constipation in children

How do we define therapy-resistant Constipation in Children 4-18 years old? A systematic review with meta-narrative synthesis Data extraction

Background Therapy resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements fecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures. Aim To conduct a systematic review determining how pediatric interventional studies define therapy resistant constipation. Method We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy resistant constipation were identified. Data were extracted on criteria used for defining therapy resistant constipation and reported using meta-narrative approach highlighting areas of convergence and divergence in the findings. Results A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least 7 definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy resistant constipation. Out of them only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy resistant constipation. The duration before being diagnosed as therapy resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation, while 5 adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children. Conclusion The current literature has no explicit definition for therapy resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary, and maybe even harmful, invasive diagnostic and therapeutic interventions

Outcome of pediatric inflammatory bowel disease in Asian children: a multinational 1-year follow-up study

Background Epidemiological data on pediatric inflammatory bowel disease (PIBD) have been reported in Asian countries. However, short-term follow-up data, especially in Southeast Asian countries, are limited. Purpose Analyze and compare the baseline and 1-year follow-up (1FU) data for PIBD in Asian children. Methods The multinational network included patients with PIBD (aged <19 years) in 5 Asian countries (Malaysia, Philippines, Singapore, Sri Lanka, and Thailand). The diagnosis of PIBD requires gastrointestinal endoscopy. The patients' demographics, clinical information, disease- related outcomes, and treatment data at 1FU were collected. Results In 1995–2021, 368 patients were enrolled (Crohn disease [CD], 56.8%; ulcerative colitis [UC], 38%; and inflammatory bowel disease [IBD]-unclassified, 5.2%). At 1FU, symptoms including diarrhea, bloody stools, and nausea/vomiting subsided in <3%, while abdominal pain persisted in 10.5% of patients with CD and 7.1% of patients with UC. Assessment endoscopy was performed at 1FU in 38% of CD and 31% of UC cases, of which 21% and 23% showed mucosal healing, respectively. Oral prednisolone was administered to 55.3% of patients at diagnosis and 26.8% at 1FU, while infliximab was administered to 2.5% and 7.2% of patients at diagnosis and 1FU, respectively. Independent factors of 1-year clinical remission for CD were oral prednisolone (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.06–0.68), antibiotic use (OR, 0.09; 95% CI, 0.01–0.54), and immunomodulator use (OR, 5.26; 95% CI, 1.52–18.22). A history of weight loss at diagnosis was the only independent risk factor of an IBD flare by 1FU (OR, 2.01; 95% CI, 1.12–3.63). Conclusion The proportion of children with PIBD and abdominal pain at 1FU remained high. The rates of repeat endoscopy and infliximab use were suboptimal with high rates of systemic corticosteroid use. Quality improvement based on the aforementioned predictors may enhance PIBD care in this geographic region or similar settings

Prevalence of Acanthosis Nigricans in an urban population in Sri Lanka and its utility to detect metabolic syndrome

<p>Abstract</p> <p>Background</p> <p>Insulin resistance (IR) plays a major role in the pathogenesis of metabolic syndrome. Acanthosis nigricans (AN) is an easily detectable skin condition that is strongly associated with IR. The aims of this study were, firstly, to investigate the prevalence of AN among adults in an urban Sri Lankan community and secondly, to describe its utility to detect metabolic syndrome.</p> <p>Findings</p> <p>In a community based investigation, 35-64 year adults who were selected using stratified random sampling, underwent interview, clinical examination, liver ultrasound scanning, and biochemical and serological tests. Metabolic syndrome was diagnosed on revised ATP III criteria for Asian populations. AN was identified by the presence of dark, thick, velvety skin in the neck.</p> <p>2957 subjects were included in this analysis. The prevalence of AN, metabolic syndrome and type 2 diabetes mellitus were 17.4%, 34.8% and 19.6%, respectively. There was a strong association between AN and metabolic syndrome. The sensitivity, specificity, positive predictive value and negative predictive value of AN to detect metabolic syndrome were 28.2%, 89.0%, 45.9% and 79.0% for males, and 29.2%, 88.4%, 65.6% and 62.3% for females, respectively.</p> <p>Conclusions</p> <p>AN was common in our study population, and although it did not have a high enough sensitivity to be utilized as a screening test for metabolic syndrome, the presence of AN strongly predicts metabolic syndrome.</p

Disease phenotypic and outcome of very-early onset inflammatory bowel disease in Asian children: an understudied population

BackgroundThere is a paucity of knowledge on disease phenotype and outcome of very early-onset (VEO) inflammatory bowel disease (VEO-IBD) from recently developed and developing countries, including from Southeast Asia. We studied disease phenotype, clinical characteristics, management and outcome of VEO-IBD in South and Southeast Asian children.Materials and methodsWe extracted data from a multicentre Asian pediatric (onset &lt;18 years) IBD registry. VEO- and later-onset pediatric (LO-p) IBD were defined as onset of disease &lt;6 years and ≥6 years, respectively. We excluded monogenic IBD.ResultsOf 440 children with IBD cases; 112 (25.5%) were VEO-IBD; Crohn's disease (CD) 36 (32.1%); ulcerative colitis (UC) 68 (60.7%), and IBD-unspecified 7 (7.1%). UC was more common in VEO-IBD while CD more common in LO-pIBD (CD = 68.9% vs. UC = 25.9%; p &lt; 0.001). Disease location/extent of disease and disease severity were similar in both age groups for both CD and UC. For CD, inflammatory disease behavior was equally common in both age group (77.8% in VEO-IBD vs. 76.6% of LO-pIBD), majority had isolated colonic disease (27.8% VEO-IBD vs. 36.3% LO-pIBD), while stricturing and penetrating diseases were not observed in VEO-CD, but noted in 4.9% and 8.4% of LO-pCD, respectively. Among UC cases, pancolitis was observed in 60.3% of VEO-IBD vs. 65.9% of LO-pIBD. Most UC never had severe disease regardless of age group. Five years after diagnosis, VEO-IBD were more likely to have corticosteroids, immunomodulators or biologics than LO-pIBD. Despite this, inactive/mild disease activity was the predominant outcome at 5 year follow up for both VEO-CD (98.2%) and VEO- UC (96.1%). Bowel surgery rate was 2.4% and 1.7% for VEO- and LO-IBD at 5 years, respectively.ConclusionsDespite differences in disease phenotype at diagnosis, disease behaviour, location/extent and disease severity were similar between VEO- and LO-IBD, with a comparable overall clinical remission rates between both age groups at 5 years after diagnosis