Colonic transit times and behaviour profiles in children with defecation disorders

Aims: To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL). Methods: A total of 215 patients were divided into three groups: 135 (5–14 years of age) with paediatric constipation (PC), 56 (5–17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5–16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG). Results: No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles. Conclusion: There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.     

Is encopresis always the result of constipation?

Encopresis is often the result of chronic constipation in the majority of paediatric patients. In clinical practice, however, encopresis is also seen without constipation and it is unknown whether these two clinical variants are based on similar or different pathophysiological mechanisms, requiring different therapeutic approaches. We analysed clinical symptoms, colonic transit time (CTT), orocaecal transit time (OCTT), anorectal manometric profiles, and behavioural scores. Patients were divided into two groups, one consisted of 111 children with paediatric constipation, and another group of 50 children with encopresis and/or soiling without constipation. Significant clinical differences in children with encopresis/soiling existed compared with children with paediatric constipation regarding: bowel movements per week, the number of daytime soiling episodes, the presence of night time soiling, the presence and number of encopresis episodes, normal stools, pain during defecation, abdominal pain, and good appetite. Total and segmental CTT were significantly prolonged in paediatric constipation compared with encopresis/soiling, 62.4 (3.6-384) and 40.2 (10.8-104.4) hours, respectively. No significant differences were found in OCTT. Among the two groups, all manometric parameters were comparable, except for a significantly higher threshold of sensation in children with paediatric constipation. The defecation dynamics were abnormal in 59% and 46% in paediatric constipation and encopresis/soiling, respectively, and were significantly different from controls. Using the child behaviour checklist no significant differences were found when comparing children with paediatric constipation and encopresis/soiling, while both patient groups differed significantly from controls. In conclusion, our findings support the concept of the existence of encopresis as a distinct entity in children with defecation disorders. Identification of such children is based on clinical symptoms, that is, normal defecation frequency, absence of abdominal or rectal palpable mass, in combination with normal marker studies and normal anal manometric threshold of sensation, Thus, encopresis is not always the result of constipation and can be the only clinical presentation of a defecation disorder.     

Randomised controlled trial of biofeedback training in persistent encopresis with anismus

BACKGROUND: Paradoxical external anal sphincter contraction during attempted defecation (anismus) is thought to be an important contributor to chronic faecal retention and encopresis in children. Biofeedback training can be used to teach children to abolish this abnormal contraction. METHODS: A randomised controlled trial in medical treatment resistant and/or treatment dependent children with anismus using surface electromyographic (EMG) biofeedback training to determine whether such training produces sustained faecal continence. Up to four sessions of biofeedback training were conducted at weekly intervals for each patient. Anorectal manometry was performed before randomisation and six months later. Parents of patients completed the "child behaviour checklist" (CBCL) before randomisation and at follow up. RESULTS: Sixty eight children underwent anorectal manometry and EMG. Of these, 29 had anismus (ages 4-14 years) and were randomised to either EMG biofeedback training and conventional medical treatment (BFT) (n = 14) or to conventional medical treatment alone (n = 15). All but one child were able to learn relaxation of the external anal sphincter on attempted defecation. At six months' follow up, laxative free remission had been sustained in two of 14 patients in the BFT group and in two of 15 controls (95% confidence interval (CI) on difference, -24% to 26%). Remission or improvement occurred in four of 14 patients in the BFT group and six of 15 controls (95% CI on difference, -46% to 23%). Of subjects available for repeat anorectal manometry and EMG at six months, six of 13 in the BFT group still demonstrated anismus v 11 of 13 controls (95% CI on difference, -75% to -1%). Of the four patients in full remission at six months, only one (in the BFT group) did not exhibit anismus. Rectal hyposensitivity was not associated with remission or improvement in either of the groups. Mean CBCL total behaviour problem scores were not significantly different between the BFT and control groups, but there was a significant improvement in CBCL school scale scores in the BFT group, and this improvement was significantly greater than that seen in the control group. CONCLUSIONS: The result of this study, together with those reported in other controlled trials, argues against using biofeedback training in children with encopresis.     

