Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation
| Autor: | Pablo Lezama-Del Valle, José Luis Arredondo-García, Karla Alejandra Santos-Jasso, Jorge Maza-Vallejos |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Sennosides Constipation Adolescent Senna medicine.medical_treatment Laxative Bowel management Gastroenterology Drug Administration Schedule law.invention Polyethylene Glycols 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law 030225 pediatrics Internal medicine Medicine Humans Child Cross-Over Studies biology business.industry Cathartics Megarectum Senna Extract digestive oral and skin physiology General Medicine medicine.disease biology.organism_classification Crossover study Anorectal Malformations Treatment Outcome Laxatives Anesthesia Child Preschool Pediatrics Perinatology and Child Health Defecation 030211 gastroenterology & hepatology Surgery Female medicine.symptom business |
| Zdroj: | Journal of pediatric surgery. 52(1) |
| ISSN: | 1531-5037 |
| Popis: | Purpose Constipation is present in 80% of children with corrected anorectal malformations, usually associated to rectal dilation and hypomotility. Osmotic laxatives are routinely used for idiopathic constipation. Senna is a stimulant laxative that produces contractions improving colonic motility without affecting the stool consistency. We designed this trial to study the effectiveness of Senna versus polyethylene glycol for the treatment of constipation in children with anorectal malformation. Methods A randomized controlled crossover design clinical trial, including a washout period, was conducted, including children with corrected anorectal malformations with fecal continence and constipation. The sample size was calculated for proportions (n=28) according to available data for Senna. Effectiveness of laxative therapy was measured with a three variable construct: 1) daily bowel movement, 2) fecal soiling, 3) a "clean" abdominal x-ray. Data analysis included descriptive statistics and a Fisher's exact test for the outcome variable (effectiveness). Results The study was terminated early because the interim analysis showed a clear benefit toward Senna ( p = 0.026). The sample showed a normal statistical distribution for the variables age and presence of megarectum. The maximum daily dose of Senna (sennosides A and B) was 38.7mg and 17g for polyethylene glycol. No adverse effects were identified. Conclusion Therapy with Senna should be the laxative treatment of choice as part of a bowel management program in children with repaired anorectal malformations and constipation, since the stimulation of colonic propulsion waves could lead to stool evacuation without modification of its consistency which can affect fecal continence. Level of Evidence I – randomized controlled trial with adequate statistical power. |
| Databáze: | OpenAIRE |
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