Quality of life in children with slow transit constipation

doi:10.1016/j.jpedsurg.2007.10.020

Journal of Pediatric Surgery

Volume 43, Issue 2, February 2008, Pages 320-324

https://doi.org/10.1016/j.jpedsurg.2007.10.020 Get rights and content

Abstract

Background

Slow transit constipation (STC) causes intractable symptoms not readily responsive to laxatives, diet, or life-style changes. Children with STC have irregular bowel motions associated with colicky abdominal pain and frequent uncontrollable soiling.

This study assessed the physical and psychosocial quality of life (QOL) in children with long-standing (≥2 years) STC vs healthy controls.

Methods

Children (aged 8-18) were recruited from gastrointestinal and surgical clinics and a Scout Jamboree. After informed consent was obtained, the questionnaire (Pediatric Quality of Life Inventory) was administered. This consists of parallel child and parent self-report scales encompassing physical functioning, emotional functioning, social functioning, and school functioning. Higher scores indicate better QOL. P value less than .05 was considered statistically significant.

Results

In 51 children with STC (mean, 11.5 years; male/female, 2:1) and 79 controls (mean, 12.1 years; male/female, 1.9:1), Pediatric Quality of Life Inventory QOL score was significantly lower in the STC group (72.90 vs 85.99; P < .0001). In addition, parents of children with STC reported a significantly lower QOL score than their child compared with the child's own report (64.43 vs 72.90; P = .0034). Parents of controls did not (84.25 vs 85.99; P = .12).

Conclusions

Slow transit constipation is a debilitating condition affecting both physical and emotional functioning in children. Parental perception of QOL is significantly worse, highlighting the considerable family impact of constipation and uncontrollable soiling.

Section snippets

Subjects and methods

After the attainment of informed consent, the questionnaire (Pediatric Quality of Life Inventory [PedsQL]) was administered by 1 of 3 investigators (M.C., C.C., or J.C.). The PedsQL 4.0 Generic Core Scales consist of parallel child and parent self-report scales and have been validated in children and adolescents aged 2 to 18 years [18], [19], [20], [21]. The questionnaires consist of 23 items encompassing (i) physical functioning (8 items); (ii) emotional functioning (5 items); (iii) social

Results

From March 2006 to March 2007, 51 children (34 male, 17 female) with STC and 79 healthy controls (48 male, 31 female) were recruited into the study (Table 1). All children and their parents successfully completed the PedsQL.

Child-reported QOL was significantly lower in children with STC compared with normal children (72.90 vs 85.99; P < .0001) (Fig. 1). Parent-reported QOL was significantly lower for children with STC compared with the control group (64.43 vs 84.25; P < .0001) (Fig. 2).

Discussion

Quality of life can be defined as “an individual's subjective perception of overall wellbeing and satisfaction with life” [23] or “physical, social and emotional aspects of a patient's well being that are important to the individual” [24]. QOL is a multidimensional concept that incorporates the assessment of recognized core domains and indicators.

Many studies have looked at the QOL in children with chronic disease; however, there are few studies that have specifically examined the impact of

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Cited by (72)

