Comparison of effectiveness between polyethylene glycol 4000 and lactulose in the treatment of pediatric functional constipation

Abstract

Aim: Functional constipation is a common illness in children that requires close follow-up and long-term treatment. This study aims to compare the effectiveness of lactulose and PEG 4000 in the treatment of pediatric functional constipation.
Methods: One hundred and twenty-three patients included in this cross-sectional study were all diagnosed with functional constipation according to Rome IV criteria. The ages of the patients, who were all referred to the pediatric gastroenterology outpatient clinic between November 2017 and May 2018, ranged between 8 months and 4 years. Patients with accompanying organic diseases were excluded from the study. Children treated with Lactulose were included in the LAC group and those treated with PEG 4000 were included in the PEG group. The number of bowel movements, Bristol Stool Form Scale (BSFS), pain during bowel movements, formation of anal fissures and fecal impaction at diagnosis and during follow-up were noted from the patient files. A comparison was then made in 1st and 3rd months between the diagnostic findings and follow-up of patients in both groups.
Results: There were no age or gender-based differences between the two groups. Sixty-two (50%) patients received lactulose and the remaining 61 patients (50%) received PEG 4000 as treatment. At the end of the third month, patients had improved significantly more in the PEG group in terms of number of daily bowel movements, the presence of pain during bowel movement and median BSFS score (P<0.001).
Conclusion: While lactulose and PEG 4000 are both effective in the treatment of functional constipation in children, PEG 4000 is a more effective and successful treatment option compared to lactulose without increased side effects.

Keywords

• Child
• Polyethylene glycol 4000
• Lactulose
• Constipation

Çocuklarda fonksiyonel konstipasyon tedavisinde polietilen glikol 4000 ve laktuloz etkinliklerinin karşılaştırılması

Öz

Amaç: Fonksiyonel konstipasyon çocukluk çağında sık görülen ve yakın takip gerektiren bir hastalıktır. Tedavide PEG 4000 tedavisinin daha etkili olduğu düşünülmektedir. Bu çalışmada fonksiyonel konstipasyonu olan çocuklarda PEG 4000 ve laktuloz tedavilerinin etkinliklerini karşılaştırmayı amaçladık.
Yöntemler: Çalışma Roma 4 kriterlerine göre fonksiyonel konstipasyon teşhisi konulan çocukları içermektedir. Bu çalışma karşılaştırmalı ve kesitsel bir çalışmadır. Çocuk Gastroenteroloji polikliniğine Kasım 2017 ve Mayıs 2018 tarihleri arasında başvuran 123 hasta dahil edilmiştir. Eşlik eden organik hastalığı saptanan hastalar çalışma dışı bırakılmıştır. Laktuloz tedavisi verilen çocuklar LAC grup, PEG 4000 tedavisi verilen çocuklar PEG grup olarak tanımlandı. Hastaların tanı ve takipte bağırsak hareketlerinin sayısı, Bristol Stool Score Form Ölçeği (BSFS), bağırsak hareketleri sırasında ağrı, anal fissür oluşumu ve fekal inkontinans kaydedildi. Daha sonra sırasıyla LAC grup ve PEG grup hastaların takibi arasında 1. ve 3. aylarda karşılaştırma yapılmıştır.
Bulgular: Çalışmaya 123 hasta alındı. 62 hastaya (%50) laktuloz ve geri kalan 61 hastaya (%50) tedavi olarak PEG 4000 verildi. Yaş ve cinsiyet açısından iki grup açısından fark saptanmadı. Üçüncü ayın sonunda, PEG grup çocuklarda iyileşme, günlük bağırsak hareketlerinin sayısı, bağırsak hareketi sırasında ağrı varlığı ve medyan BSFS skoru açısından laktuloz tedavisi gören hastalardan anlamlı olarak farklılık saptandı (P<0,001).
Sonuç: Hem laktuloz hem de PEG 4000, çocuklarda fonksiyonel konstipasyonun tedavisinde etkili olsa da, PEG 4000 tedavisi yan etkileri arttırmayan, laktuloza kıyasla daha etkili ve başarılı bir tedavi seçeneğidir.

Anahtar Kelimeler

• Çocuk
• Polietilenglikol 4000
• Laktuloz
• Konstipasyon

Kaynakça

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