Clinical profile of functional constipation in Saudi children

BACKGROUND:
Functional constipation (FC) is a common condition in children, and information on the clinical characteristics of FC in Saudi children is scarce.


OBJECTIVE:
Describe the clinical profile of FC in Saudi children.


DESIGN:
Retrospective


SETTING:
Hospital that provides primary, intermediate and tertiary care.


PATIENTS AND METHODS:
All children diagnosed with FC according to the Rome IV criteria were included and had at least one follow-up clinic visit. Demographic and clinical data collected from medical records included the age at onset, duration of constipation, clinical features, treatment modalities, and factors associated with clinical response. Descriptive statistics and Pearson's chi-squared test were used in the statistical analysis to see how categorical study variables were linked to clinical response. A P value of ≤.05 was used to report statistical significance.


MAIN OUTCOME MEASURE:
Compliance and clinical response to polyethylene glycol (PEG) compared with lactulose.


SAMPLE SIZE:
370 children from 0.1 to 13 years of age.


RESULTS:

The median (IQR) age of onset was 4 (5) years and less than one year in 14%. The median (IQR) duration of constipation was 4 months (11) and less than two months in 93/370 (25%). Abdominal pain was the most commonly associated feature (44%). Screening for celiac disease and hypothyroidism was negative. A Fleet enema was the most common disimpaction method (54%) and PEG was the most common maintenance medication (63.4%). PEG was significantly better tolerated (
P
=.0008) and more effective than lactulose (
P
<.0001). Compliance was the only variable significantly associated with clinical response.



CONCLUSIONS:
PEG was better tolerated and more effective than lactulose in our study, a finding in agreement with the literature. Therefore, PEG should be the drug of choice in the initial management of FC in Saudi children. Prospective studies on the causes of noncompliance are needed to improve the response to treatment.


LIMITATIONS:
The limitations of retrospective design are missing data, recall bias, and hospital-based limitation, such as missing milder cases treated at the outpatient level. However, the sample size of 370 may have minimized these limitations.