- Fecal Incontinence
|Treatment failure in children diagnosed with constipation in a paediatric emergency department in relation to Rome III criteria
Eltorki M1, Bhattacharjee A2, Khan M3, Martin E4, Shyleyko R5, Freedman SB6. Paediatr Child Health. 2019 Jun;24(3):185-192. doi: 10.1093/pch/pxy121. Epub 2018 Oct 3.
1 Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, Hamilton, Ontario.
2 Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
3 Faculty of Nursing, University of Calgary, Calgary, Alberta.
4 Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
5 Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
6 Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
OBJECTIVE: To determine if treatment failure varies based on ROME III classification and adherence to guideline congruent therapy among children diagnosed in an emergency department with functional constipation.
METHODS: Children aged 1 month to 18 years who were diagnosed with constipation in a paediatric emergency department underwent chart review and 7-day phone follow-up to complete the ROME III questionnaire, confirm treatments administered, and assess treatment failure. Participants were classified according to the ROME III criteria as having functional constipation (FC) or irritable bowel syndrome - constipation (IBS-C) subtype. The primary outcome was treatment failure defined as ≥ 2 of the following: 1) presenting symptom persistence; 2) < 1 bowel movement every other day; 3) pain/difficulty passing stools; and 4) abdominal pain between bowel movements.
RESULTS: Five hundred and thirteen children completed follow-up; 40% (204/513) had FC, 23% (118/513) IBS-C, and 37% (191/513) did not meet either criteria. Treatment failure rates in children who received guideline congruent treatment were 28% (38/135) among those classified as FC and 43% (37/86) among those with IBS-C; P=0.02, a difference of 15% (95% confidence interval [CI]: 0.02, 0.27). On regression analysis, ROME III classification was not an independent predictor of treatment failure (odds ratio [OR]: 1.56 [95% CI: 0.97, 2.51]). At 7-day follow up, pain in between bowel movements was present in 22% (44/204) in FC patients versus 45% (53/118) of IBS-C patients; P=0.001.
CONCLUSIONS: Treatment failure rates in children who receive guideline congruent therapy are higher among those with IBS-C, however, after adjustment for known confounders the relationship was not statistically significant.