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Abstract

Objective: The aim of this study was to determine whether there is a change in the quality of life (QOL) in preschool children with functional constipation (FC) after undergoing standard treatment.Patients and Methods: Sixty-five patients, between 2-6 years of age, with FC, were included in the study. The mothers completed the Pediatric Quality of Life (QOL) Inventory and Symptom Checklist-90-Revised (SCL-90-R) before starting the treatment and at the 6th week of the treatment. The change in QOL and SCL-90-R scores were compared using repeated measures ANOVA and Wilcoxon tests.Results: Mother-perceived total QOL was improved at 6th week of treatment compared with baseline (82.87 ± 13.91 vs 74.24 ± 15.40, p < 0.001) and improvement in all domains of QOL was significant. A significant decrease in the global severity index (GSI) of maternal psychological distress (1.09 ± 0.76 vs 0.78 ± 0.64, p<0.001) was also reported. Improvement in physical, social and total QOL was maintained after GSI scores of the mothers were statistically controlled.Conclusion: Significant improvement in all QOL categories was detected. Decrease in symptoms of constipation seemed to effect physical and social aspects of QOL directly, whereas improvement in emotional functioning seemed rather be an indirect effect of treatment via decrease in psychological distress of the mothers.

Keywords

• Functional constipation, Quality of life, Preschool children, Treatment

Çocuklarda fonksiyonel kabızlık tedavisinin yaşam kalitesi üzerine etkisi

Abstract

Amaç: Bu çalışmanın amacı okul öncesi dönemde fonksiyonel kabızlığı (FK) olan çocuklarda standart tedavi sonrasında yaşam kalitelerinde değişiklik olup olmadığının değerlendirilmesidir. Hastalar ve Yöntem: İki ve altı yaşlar arasındaki FK tanılı altmış beş hasta çalışmaya dahil edildi. Hastaların anneleri tedavi öncesi ve tedavinin 6. haftasında Çocuklar için Yaşam Kalitesi Ölçeği ve Gözden geçirilmiş Belirti Tarama Listesi-90’ı (BTL- 90-R) doldurdular. Çocukların yaşam kalitesi ve annelerin BTL- 90-R puanlarındaki değişim tekrarlayan ölçümlü ANOVA ve Wilcoxon testleri kullanılarak değerlendirildi. Bulgular: Annelerin algıladığı toplam yaşam kalitesi tedavinin 6. haftasının sonunda başlangıca kıyasla anlamlı düzeyde artış gösterdi (82,87 ± 13,91’e karşı 74,24 ± 15,40, p < 0,001) ve tüm alanlardaki artış anlamlı düzeydeydi. Ayrıca annelerin psikolojik zorlanma düzeylerini yansıtan global şiddet indeksi (GŞİ) puanlarında da belirgin azalma (1,09 ± 0,76’e karşı 0,78 ± 0,64, p < 0,001) bildirildi. Fiziksel, sosyal ve toplam yaşam kalitesi puanlarındaki fark annelerin GŞİ puanları istatistiksel olarak kontrol edildiğinde de korundu. Sonuç: Hastalarımızda tüm yaşam kalitesi alanlarında ve toplam puanda belirgin artış gözlendi. Kabızlık belirtilerindeki azalma, fiziksel sağlık ve sosyal alandaki iyileşmeyi direkt olarak etkilerken, duygusal işlevsellikteki iyileşme, annelerin psikolojik zorlanmasının azalması ile ilişkili, dolaylı bir etki olduğu görülmektedir.

Keywords

• Fonksiyonel kabızlık, Yaşam kalitesi, Okul öncesi çocuklar, Tedavi

References

1. 1. Van Dijk M, Benninga MA, Grootenhuis MA, Last BF. Prevalence and associated clinical characteristics of behavior problems in constipated children. Pediatrics 2010;125:e309-17. doi: 10.1542/ peds.2008-3055
2. 2. Saps M, Sztainberg C, Di Lorenzo C. A prospective communitybased study of gastroenterological symptoms in school-age children. J Pediatr Gastroenterol Nutr 2006;43:477-82. doi: 10.1097/01. mpg.0000235979.41947.f6
3. 3. Wald E, Di Lorenzo C, Cipriani L, Colborn DK, Burgers R, Wald A. Bowel habits and toilet training in a diverse population of children. J Pediatr Gastroenterol Nutr 2009;48:294-8. doi: 10.1097/ MPG.0b013e31817efbf7
4. 4. Miele E, Simeone D, Marino A, et al. Functional gastrointestinal disorders in children: An Italian prospective survey. Pediatrics 2004;114:73-8. doi: 10.1254/jphs.FPE04003X
5. 5. Van den Berg MM, Benninga MA, DiLorenzo C. Epidemiology of childhood constipation: A systematic review. Am J Gastroenterol 2006;101:2401-9. doi: 10.1111/j.1572-0241.2006.00771.x
6. 6. Bongers ME, Benninga MA. Long-term follow-up and course of life in children with constipation. J Pediatr Gastroenterol Nutr 2011;53 Suppl2:S55-6.
7. 7. Lisboa VC, Felizola MC, Martins LA, Tahan S, Neto UF, de Morais MB. Aggressiveness and hostility in the family environment and chronic constipation in children. Dig Dis Sci 2008;53:2458-63. doi: 10.1007/s10620-008-0230-1
8. 8. Kaugars AS, Silverman A, Kinservik M, et al. Families’ perspectives on the effect of constipation and fecal incontinence on quality of life. J Pediatr Gastroenterol Nutr 2010;51:747-52. doi: 10.1097/ MPG.0b013e3181de0651

