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Çocuklarda Kronik Kabızlık Olgularının Değerlendirilmesi

Year 2014, Volume: 8 Issue: 3, 117 - 123, 01.06.2014

Abstract

Amaç: Kronik kabızlık sıklıkla teşhis edilmeyen ve çok az tedavi verilen genel ve ciddi bir çocukluk çağı sorunudur ve çocuk gastroenteroloji ünitelerine en sık başvuru nedenlerindendir. Bu çalışmada amaç kronik kabızlık yakınması ile getirilen olgularda klinik özellikleri, etiyolojik nedenleri ve izlem sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Mart 2004 ile Eylül 2005 tarihleri arasında çocuk gastroenteroloji, hepatoloji ve beslenme bilim dalı polikliniğine kabızlık yakınması ile getirilen 1 ay ile 16 yaş arasındaki olguların dosyaları geriye dönük olarak incelendi. Uygun olan 100 olgu çalışmaya dahil edildi. Düzenli poliklinik takiplerine gelen 74 olgu ileriye dönük olarak tedavi ve klinik yanıt açısından değerlendirildi.Bulgular: Çalışmaya dahil edilen olguların ortalama yaşı 4,48 olup, %51’i erkekti. Kabızlık yakınmalarına ek olarak olguların %66’sında karın ağrısı mevcuttu. Kabızlık yakınma süreleri ort: 33 aydı. Dışkılama sıklığı %62 olguda 2-3 günde bir olarak kaydedildi. Dışkının kıvam ve şekli ise %61 olguda sert ve küçüktü. Olguları %92’si ilk 24 saat içinde mekonyum yapmıştı. %18’inde aile öyküsü vardı. Diyetteki lif içeriği 78 olguda yetersiz iken, sıvı alımı ise olguların %67’sinde yetersiz olarak bulundu. Olguların %4’ünde kronik kabızlıkla birlikte altta yatan psikolojik bir neden vardı. Fizik muayenede, %10 olguda büyüme gelişme geriliği mevcuttu. Olguların %92’sinde fonksiyonel kabızlık saptanırken, %8’inde organik kaynaklı bir kronik kabızlık nedeni mevcuttu. Tedavide %28 olguya sadece uygun diyet ve tuvalet eğitimi verilmiş, %72 olguya ise medikal tedavi verilmişti. Düzenli poliklinik kontrollerine gelen (n=74) olguların 68’inde (%92), 4 - 8 haftalık süre içinde tam klinik yanıt alındı. Tam klinik yanıt alınamayan olguların gereken tedavi uyumunu gösterememiş oldukları öğrenildi.Sonuç: İdiyopatik kronik fonksiyonel kabızlığı olan çocukların çoğunun tanısı için genellikle detaylı bir klinik sorgulama ve fizik muayene yeterli olmaktadır. Kabızlık tedavisinde organik nedenler dışlandıktan sonra tuvalet alışkanlığının düzeltilmesi, diyet değişiklikleri ve tıbbi tedavi ile başarı şansı yüksektir. Ülkemizde kabızlık yakınması olan çocuklar hakkında yapılacak geniş kapsamlı araştırmalara ve istatistiksel verilere ihtiyaç vardır.

