Çocukluk Çağında Fonksiyonel Kabızlık Tedavisi: Senna, Trimebutin ve Laktülozun Karşılaştırılması

Year 2020, , 295 - 301, 26.06.2020

Arzu Meltem Demir , Zarife Kuloğlu , Aydan Kansu

https://doi.org/10.12956/tchd.619141

Abstract

Amaç:
Çocukluk çağında kabızlık yaygın olup sıklıkla fonksiyoneldir. Çocuklarda
fonksiyonel kabızlık tedavisinde kullanılan ilaçlarla ilgili bilgiler
sınırlıdır. Amacımız fonksiyonel kabızlık (FK) veya fonksiyonel fekal
inkontinans (FFİ) olan çocuklarda senna, trimebutin ve laktülozun etkinliğini
değerlendirmektir.  

Gereç ve Yöntemler:
Roma III kriterlerine göre fonksiyonel kabızlık (FK) veya fonksiyonel fekal
inkontinans (FFI) tanısı koyulan, laktüloz (n=36), senna (n=29) ve trimebutin
(n=33) tedavisi alan hastalar (2-18 yaş) alındı. Hastalar semptomlarıyla ilgili
0-5 Likert anket ölçeğini doldurdular. Dışkı kıvamı (DK) Bristol Dışkı
Skalasına göre değerlendirildi. Tedaviye uyum, tolerans ve yan etkiler
kaydedildi. Klinikteki düzelme (KD) değerlendirildi,  farmakoekonomik inceleme yapıldı. 

Bulgular:
Senna grubundaki KD anlamlı ölçüde yüksekti (p=0.036). Senna DK'da en fazla
iyileşme sağladı (p<0.001) ve fekal inkontinansı azalttı (p=0.039). Karında
distansiyon, karın ağrısı, bulantı/kusma ve anal fissür trimebutinle düzeldi
(p<0.05). Senna ve trimebutin ağrılı defekasyonu ve dışkı tutmayı azalttı.
Laktüloz iştahsızlık ve anal fissürü iyileştirdi. Senna en fazla maliyet
etkinliği olan ilaçtı.

Tartışma:
Kabızlık için tedavi seçenekleri ağırlıklı görülen semptoma göre dizayn
edilmelidir. Senna obesite ve/veya fekal inkontinans olan çocuklarda başlangıç
tedavisi olarak önerilebileceği gibi, trimebutin karında distansiyon, karın
ağrısı, bulantı/kusma veya anal fissür olanlarda, laktüloz iştahsızlık veya
anal fissür olanlarda ayrı olarak seçilebilir. 

Keywords

Kabızlık, Laktüloz, Senna, Trimebutin

Treatment of Childhood Functional Constipation: Comparison of Senna, Trimebutine and Lactulose

Abstract

Objective:
Childhood constipation is common and usually functional. Data for the drugs
used in maintenance therapy of functional constipation is limited in childhood.
Our aim was to evaluate the efficacy
of senna, trimebutine and lactulose in children with functional constipation
(FC) or functional fecal incontinence (FFI).

Material and Methods: Patients  (2-18 years old) diagnosed as FC or FFI according
to Rome III criteria who were treated with lactulose (n=36), senna (n=29) and
trimebutine (n=33)were included. Patients completed a 0-5 Likert scale
questionnaire about their symptoms. Stool consistency (SC) was evaluated by
Bristol Stool Chart. Compliance and tolerance to treatment and side effects
were recorded. Clinical improvement (CI) and pharmacoeconomic evaluation were performed.

Results: CI
in the senna group was significantly higher (p=0.036). Senna showed the highest
improvement in SC (p<0.001) and decreased fecal incontinence (p=0.039).
Abdominal distention, abdominal pain, nausea/vomiting and anal fissure were
improved by trimebutine (p<0.05). Both senna and trimebutine decreased
painful defecation and stool witholding. Lactulose improved anorexia and anal
fissure. Senna was the most cost-effective drug. Conclusion: Treatment options for constipation should be tailored
according to the predominant symptom. Senna may be recommended as the
initial treatment for children with obesity and/or fecal incontinence, trimebutine
in patients with abdominal distention,  abdominal pain,  nausea/vomiting or anal fissure, lactulose in
patients with anorexia or anal fissure, respectively.

 

Keywords

Constipation, Lactulose, Senna, Trimebutin

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