9. 9. Youssef NN, Langseder AL, Verga BJ, Mones RL, Rosh JR. Chronic childhood constipation is associated with impaired quality of life: a case-controlled study. J Pediatr Gastroenterol Nutr 2005;41:56-60. doi: 10.1097/01.mpg.0000167500.34236.6a
10. 10. Faleiros FT, Machado NC. Assessment of health-related quality of life in children with functional defecation disorders. J Pediatr (Rio J) 2006;82:421-5. doi:10.2223/JPED.1530
11. 11. Clarke MCC, Chow CS, Chase JW, Gibb S, Hutsun JM, Southwell BR. Quality of life in children with slow transit constipation. J Pediatr Surg 2008;43:320-4. doi: 10.1016/j.jpedsurg.2007.10.020
12. 12. Bongers ME, Van Dijk M, Benninga MA, Grootenhuis MA. Health related quality of life in children with constipation-associated fecal incontinence. J Pediatr 2009;154:749–53. doi: 10.1016/j. jpeds.2008.11.029
13. 13. Oostenbrink R, Jongman H, Landgraf JM, Raat H, Moll HA. Functional abdominal complaints in pre-school children: parental reports of health-related quality of life. Qual Life Res 2010;19:363-9. doi: 10.1007/s11136-009-9583-y.
14. 14. Rajindrajith S, Devanarayana NM, Weerasooriya L, Hathagoda W, Benninga MA. Quality of life and somatic symptoms in children with constipation: a school-based study. J Pediatr 2013;163:1069-72. doi:10.1016/j.jpeds.2013.05.012
15. 15. Nolan T, Debelle G, Oberklaid F, Coffey C. Randomised trial of laxatives in treatment of childhood encopresis. Lancet 1991;338:523- 7. doi: 10.1016/0140-6736(91)91097-E
16. 16. Young MH, Brennen LC, Baker RD, Baker SS. Functional encopresis: symptom reduction and behavioral improvement. J Dev Behav Pediatr 1995;16:226-32.
17. 17. Van der Plas RN, Benninga MA, Redekop WK, Taminiau JA, Buller HA. Randomised trial of biofeedback training for encopresis. Arch Dis Child 1996;75:367-74.
18. 18. Levine MD, Mazonson P, Bakow H. Behavioral symptom substitution in children cured of encopresis. Am J Dis Child 1980;134:663-7.
19. 19. Clarke MCC, Chase JW, Gibb S, Hutson JM, Southwell BR. Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. J Pediatr Surg 2009;44:1268-72. doi: 10.1016/j.jpedsurg.2009.02.031
20. 20. Har IF, Rescorla FJ, Croffie JM. Quality of life in pediatric patients with unremitting constipation pre and post Malone Antegrade Continence Enema (MACE) procedure. J Pediatr Surg 2013;48:1733- 7. doi: 10.1016/j.jpedsurg.2013.01.045
21. 21. Joinson C, Heron J, von Gontard A, Butler U, Golding J, Emond A. Early childhood risk factors associated with daytime wetting and soiling in school-age children. J Pediatr Psychol 2008;33:739-50. doi: 10.1093/jpepsy/jsn008
22. 22. Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 2005;40:273-5. doi: 10.1097/01.MPG.0000158071. 24327.88
23. 23. Varni JW, Seid M, Rode CA. The PedQL: measurement model for the Pediatric Quality of Life Inventory. Medical Care 1999;37:126-39. doi: 10.1097/00005650-199902000-00003
24. 24. Üneri ÖŞ. Çocuklar için Yaşam Kalitesi Ölçeğinin 2-7 yaşlarındaki Türk çocuklarında geçerlik ve güvenirliği. Yayınlanmamış uzmanlık tezi. Kocaeli Üniv.Tıp Fak. Çocuk Psikiyatrisi AD, Kocaeli, 2005.
25. 25. Derogatis LR. SCL-90-R: Administration, scoring and procedure Manual-I for the revised version. Baltimore: MD John Hopkins University School of Medicine, Clinical Psychometrics Unit, 1977.
26. 26. Dag I. Reliability and validity of Symptom Check List-90-Revised among university students. Türk Psikiyatri Derg 1991;2:5-12.
27. 27. Cohen J. Statistical power analysis for the behavioral sciences. 2nd edition. Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1988.
28. 28. Benninga MA, Voskuijl WP, Taminiau JAJM. Childhood constipation: Is there New light in the tunnel? J Pediatr Gastroenterol Nutr 2004;39:448–64. doi: 10.1097/00005176-200411000-00002
29. 29. Wald A, Sigurdsson L. Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol 2011; 25:19-27. doi: 10.1016/j.bpg.2010.12.004
30. 30. Gallagher B, West D, Puntis JWL, Stringer MD. Characteristics of children under 5 referred to hospital with constipation: A one year prospective study. Int J Clin Pract 1998;52:165–7.