Quality of Life in Children with Functional Constipation: A Systematic Review and Meta-Analysis
2019, Journal of Pediatrics
Citation Excerpt :
Mean total PedsQL scores of children with functional constipation were lower when compared with healthy reference scores as reported by previous studies10,11 (Figure 1). Two studies were excluded from the meta-analysis because 1 study did not provide the mean HRQoL score and the other study did not provide the SD scores.17,25 The remaining 13 studies were used to calculate sample size–weighted pooled mean HRQoL scores of children with functional constipation.
To systematically review the literature on health-related quality of life (HRQoL) in children with functional constipation and to identify disease-related factors associated with HRQoL.
The Pubmed, Embase, and PsycINFO database were searched. Studies were included if they prospectively assessed HRQoL in children with functional constipation according to the Rome criteria. Articles were excluded if patients had organic causes of constipation and if HRQoL was only assessed after successful therapeutic interventions. A meta-analysis was performed calculating sample size–weighted pooled mean and SD of HRQoL scores. The quality of the studies was also assessed.
A total of 20 of 2658 studies were included, providing HRQoL data for 2344 children. Quality of evidence was considered to be poor in 9 of the 20 studies (45%); 13 of the 20 studies reported sufficient data to be included in the meta-analysis. Pooled total HRQoL scores of children with functional constipation were found to be lower compared with healthy reference samples (65.6 vs 86.1; P < .01). Similar HRQoL scores were found according to self-report and parent proxy report. Hospital-based studies reported lower HRQoL scores as compared with community-based studies. Two studies reported on HRQoL scores of children with and without fecal incontinence, but no significant difference was found.
HRQoL is compromised in children with functional constipation.
Home-Based Transabdominal Interferential Electrical Stimulation for Six Months Improves Paediatric Slow Transit Constipation (STC)
2018, Neuromodulation
Transcutaneous electrical stimulation (TES) for one to two months has produced some improvement in treatment-resistant slow-transit constipation (STC) in children. Optimal parameters for treatment are not known. It is possible that more improvement would occur with stimulation for longer. This study examined the effectiveness of stimulation for six months.
Children with STC confirmed by nuclear transit study (NTS) were enrolled prospectively. All had chronic constipation for greater than two years and had failed medical treatment. TES was performed for one hour/day for six months using the INF 4160 (Fuji Dynamics) portable stimulator and 4 cm × 4 cm electrodes near the belly button and on the back. Families kept bowel diaries and completed PEDSQLCore QOL (4.0) questionnaires before and at end of treatment.
Sixty-two children (34 females; seven years, 2–16 year) with STC were studied. Defecation frequency increased in 57/62 (91%, mean ± SEM pre- 1.49 ± 0.20 vs. post- 3.25 ± 0.25 defecation/week, p < 0.0001) with the number with ≥3BA increasing from 6 to 37 (10–59%). Soiling frequency decreased from 4.8 to 1.1 days/week (p <0.001). Abdominal pain decreased from 1.7 to 0.3 days/week (<0.0001), and spontaneous urge to defecate improved. Quality of life (p < 0.01), mean transit index and gastric emptying on NTS improved (p < 0.005).
Treatment-resistant STC responds to TES using interferential current across the abdomen when given daily for many months. Battery operated stimulators allowed stimulation at home for an hour each day. Stimulation for six months produced clinically significant improvement in defecation frequency, soiling, abdominal pain, urge to defecate, and quality of life in half of these chronic patients.
Non-invasive measures of oral-rectal transit in young pigs
2016, Livestock Science
The gastrointestinal transit of markers in pigs has been well studied, but the methods and approaches are different from gastrointestinal studies performed in humans clinically.
To develop a non-invasive method of estimating oral-rectal transit times in young pigs.
We performed transit studies in 3 groups of 4 week-old, Large White female pigs. Group 1. Ten animals (5.7±0.34 kg (mean±SEM)) were fed blue-dyed grower feed and placed under video surveillance. Group 2a. Twenty-two animals (7.7±0.59 kg) from the same pig supplier were administered 18 4 mm-diameter radio-opaque plastic markers under light anaesthesia (5% isofluorane), and we took abdominal x-rays at 6, 30, 54 and 78 h. Group 2b. Eight pigs (9.2±0.48 kg) from a different supplier also underwent plastic marker transit studies.
Using blue dye (fluid transit), the median (25th, 75th percentiles) time to first incidence of blue-dyed stool was 13.2 (10.2, 18.1) h and to last blue stool was 24.1 (22.4, 40.3) h. Using plastic markers, markers were evacuated between 30 and 80+ hours with differences in stomach emptying between two groups of animals from different farms. Median oral-rectal transit times were 25.2 (17.8, 40.5) h and 48.9 (26.9, 68.3) h in the second and third groups (M-W test, P=0.04).
There are differences in the transit of fluid- and solid-phase marker in pigs. Fluid-phase markers appear earlier than solid markers. Monitoring the evacuation of fluid-phase dye using video surveillance is difficult. Using plastic markers and x-rays to estimate the segmental and oral-rectal transit times in young pigs may be a useful method that can be correlated to oral-rectal transit studies performed in humans. The ability of pigs to hold solids in the stomach for extended times complicates transit studies. There are some differences in transit in pigs from different breeders.
Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation
2023, Pediatric Surgery International
Constipation
2023, Pediatric Surgery: Diagnosis and Management
Mediterranean diet is associated with better gastrointestinal health and quality of life, and less nutrient deficiency in children/adolescents with disabilities
2023, Frontiers in Public Health

View all citing articles on Scopus

: Presented at the British Association of Paediatric Surgeons meeting, Edinburgh, Scotland, July 17-20, 2007.

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BAPS PapersQuality of life in children with slow transit constipation

Abstract

Background

Methods

Results

Conclusions

Section snippets

Subjects and methods

Results

Discussion

J Adolesc Health

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Gastroenterology

J Pediatr Surg

J Pediatr Surg

Ambul Pediatr

J Pediatr Surg

Colonic transit time in constipated children: does pediatric slow-transit constipation exist?

J Pediatr Gastroenterol Nutr

Chronic constipation in children: organic disorders are a major cause

J Paediatr Child Health

Paediatric constipation for adult surgeons—article 1: targeting the cause

ANZ J Surg

Slow transit constipation in children

J Paediatr Child Health

BAPS Papers
Quality of life in children with slow transit constipation