References

  • Baker SS, Liptak GS, Colletti RB, Croffi e JM, Di Lorenzo C, Ector W, et al. Constipation in infants and children: Evaluation and treatment. J Pediatr Gastroenterol Nutr 1999;29:612-26.
  • Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology 2006;130:1527-37.
  • Loening-Baucke V. Chronic constipation in children. Gastroentero- logy 1993;105:1557-64.
  • İnan M, Aydıner CY, Tokuç B, Aksu B, Ayvaz S, Ayhan S, et al. Factors associated with childhood constipation. J Paediatr Child Health 2007;43:700-6.
  • Kocaay P, Egritas O, Dalgıc B. Normal defecation pattern, frequency of constipation and factors related to constipation in Turkish children 0-6 years old. Turk J Gastroenterol 2011;22: 369-75.
  • Youssef NN, Di Lorenzo C. Childhood constipation. Evaluation and treatment. J Clin Gastroenterol 2001;33:199-205.
  • Sauvat F. Severe functional constipation in child: What is the solution? J Pediatr Gastroenterol Nutr 2004;38:10-1.
  • Ip KS, Lee WT, Chan JS, Young BW. A community-based study of the prevalance of constipation in young children and role of dietary fi bre. Hong Kong Med J 2005;11:431-6.
  • van den Berg MM, van Rossum CH, de Lorijn F, Reitsma JB, Di Lorenzo C, Benninga MA. Functional constipation in infants: A follow-up study. J Pediatr 2005;147:700-4.
  • Sarı Y, Doğan Y. Kabızlık yakınması olan olgularda klinik bulguların, etiyolojik nedenlerin ve izlem sonuçlarının değerlendirilmesi. F Ü Sağ Bil Tıp Derg 2012;26:121-5.
  • Doğan Y. Kabızlık yakınması olan olguların geriye dönük olarak dökümü. Türk Pediatri Arşivi 2005;40:23-7.
  • Amendola S, DeAngelsis P, Dall’Oglio L, Di Abriola F, Di Lorenzo M. Combined approach to functional constipation in children. J Pediatr Surg 2003;38:819-23.
  • Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: A longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr 1984;3:460-7.
  • Anonymous. Position of the American Dietetic Association: Health implications of dietary fi ber. J Am Diet Assoc 2002;102:993-1000.
  • Weber TK, Toporovski MS, Tahan S, Neufeld CB, de Morais MB. Dietary fi ber mixture in pediatric patients with controlled chronic constipation. J Pediatr Gastroenterol Nutr 2014;58:297-302.
  • Cox DJ, Sutphen J, Ling W, Quillian W, Borowitz S. Additive effects of laxative, toilet training and biofeedback therapies in the treatment of pediatric encopresis. J Pediatr Psychol 1996;21:659-70.
  • Cusick EL, Woodward MN. Hirschsprung’s disease: Outcome and how to follow-up. Curr Pediatr 2001;11:286-90.
  • Erkan T, Cam H, Ozkan HC, Kiray E, Erginoz E, Kutlu T, et al. Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study. Pediatr Int 2004;46:325- 9.
  • Aydoğdu S, Selimoğlu MA, Ünal F, Alım HÇ, Yağcı RV. Çocukluk yaş grubunda konstipasyon ve yönetimi. Ankara: XXX. Ulusal Pediatri Kongresi, 19-23 Mayıs 1999;126.
  • Halabi IM. Cisapride in management of chronic pediatric
  • constipation. J Pediatr Gastroenterol Nutr 1999;28:199-202.
  • Özen H. Enkoprezis. Ro-CODEC: Çocuklarda kronik hastalıkların sıklığı tarama çalışması (Roche). Ankara: Medi Graphics (HYB), 1997;53-5.
  • Dehghani SM, Basiratnia M, Matin M, Hamidpour L, Haghighat M, Imanieh MH. Urinary tract infection and enuresis in children with chronic functional constipation. Iran J Kidney Dis 2013;7:363-6.
  • Mohkam M. Voiding dysfunction in children with chronic functional constipation. Iran J Kidney Dis 2013;7:336-8.
  • Loening Baucke V. Constipation in early childhood: Patient characteristics; treatment and longterm follow up. Gut 1993;34: 1400- 4.
  • Guerrero RA, Cavender CP. Constipation: Physical and psycholo- gical sequelae. Pediatr Ann 1999;28:312-6.
  • Borowitz SM, Sutphen JL. Recurrent vomiting and persistent gastroesophageal refl ux caused by unrecognized constipation. Clin Pediatr 2004;43:461-6.
  • Felt B, Wise CG, Olson A, Kochhar P, Marcus S, Coran A. Guidelines for the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med 1999;153:380-5.
  • Gordon M, Naidoo K, Akobeng AK, Thomas AG. Cochrane review: Osmotic and stimulant laxatives for the management of childhood constipation (Review). Evid Based Child Health 2013;8:57-109.
  • Croffi e J, Fitzgerald JF. Idiopathic constipation, In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB (eds). Pediatric Gastrointestinal Disease, Pathophysiology, Diagnosis, Management. 3 rd ed B C Decker Inc, 2000:830-44.
  • Phatak UP, Pashankar DS. Role of polyethylene glycol in childhood constipation. Clin Pediatr (Phila) 2013, [Epub ahead of print].
  • Ustundag G, Kuloglu Z, Kırbas N, Kansu A. Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation? Turk J Gastroenterol 2010;21:360-4.
  • Belloma-Brandao MA, Collares EF, da-Costa EAL. Use of erythromycin for the treatment of severe chronic constipation in children. Braz J Med Biol Res 2003;36:1391-6.
  • Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: A double-blind, randomized, placebo- controlled study. J Pediatr 2010;157:598-602.
  • Asburçe M, Olgaç B, Balcı Sezer O, Özçay F. Fonksiyonel kabızlığı olan çocuklarda probiyotik ve laktuloz tedavilerinin etkinliğinin karşılaştırılması ve kabızlık tedavisinin yaşam kalitesi üzerine olan etkisinin değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2013;56:1-7.
  • Ejerskov Pedersen C, Jİnsson IM, Siggaard C, Krogh K. Treatment of chronic constipation in children. Ugeskr Laeger 2013;175: 1855-8.
  • Clayden GS. Management of chronic constipation. Arc Dis Child 1992;67:340-4.
  • Voskujil WP, Heijmans J, Heijmans HSA, Taminiau JAJM, Benninga MA. Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. J Pediatr 2004;145:213-7.

