Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A Randomized Clinical Trial
| Autor: | Farzaneh Motamed, Fatemeh Farahmand, Gholamhossein Fallahi, Lida Sharifi-Rad, Behnam Nabavizadeh, Hosein Alimadadi, Seyedeh-Sanam Ladi-Seyedian, Arash Fallahi, Maryam Alijani, Abdol-Mohammad Kajbafzadeh |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Constipation Adolescent law.invention Internal anal sphincter 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Refractory Quality of life Administration Rectal law Surveys and Questionnaires medicine Humans Botulinum Toxins Type A Child Hepatology business.industry Gastroenterology medicine.disease Comorbidity Treatment Outcome Neuromuscular Agents Child Preschool 030220 oncology & carcinogenesis Anesthesia Defecation Female 030211 gastroenterology & hepatology medicine.symptom business Botulinum toxin type |
| Zdroj: | American Journal of Gastroenterology. 115:2060-2067 |
| ISSN: | 1572-0241 0002-9270 |
| DOI: | 10.14309/ajg.0000000000000940 |
| Popis: | INTRODUCTION Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection. METHODS From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire. RESULTS After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively). DISCUSSION BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia. |
| Databáze: | OpenAIRE |
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