功能性便秘流行病学调查及临床分析

目的 调查小儿功能性便秘(FC)的发病率，探讨其临床特征。方法 采用整群调查方法，符合FC诊断者纳入观察对象；对确诊为FC患儿进行临床分析。结果 1．2～14岁1001名儿童中FC共38例，本组FC发病率为3．8％；城区发病率为4．65％，农村2．38％(yz＝2．48P＜0．05)，城区患病明显高于农村；男童FC患病率2．73％，女童4．07％(yz＝275．8lP＜0．001)；各年龄组患病率无差异；2．本组FC患儿排干硬条状成形便占74％，球形硬便占13％。82％患儿等待自行排便，多数家长未采用解除便秘措施；经常进行排便练习的患儿仅占5．26％；精神欠佳者占26％，腹痛者占21％，伴轻度营养障碍者60％，食欲欠佳及厌食占34％和21％，FC患儿很少进食水果及蔬菜者分别占42％及37％，喜甜食及肉食者为40％及53％。结论 1．本次调查小儿FC发病率为3．8％，城区高于农村，女童高于男童；2．FC患儿生活质量及生长发育受一定影响，应予以关注；3．FC患儿饮食结构有偏差。     

Chronic constipation in children: organic disorders are a major cause

Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment-resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation. This paper reviews recent data suggesting that a significant number of the children with chronic treatment-resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment-resistant constipation.     

Cow's milk protein intolerance and chronic constipation in children

Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, α-lactoalbumin, β-lactoglobulin, and a food group; and skin-prick tests with whole milk, α-lactoalbumin, β-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48–72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.     

排便习惯训练与儿童功能性便秘发病相关分析

为探讨排便习惯训练(DHP)对小儿功能性便秘(FC)发病的影响，并确定DHP。在预防、治疗小儿FC的作用，自行拟订DHP情况调查问卷，由经专题培训的人员，对38例FC患儿观察组及92名健康对照组小儿家长依据问卷内容进行详细调查，有关数据经U检验行统计学处理。结果表明，观察组未进行DHP者占42．10％，不规范DHP者57．90％。对照组小儿自6个月开始全部进行规范DHP，其中排软便者84．78％，条形干便14．13％，球形干便1．09％，患FC者仅1例。两组小儿膳食结构差异无显著性。表明小儿FC的发病与未曾进行或不规范的DHP高度相关，DHP在预防和治疗小儿FC时有重要作用。     

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便秘是儿科临床最常见的胃肠功能不良的症状之一[1-6],涉及范围达全世界儿童的0.7%～29.6%[5-7]。儿童便秘常可起始于婴儿及新生儿期[7],且约1/3患儿的症状会持续至成人期[5],表现为慢性顽固性便秘,有些甚至需要外科手术治疗,漫长的病程和复杂的病情严重影响了患儿和家庭成员的身心健康和生活质量。近十余年来,符合循证医学要求的相关便秘病理生理基础的深入研究以及采用现代临床管理策略的长期研究结果,已明确显示临床治疗效果和预后的改善[5,8-9]。董梅,主任医师。现工作于北京协和医院儿科。兼任卫生部卫生专业技术资格考试专家委员会委员,中华医学会儿科学分会消化学组委员。担任多种儿科核心期刊编委。参编专著十余部,发表专业论文30余篇。     

儿童功能性便秘的危险因素分析

目的了解儿童功能性便秘的危险因素。方法采用横断面调查方法,调查2013年3月至2014年2月期间消化专科门诊确诊的182例功能性便秘患儿的便秘相关危险因素。结果功能性便秘以男性患儿多见,并以学龄前期为主;患儿主要存在不喜食蔬菜水果(52.2%),饮水少(44.0%),未养成每天排便习惯(39.5%),存在排便恐惧(36.3%),食物摄取不足(25.8%)等危险因素;不同年龄阶段的危险因素有所不同。结论功能性便秘与性别、年龄、饮食生活习惯和精神心理相关。     