核素排便造影在小儿便秘诊断中的应用价值

目的　研究核素排便造影方法在小儿便秘诊断和疾病程度判定方面的应用价值。方法　对 2 5例特发性便秘患儿和 11例正常儿进行核素排便造影检查。根据直肠肛管排空曲线可计算出残留率、排空率和半排时间等反映排便能力的客观指标 ,根据采集的直肠肛管图像可获得反映耻骨直肠肌功能的静息、收缩和排便状态下的直肠肛管角。所有患儿同时进行结肠传输实验和X线排便造影检查。结果　便秘患儿直肠肛管排空曲线平直或下降缓慢 ,而正常儿的排空曲线为快速弧形下降曲线。便秘患儿排便能力明显下降 ,正常儿半排空时间、排空率和残留率分别是 1 97± 0 86min、78 30 %± 12 0 3%和 2 0 5 0 %± 7 6 7% ,而便秘患儿这三项分别为 15 16± 3 6 7min、4 4 84 %± 14 0 0 %和 5 3 5 2 %± 15 0 2 % ,两组差异有显著意义 (P <0 0 5 )。根据结肠传输实验结果有 6例患儿为慢传输型便秘 ,17例为出口梗阻型便秘 ,出口梗阻型便秘患儿的排便能力明显低于慢传输型便秘。结论　核素排便造影可以对便秘进行准确诊断和疾病程度判定 ,同时也能对耻骨直肠肌功能进行准确评价 ,而且具有操作简单、安全、受放射线照射量很低等优点 ,是评价直肠肛管排便功能的重要客观检测方法。     

New insight into rectal function in pediatric defecation disorders: disturbed rectal compliance is an essential mechanism in pediatric constipation

OBJECTIVE: To evaluate rectal sensitivity in patients with pediatric constipation (PC) and nonretentive fecal soiling (FNRFS) using pressure-controlled distention (barostat). STUDY DESIGN: Thresholds for rectal sensitivity (first sensation, urge to defecate, and pain), and rectal compliance were determined using a barostat. RESULTS: A total of 69 patients with PC (50 males; mean age, 10.9 +/- 2.2 years) and 19 patients with FNRFS (15 males; mean age, 10.0 +/- 1.9 years) were compared with 22 healthy volunteers (HVs) (11 males; mean age, 12.7 +/- 2.6 years). Sensitivity thresholds were not significantly different among the 3 groups. Rectal compliance was increased in 58% of the patients with PC (P < .0001 vs HVs). Rectal compliance did not differ between patients with FNRFS and HVs. Children with PC with abnormal rectal function required significantly larger rectal volumes at urge to defecate. CONCLUSIONS: Increased compliance is the most prominent feature in patients with PC. Because of higher compliance in these children, larger stool volumes are required to reach the intrarectal pressure of the urge to defecate. Children with FNRFS have normal rectal function.     

Defaecation disorders in children,colonic transit time versus the Barr-score

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5–14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter-and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns.Conclusion Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation. Marker studies should be performed in the second stage of evaluation after failure of initial therapy.     

经Ⅰ期造瘘口单部位腹腔镜辅助Martin-Duhamel术在全结肠型巨结肠症治疗中的应用

目的探讨经Ⅰ期造瘘口单部位腹腔镜辅助Martin-Duhamel术在先天性全结肠型巨结肠症患儿治疗中的应用价值,并对患儿术后排便功能进行评价。方法回顾性分析2014年6月至2017年6月间河北医科大学第二医院小儿外科收治的15例先天性全结肠型巨结肠症患儿的诊治及术后随访资料,其中男11例,女4例,月龄(5.11±2.67)个月,所有患儿Ⅰ期行回肠末端造瘘术,Ⅱ期行腹腔镜辅助Martin-Duhamel手术。术后随访2年,采用李正肛门功能临床评分法进行排便功能评分。定期肛管直肠测压,记录和比较患儿排便频率、性状及近远期并发症情况。结果15例均顺利完成手术,无中转开腹和死亡病例。手术时间(184.43±30.46)min,出血量(27.57±10.63)mL,肠功能恢复时间(3.29±0.91)d,术后住院时间(7.86±1.77)d。术后1~3个月排便频率为8~20次/日,术后6~9个月排便频率为4~8次/日,术后1~2年排便频率为2~4次/日(接近正常水平)。术后3个月和术后6个月排便评分无显著性差异(P=0.115),术后6个月和术后1年排便评分有显著性差异(P=0.040),术后1年和术后2年排便评分无显著性差异(P=0.542)。肛管直肠测压从术后6个月开始逐渐恢复至正常范围,与术前比较有显著性差异(肛管反射舒张压P=0.027;肛管静息压P=0.010;直肠静息压P=0.034)。术后6个月内因排便次数多致肛周湿疹、皮肤破溃6例,予以造口粉、氧化锌或芦荟软膏涂抹后恢复;小肠结肠炎1例,经保守治疗后缓解;无便秘等其他并发症发生。结论经Ⅰ期造瘘口单部位腹腔镜辅助Martin-Duhamel术治疗全结肠型巨结肠症患儿安全可行;排便功能可在术后6个月至1年逐渐恢复至接近正常儿童的水平。     

