The Role of Metoclopramide for Treatment of Functional Constipation in Children: A Double Blind Study

Abstract

Background: The treatment of functional constipation is a concern worldwide. Various studies have evaluated the effect of prokinetic agents such as cisapride in management of chronic constipation, however due to the possible lethal side effects, its consumption has been limited. In this study we assessed the effect of metoclopramide a drug with similar prokinetic effects and less side effects in management of chronic constipation.

Method: All pediatric patients less than 12 year of age with diagnosis of chronic functional constipation according to the ROME III criteria were included during the study period. Through this double blind study, patients were randomly divided into two groups. Group A received polyethylene glycol and placebo and group B polyethylene glycol with metoclopramide. The two groups were compared regarding their symptoms and Rome III criteria following therapy.

Results: Of the total 102 pediatric patients, 50 subjects completed regime A and 52 patients, regime B. The interval between defecations prior to treatment was 4.8±2.7 days in subjects of group A and 5.9±3.6 days in those of group B. Response to treatment; defined as decrease in signs and symptoms that would not fulfill Rome III criteria, and without any recurrence of fecal impaction with discontinuation of medication, was almost equal in both groups: 84% (42 of 50) in patients receiving regime A vs. 84.6% (44 of 52) in regime B group (p=0.39).

Conclusion: In this study we achieved no significant response from consumption of metoclopramide as a prokinetic agent in the treatment of chronic constipation of children.

Keywords

• Constipation
• Metoclopramide
• Treatment

References

1. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101: 2401–2409.
2. Tabbers M, Boluyt N, Berger M, Benninga M. Diagnosis constipation. Eur J Pediatr 2011; 170: 955–963.
3. Benninga M, Candy DC, Catto-Smith AG, Clayden G, Loening-Baucke V, Di Lorenzo C, et al. Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 2005; 40: 273–275.
4. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, et al. Childhood functional gastrointestinal disorders. Gut 1999; 45 Suppl II:1160-1168.
5. Benninga MA, Voskuijl WP, Taminiau JA. Childhood constipation: is there new light in the tunnel? J Pediatr Gastroenterol Nutr 2004; 39:448-464
6. Rajindrajith S, Devanarayana NM. Constipation in children: Novel insight into epidemiology, pathophysiology Neurogastroenterol Motil 2011; 17: 35–47.
7. Perkin JM. Constipation in childhood: a controlled comparison between lactulose and standardized senna. Curr Med Res Opin 1977;b 4:540-543.
8. Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, et al. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr 2005;41:625-633.

9. Aboumarzouk OM, Agarwal T, Antakia R, Shariff U, Nelson RL. Cisapride for intestinal constipation. Cochrane Database Syst Rev 2011; (1): CD 007780.
10. Muller-Lissner SA. Bavarian Constipation Study Group. Treatment of chronic constipation with cisapride and placebo. Gut 1987; 28: 1033-1038.
11. Staiano A, Cucchiara S, Andreotti MR, Minella R, Manzi G. Effect of cisapride on chronic idiopathic constipation in children. Dig Dis Sci 1991; 36: 733-736.
12. Halabi IM. Cisapride in management of chronic pediatric constipation. J Pediatr Gastroenterol Nutr 1999; 28: 199-202.
13. Odeka EB, Sagher F, Miller V, Doig C. Use of cisapride in treatment of constipation in children. J Pediatr Gastroenterol Nutr 1997; 24: 199-203.
14. Nurko S, Garcia-Aranda JA, Worona LB, Zlochisty O. Cisapride for the treatment of constipation in children: A double-blind study. J Pediatr 2000; 136: 35-40. 15. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43: 405–407.
15. Bellomo-Brandao MA, Collares EF, da-Costa- Pinto EA. Use of erythromycin for the treatment of severe chronic constipation in children. Braz J Med Biol Res 2003; 36: 1391–1396.
16. Venkatasubramani N, Rudolph CD, Sood MR. Erythromycin lacks colon prokinetic effect in children disorders: Gastroenterology 2008; 8: 38.
17. gastrointestinal study. BMC
18. Sweetman S, editor. Martindale: The complete drug reference. 34th ed. London: Pharmaceutical Press; 2004.