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便秘(constipation)是指以大便干燥、排便困难,排便时间间隔久或虽有便意而排不出大便等一系列症状为临床表现的疾病,是儿童时期的常见病与多发病,影响儿童生活质量,给儿童及家长带来痛苦。了解便秘的临床特点及诊治流程,对于合理及有效地治疗便秘有重要的意义。1便秘的流行病学及临床特点1.1便秘的流行病学儿童便秘的发病率高,其中90%～95%为功能性便秘(FC)。由于仅有一小部分患儿会因便秘问题就诊,且诊断标准又多有不同,导致很多对便秘发     

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便秘(constipation)是最常见的儿童排便功能障碍症候群之一,多数隶属于功能性便秘(functional constipation,FC)范畴。我国北方5市一项多中心流行病学调查结果显示,儿童FC的群体患病率为4.73%,为儿童胃肠门诊最常见的病症之一[1-2]。随着现代分子生物学、影像学以及生物物理学的快速发展,人们对儿童便秘的认识和研究不断深入,如先天性巨结肠及其同源病、肠神经发育不良、肛门括约肌失迟缓等,在此基础上针对病因的个体化治疗逐步获     

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??Functional constipation is a common functional disease of digestive system that arises in children of all ages. The symptoms include infrequent defecation??hard?? painful stools that are difficult to pass??fecal incontinence and abdominal pain. These symptoms are known to have a significant impact on the mood??appetite and life quality of children. The pathogenesis underlying FC remains unclear??but with the development of the research in micro-ecosystem of intestines?? more and more evidences support that an alteration of the gut microbiota may be a possible mechanism for the development of FC. Probiotics are live microorganisms that can enrich microorganism species?? lower intraluminal pH and regulate intestinal immune function??which make it a good prospect in the treatment of FC. Then??this paper will make a brief introduction to the application of probiotics in children with FC by referring to its domestic and abroad research progresses.     

A comparative study: The efficacy of liquid paraffin and lactulose in management of chronic functional constipation

Abstract Objectives : To determine and compare efficacy, safety and optimal dose of two laxatives, liquid paraffin and lactulose, in 40 children with chronic functional constipation.
Methods : A total of 20 children were treated with liquid paraffin and 20 with lactulose for 8 weeks and at an initial dose of 1 mL/kg per day for both drugs. The dose was adjusted every 3 days as required and a diary was kept to monitor dose, side-effects, stool frequency and consistency, and other symptoms.
Results : During first 4 weeks, improvement in stool consistency and frequency was significantly higher in liquid the paraffin group ( P <  0.01 and P  < 0.05, respectively). Improvement in the number of stools per week was also significantly higher in the liquid paraffin group during the last 4 weeks of therapy ( P <  0.05).
Compliance rates averaged 95% in the liquid paraffin group and 90% in the lactulose group during the first 4 weeks of therapy and 90% in the liquid paraffin group and 60% in the lactulose group during the last 4 weeks of therapy (χ² = 4.8, SD = 1, P  = 0.02). During the first 4 weeks of therapy and during the last 4 weeks of therapy, mostly side-effects and poor symptom control, respectively, influenced the compliance in the liquid paraffin group.
Conclusions : Liquid paraffin is more effective in the treatment of children with constipation. Patients treated with liquid paraffin responded more rapidly than patients responding to lactulose and showed fewer side-effect. It is considered that late response and side-effects in conjunction with poor symptom control influence the patient compliance and the successful treatment of childhood constipation.     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P＞0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P＞0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P＜0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均＜0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均＞0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Slow transit constipation in children