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.     

Personality profiles and pulmonary function of children with sighing dyspnoea

AIM: This study compared the personality profiles of children with sighing dyspnoea with healthy children and tested the hypothesis of heightened anxiety scores in sighing dyspnoeic subjects using the Childhood Behavior Check List for Ages 4 to 18 (CBCL/4-18). The pulmonary function tests of these two groups of children were also compared. METHODS: This prospective study enrolled paediatric patients with sighing dyspnoea presented to a paediatric pulmonary clinic but free from apparent cardiopulmonary diseases, and age-matched healthy children were recruited for comparison. The psychological profiles of the patients were collected by the CBCL/4-18, which was completed by the parents. Spirometry was performed on sighing children as well as volunteer healthy children, before and after bronchodilator. RESULTS: Twenty patients complained of sighing dyspnoea and 31 healthy children were included in the study. Both groups of children scored consistently within the normal ranges of all subscales including anxiety, somatic complaints or internalising behaviour on CBCL/4-18. The t-scores were not significant different between children with sighing dyspnoea and age-matched controls. Baseline forced vital capacity in the sighing patients appeared to be lower than the healthy children, but was not statistically significant. CONCLUSIONS: The CBCL/4-18 scores of children with sighing dyspnoea were not significant different from age-matched healthy children and a heightened anxiety score was not confirmed in this study. Office spirometric values in patients with sighing dyspnoea were normal.     

无肛畸形术后患儿心理障碍的临床分析

目的 对无肛畸形患儿术后远期心理障碍的产生进行临床分析。方法 46例无肛术后6年～8年的患儿与46名正常儿童进行对照，运用Achenbach小儿行为调查表，依据排便功能临床评分标准，分别比较其心理障碍的发生率。结果 排便功能差的病例心理障碍发生率高于排便功能优、良者及对照组。观察组心理障碍发生率明显高于对照组。结论 无肛术后患儿心理障碍发生率与排便功能有关。排便功能的改善是心理障碍发生的预防关键。     

Parent and teacher perceptions of child behaviour following cardiac surgery

To determine if parents whose children had undergone successful cardiac surgery perceived their children any differently from parents of children who had not undergone surgery, we used the Achenbach Child Behaviour Checklist (CBCL) to compare parent and teacher perceptions in these two groups. Subjects included 168 children who had undergone cardiac surgery 4 to 8 years previously and 51 controls. On the behaviour scale of the CBCL, the teachers' mean t scores showed no significant difference bctween the cardiac and control groups, in contrast to the parents' scores where parents perceived a higher degree of behavioural problems in children who had undergone cardiac surgery. On the Social competence scale of the CBCL, the parents scored their children who had undergone cardiac surgery as less Socially competent than did the parents of the controls. Teachers' scores showed no difference between groups.     

