دوره 13، شماره 3 - ( 6-1404 )
جلد 13 شماره 3 صفحات 0-0 |
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Ethics code: A-10-1131-1
Clinical trials code: A-10-1131-1
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Afolayan M, Ozturk C. Drug versus Behavioral Therapies for Functional Constipation in Children Aged 0 to 5 Years: A Systematic Review of Treatment Outcomes and Preventive Strategies. Iran J Health Sci 2025; 13 (3)
URL: http://jhs.mazums.ac.ir/article-1-1016-fa.html
URL: http://jhs.mazums.ac.ir/article-1-1016-fa.html
Drug versus Behavioral Therapies for Functional Constipation in Children Aged 0 to 5 Years: A Systematic Review of Treatment Outcomes and Preventive Strategies. علوم بهداشتی ایران. 1404; 13 (3)
چکیده: (29 مشاهده)
Background and Purpose: Functional constipation is a gastrointestinal disorder that mainly affects the quality of life of children under five years of age. This systematic review aims to compare the effectiveness of drug and behavioral therapies, their treatment outcomes, and preventive strategies.
Materials and Methods: This review followed PRISMA guidelines and was registered with PROSPERO (CRD42024573684). To ensure it included studies that incorporated updated diagnostic criteria, evolving treatment recommendations, and clinical practices in managing pediatric constipation, a comprehensive search was conducted in PubMed, Web of Science, CINAHL, EBSCO, and Cochrane CENTRAL for English-language randomized controlled trials published over the past decade, from 2014 until June 2024. Thirteen studies met the inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane Risk of Bias tool.
Results: PEG consistently showed rapid symptom relief. In one study, the PEG group achieved 7.9 defecations per week versus 5.7 in the lactulose group (P = 0.008). Adverse events were also fewer in the PEG group (15 vs 23, P = 0.02). In another trial, PEG 3350 + electrolytes showed higher treatment efficiency (79.5%) compared to rectal enemas (58.3%) in children under two. A systematic review found that PEG doses between 0.45–1.1 g/kg/day were both safe and effective in children under 24 months, with a low incidence of side effects. Behavioral interventions, including toilet training and dietary changes, were effective in reducing recurrence and improving long-term bowel regularity. Their efficacy and impact on quality of life can vary based on age, severity of constipation, and duration of treatment.
Conclusion: The combined use of both strategies provides the most effective and sustainable outcomes. These findings suggest the implementation of a holistic treatment approach that considers age, severity, and individual needs. To improve the efficacy of combined therapies, further high-quality randomized controlled trials (RCTs) are required to determine the most effective age-specific behavioral strategies and the best timing for implementation.
Materials and Methods: This review followed PRISMA guidelines and was registered with PROSPERO (CRD42024573684). To ensure it included studies that incorporated updated diagnostic criteria, evolving treatment recommendations, and clinical practices in managing pediatric constipation, a comprehensive search was conducted in PubMed, Web of Science, CINAHL, EBSCO, and Cochrane CENTRAL for English-language randomized controlled trials published over the past decade, from 2014 until June 2024. Thirteen studies met the inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane Risk of Bias tool.
Results: PEG consistently showed rapid symptom relief. In one study, the PEG group achieved 7.9 defecations per week versus 5.7 in the lactulose group (P = 0.008). Adverse events were also fewer in the PEG group (15 vs 23, P = 0.02). In another trial, PEG 3350 + electrolytes showed higher treatment efficiency (79.5%) compared to rectal enemas (58.3%) in children under two. A systematic review found that PEG doses between 0.45–1.1 g/kg/day were both safe and effective in children under 24 months, with a low incidence of side effects. Behavioral interventions, including toilet training and dietary changes, were effective in reducing recurrence and improving long-term bowel regularity. Their efficacy and impact on quality of life can vary based on age, severity of constipation, and duration of treatment.
Conclusion: The combined use of both strategies provides the most effective and sustainable outcomes. These findings suggest the implementation of a holistic treatment approach that considers age, severity, and individual needs. To improve the efficacy of combined therapies, further high-quality randomized controlled trials (RCTs) are required to determine the most effective age-specific behavioral strategies and the best timing for implementation.
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