Evaluation of Cases with Chronic Constipation in Children

Year 2014, Volume: 8 Issue: 3, 117 - 123, 01.06.2014

Abstract

Objective: Chronic constipation is one of the most common problems in childhood leading approval to pediatric gastroenterology department. In this study, we aimed to evaluate the clinical features, etiological factors and follow-up results of children with chronic constipation. Material and Methods: Cases between the ages of 1 month and 16 years with complaints of constipation who admitted to department of pediatric gastroenterology hepatology and nutrition were analyzed retrospectively between March 2004 and September 2005. 100 patients were eligible for the study. Regularly followed 74 patients were evaluated prospectively for clinical response after medication.Results: Mean age of enrolled 100 patients were 4.48 and 51% of the patients were male. Abdominal pain was present in 66% of cases. Mean duration of symptoms was 33 months. Frequency of defecation was recorded as 2-3 days in 62% of cases. Consistency and form of stool were hard and small at 61% of the patients. 92% of our patients had made meconium within the fi rst 24 hours. 18% had family history. The diet fi ber content was inadequate in 78% of our cases whereas fl uid intake was insuffi cient in 67%. There was an underlying psychological reason at 4% of our cases. Growth

References

  • Baker SS, Liptak GS, Colletti RB, Croffi e JM, Di Lorenzo C, Ector W, et al. Constipation in infants and children: Evaluation and treatment. J Pediatr Gastroenterol Nutr 1999;29:612-26.
  • Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology 2006;130:1527-37.
  • Loening-Baucke V. Chronic constipation in children. Gastroentero- logy 1993;105:1557-64.
  • İnan M, Aydıner CY, Tokuç B, Aksu B, Ayvaz S, Ayhan S, et al. Factors associated with childhood constipation. J Paediatr Child Health 2007;43:700-6.
  • Kocaay P, Egritas O, Dalgıc B. Normal defecation pattern, frequency of constipation and factors related to constipation in Turkish children 0-6 years old. Turk J Gastroenterol 2011;22: 369-75.
  • Youssef NN, Di Lorenzo C. Childhood constipation. Evaluation and treatment. J Clin Gastroenterol 2001;33:199-205.
  • Sauvat F. Severe functional constipation in child: What is the solution? J Pediatr Gastroenterol Nutr 2004;38:10-1.
  • Ip KS, Lee WT, Chan JS, Young BW. A community-based study of the prevalance of constipation in young children and role of dietary fi bre. Hong Kong Med J 2005;11:431-6.
  • van den Berg MM, van Rossum CH, de Lorijn F, Reitsma JB, Di Lorenzo C, Benninga MA. Functional constipation in infants: A follow-up study. J Pediatr 2005;147:700-4.
  • Sarı Y, Doğan Y. Kabızlık yakınması olan olgularda klinik bulguların, etiyolojik nedenlerin ve izlem sonuçlarının değerlendirilmesi. F Ü Sağ Bil Tıp Derg 2012;26:121-5.
  • Doğan Y. Kabızlık yakınması olan olguların geriye dönük olarak dökümü. Türk Pediatri Arşivi 2005;40:23-7.
  • Amendola S, DeAngelsis P, Dall’Oglio L, Di Abriola F, Di Lorenzo M. Combined approach to functional constipation in children. J Pediatr Surg 2003;38:819-23.
  • Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: A longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr 1984;3:460-7.
  • Anonymous. Position of the American Dietetic Association: Health implications of dietary fi ber. J Am Diet Assoc 2002;102:993-1000.
  • Weber TK, Toporovski MS, Tahan S, Neufeld CB, de Morais MB. Dietary fi ber mixture in pediatric patients with controlled chronic constipation. J Pediatr Gastroenterol Nutr 2014;58:297-302.
  • Cox DJ, Sutphen J, Ling W, Quillian W, Borowitz S. Additive effects of laxative, toilet training and biofeedback therapies in the treatment of pediatric encopresis. J Pediatr Psychol 1996;21:659-70.
