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There have been no large randomised controlled trials of treatments for childhood constipation. Lactulose may cause bloating and abdominal pain because of its fermentation by colonic bacteria and it has been suggested that low-dose polyethylene glycols (PEG) could be a less troublesome alternative. Systemic absorption of PEG is said to be very low. Now Dutch workers (
) have compared lactulose with PEG 3350 (Transipeg; polyethylene glycol with electrolytes).
They randomly assigned 100 patients aged 6 months to 15 years to PEG 3350 or lactulose (under 6 years, one sachet (2.95 g PEG 3350 or 6 g lactulose) per day; over 6 years two sachets per day; dose adjusted according to response) for 8 weeks. The children had constipation defined as at least two of four symptoms or findings: less than three bowel movements per week, encopresis (more than once a week), large amounts of stool every 7–30 days, or palpable faecal abdominal or rectal mass. Enemas were given to clear the rectum before starting the trial medication.
Ninety-one children completed the study. After 8 weeks of treatment success (at least three bowel movements a week and no more than one episode of encopresis every 2 weeks) was achieved in 26/46 in the PEG group and 13/45 in the lactulose group. The mean increase in frequency of bowel movement and decrease in frequency of encopresis were similar in the two groups. Patients taking lactulose were significantly more likely to complain of abdominal pain or of pain or straining at defaecation, and patients taking PEG 3350 were significantly more likely to complain of the taste.
The authors of this paper consider that PEG 3350 should be the first choice treatment for childhood constipation.
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