Patients with chronic constipation that fails to respond to treatment remain a challenge for paediatricians and surgeons. Ongoing work in our institution suggests that a number of children with intractable symptoms have slow transit constipation, which has only been described recently in paediatrics. Common features of slow transit are: delayed passage of the first meconium stool beyond 24 h of age, symptoms of severe constipation within a year, or treatment-resistant 'encopresis' at 2-3 years, soft stools despite infrequent bowel actions, and delay in colonic transit on a transit study. A proportion of children with slow transit constipation have an abnormality of intestinal innervation associated with the dysfunctional colonic motility, recognized as intestinal neuronal dysplasia (IND). Intestinal neuronal dysplasia type B, the most common variant of IND, is defined on rectal biopsy by hyperplasia of the submucosal plexus. On laparoscopic colon muscle biopsy, many specimens show reduced numbers of excitatory substance P-immunoreactive nerve fibres in the circular muscle. Functional markers of the nerves allow new diagnostic criteria to be developed which may also allow a more rational approach to treatment. The aetiology remains obscure and the optimal management poorly defined, although subtotal colectomy, proximal colostomy or appendicostomy (for antegrade enemas) have been tried. Once the anatomy and physiology of the colon in children with slow colonic transit is better understood, we will have defined not only a new form of constipation, but also will be able to consider new therapies.     

Management of chronic constipation in children

Children are commonly affected by constipation. Management of chronic constipation requires a good understanding of the underlying pathophysiology. The presentation and management of constipation varies by age. This review aims to give the reader a clear guide to diagnosis, investigation, pharmacological and non-pharmacological management of chronic constipation in children. The way in which pathology can interrupt normal physiology and features of the clinical history are described. It will outline the age dependent presentation and management of chronic, functional constipation based on the best available evidence and examine the NICE guideline for laxative use in children.     

Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation

BACKGROUND: The purpose of the present paper was to evaluate the efficacy of probiotics (Lactobacillus casei rhamnosus, Lcr35) for treating children with chronic constipation and to compare its effect with magnesium oxide (MgO) and placebo. METHODS: This double-blind placebo-controlled, randomized study enrolled 45 children under 10 years old with chronic constipation. They were randomly assigned to receive Lcr35 (8 x 10(8) c.f.u./day; n = 18), MgO (50 mg/kg/day; n = 18), or placebo (n = 9) orally twice daily for 4 weeks. Lactulose use (1 mL/kg per day) was allowed when no stool passage for 3 days was noted. Glycerin enema was used only when no defecation was noted for >5 days or abdominal pain was suffered due to stool impaction. Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora. Comparisons of the frequency of defecation, consistency of stool and the use of lactulose or enema during the period of treatment were made among the three groups. RESULTS: The patients who received MgO or probiotics had a higher defecation frequency (P = 0.03), higher percentage of treatment success (P = 0.01), less use of glycerin enema (P = 0.04) and less hard stool (P = 0.01) than the placebo group. There was no significant difference between MgO and probiotic groups in the aforementioned comparisons. The first effect of MgO (second week) on constipation was slightly earlier than that of probiotic (second to third week). Abdominal pain occurred less frequently in the probiotic group than in both the MgO and the placebo groups (P = 0.03). There was no statistically significant difference among the three groups in the use of lactulose, episodes of fecal soiling, and change of appetite. No adverse effect was noted in probiotic and placebo groups. Only one patient in the MgO group suffered from mild diarrhea. CONCLUSION: Lcr35 was effective in treating children with chronic constipation. There is no statistically significant difference in efficacy between MgO and Lcr35, but less abdominal pain occurred when using Lcr35. Study with larger case number and longer follow up is needed in the future.     

全国城市中小学生功能性便秘危险因素研究

目的 分析中国城市中小学生功能性便秘(FC)的影响因素.方法 采用多级整群随机抽样方法,对国内6个省及2个直辖市中51 956名中小学生进行流行病学问卷调查.结果 logistic回归分析显示,喜食油炸食物、不进食时有咽部异物感、经常胸骨后疼痛、打嗝、经常采用吞气来帮助终止打嗝、纳差、失眠、疲劳、心情焦虑烦躁9种因素为慢性便秘最具可能性的危险因素,其OR值均大于1.结论 不良饮食习惯如喜食油炸食物、失眠、疲劳及心情焦虑烦躁等躯体精神心理因素,可能是诱发城市中小学生FC致病的相关危险因素.