  • Cusick EL, Woodward MN. Hirschsprung’s disease: Outcome and how to follow-up. Curr Pediatr 2001;11:286-90.
  • Erkan T, Cam H, Ozkan HC, Kiray E, Erginoz E, Kutlu T, et al. Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study. Pediatr Int 2004;46:325- 9.
  • Aydoğdu S, Selimoğlu MA, Ünal F, Alım HÇ, Yağcı RV. Çocukluk yaş grubunda konstipasyon ve yönetimi. Ankara: XXX. Ulusal Pediatri Kongresi, 19-23 Mayıs 1999;126.
  • Halabi IM. Cisapride in management of chronic pediatric
  • constipation. J Pediatr Gastroenterol Nutr 1999;28:199-202.
  • Özen H. Enkoprezis. Ro-CODEC: Çocuklarda kronik hastalıkların sıklığı tarama çalışması (Roche). Ankara: Medi Graphics (HYB), 1997;53-5.
  • Dehghani SM, Basiratnia M, Matin M, Hamidpour L, Haghighat M, Imanieh MH. Urinary tract infection and enuresis in children with chronic functional constipation. Iran J Kidney Dis 2013;7:363-6.
  • Mohkam M. Voiding dysfunction in children with chronic functional constipation. Iran J Kidney Dis 2013;7:336-8.
  • Loening Baucke V. Constipation in early childhood: Patient characteristics; treatment and longterm follow up. Gut 1993;34: 1400- 4.
  • Guerrero RA, Cavender CP. Constipation: Physical and psycholo- gical sequelae. Pediatr Ann 1999;28:312-6.
  • Borowitz SM, Sutphen JL. Recurrent vomiting and persistent gastroesophageal refl ux caused by unrecognized constipation. Clin Pediatr 2004;43:461-6.
  • Felt B, Wise CG, Olson A, Kochhar P, Marcus S, Coran A. Guidelines for the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med 1999;153:380-5.
  • Gordon M, Naidoo K, Akobeng AK, Thomas AG. Cochrane review: Osmotic and stimulant laxatives for the management of childhood constipation (Review). Evid Based Child Health 2013;8:57-109.
  • Croffi e J, Fitzgerald JF. Idiopathic constipation, In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB (eds). Pediatric Gastrointestinal Disease, Pathophysiology, Diagnosis, Management. 3 rd ed B C Decker Inc, 2000:830-44.
  • Phatak UP, Pashankar DS. Role of polyethylene glycol in childhood constipation. Clin Pediatr (Phila) 2013, [Epub ahead of print].
  • Ustundag G, Kuloglu Z, Kırbas N, Kansu A. Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation? Turk J Gastroenterol 2010;21:360-4.
  • Belloma-Brandao MA, Collares EF, da-Costa EAL. Use of erythromycin for the treatment of severe chronic constipation in children. Braz J Med Biol Res 2003;36:1391-6.
  • Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: A double-blind, randomized, placebo- controlled study. J Pediatr 2010;157:598-602.
  • Asburçe M, Olgaç B, Balcı Sezer O, Özçay F. Fonksiyonel kabızlığı olan çocuklarda probiyotik ve laktuloz tedavilerinin etkinliğinin karşılaştırılması ve kabızlık tedavisinin yaşam kalitesi üzerine olan etkisinin değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2013;56:1-7.
  • Ejerskov Pedersen C, Jİnsson IM, Siggaard C, Krogh K. Treatment of chronic constipation in children. Ugeskr Laeger 2013;175: 1855-8.
  • Clayden GS. Management of chronic constipation. Arc Dis Child 1992;67:340-4.
  • Voskujil WP, Heijmans J, Heijmans HSA, Taminiau JAJM, Benninga MA. Use of Rome II criteria in childhood defecation disorders: applicability in clinical and research practice. J Pediatr 2004;145:213-7.
There are 38 citations in total.

Details

Other ID JA62RF59FC
Journal Section Research Article
Authors

Şanlıay Şahin This is me

Fulya Gülerman This is me

Tülin Köksal This is me

Ali Osman Köksal This is me

Publication Date June 1, 2014
Submission Date June 1, 2014
Published in Issue Year 2014 Volume: 8 Issue: 3

Cite

Vancouver Şahin Ş, Gülerman F, Köksal T, Köksal AO. Evaluation of Cases with Chronic Constipation in Children. Türkiye Çocuk Hast Derg. 2014;8(3):117-23.


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