Preschool children with high adherence to inhaled corticosteroids for asthma do not show behavioural problems

Aim: To assess prevalence of behavioural problems in preschool children with asthma with electronically verified exposure to inhaled corticosteroids (ICS). Methods: Cross‐sectional study of 81 children 2–5 years of age using daily ICS for persistent asthma. During 3 months’ follow‐up, adherence to ICS treatment was recorded by an electronical logging device (Smartinhaler^®). Parents completed the Child Behavior Checklist 1.5–5 years (CBCL 1.5–5) to assess behavioural problems; results were compared to a published reference group of healthy children. Results: The median (interquartile range) adherence to ICS was 92 (78–97) %. There was no difference in total CBCL score between children with asthma on ICS (mean, [SD] 32.10 [1.99]) and the reference group (33.30 [1.87], 95% CI for difference ?6.62 to 4.22). Children with asthma were more likely to have somatic complaints (95% CI for difference 0.64 to 1.96) and less likely to have anxious/depressive symptoms (95% CI for difference ?1.57 to ?0.25) than the reference group. CBCL scores were not significantly related to the electronically measured adherence rates. Conclusions: Maintenance treatment with ICS, taken daily as prescribed, is not associated with an increased risk of behavioural problems in preschool children.     

The prevalence of mental health problems in children 1(1/2) years of age - the Copenhagen Child Cohort 2000

BACKGROUND: The Copenhagen Child Cohort, CCC 2000, was established to investigate developmental psychopathology prospectively from birth in a general population. METHODS: A random sample of 211 children from the CCC 2000 was investigated when the children were 1(1/2) years of age. The prevalence and associates of mental health problems and psychopathology were studied by clinical and standardised strategies, including videotape recordings, parent interviews and the following instruments: The Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), The Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development II (BSID II), The Parent Child Early Relationship Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS). RESULTS: Mental health problems according to International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC 0-3) diagnoses were found in 16-18% of 1(1/2)-year-old children. Most common were disturbances of emotion, behaviour and eating and the DC 0-3 diagnosis of regulatory disorder. Parent-child relationship disturbances were found in 8%. High psychosocial risk was significantly associated with emotional and behavioural disorders (OR 3.1 95% (1.2-8.1)) and disturbed parent-child relationship (OR 5.0 95% (1.6-16.0)). The strongest association of risk was found between relationship disorders and emotional and behavioural disorders (OR 11.6 95% (3.8-37.5)). CONCLUSIONS: The prevalence and distribution of psychopathology in 1(1/2)-year-old children seem to correspond to the distributions among older children. Disturbances in parent-child relationship have a key position in the risk mechanisms in early child psychopathology.     

Inhaled corticosteroids do not affect behaviour

AIM: To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders. METHODS: Questionnaires were given to three groups of children: a group of asthmatic children with inhaled corticosteroids (ICS), a group of children attending the ear, nose and throat (ENT) outpatient clinic and the healthy controls. Included were questions about health, medication use, demographical data and about behaviour, including the child behaviour check list (CBCL) and questions about attention deficit hyperactivity disorder (ADHD). RESULTS: Forty asthmatic children on ICS, 50 children visiting the ENT outpatient clinic and 183 healthy controls were studied. The total CBCL and mean ADHD scores of the children on ICS were 28.1 and 9.1, which were both significantly higher than the scores of the healthy controls (20.4 and 7.1), but not when compared with the ENT outpatient group (26.2 and 8.6). Further analysis revealed statistically significant differences between the ICS group and healthy controls in CBCL-axes. There were, however, no differences between the ENT group and the ICS on one side and the healthy controls on the other. CONCLUSION: There is a difference in behaviour between healthy children and asthmatic children on ICS, but not when compared with children visiting the ENT department. Although hyperactivity, aggressiveness and anxiety might occur in children on ICS, this is probably caused by individual susceptibility. Being under specialist care can possibly explain behavioural differences between children on ICS and healthy controls.     

Randomised controlled trial of biofeedback training in persistent encopresis with anismus

BACKGROUND—Paradoxical external anal sphincter contraction during attempted defecation (anismus) is thought to be an important contributor to chronic faecal retention and encopresis in children. Biofeedback training can be used to teach children to abolish this abnormal contraction.
METHODS—A randomised controlled trial in medical treatment resistant and/or treatment dependent children with anismus using surface electromyographic (EMG) biofeedback training to determine whether such training produces sustained faecal continence. Up to four sessions of biofeedback training were conducted at weekly intervals for each patient. Anorectal manometry was performed before randomisation and six months later. Parents of patients completed the "child behaviour checklist" (CBCL) before randomisation and at follow up.
RESULTS—Sixty eight children underwent anorectal manometry and EMG. Of these, 29 had anismus (ages 4-14 years) and were randomised to either EMG biofeedback training and conventional medical treatment (BFT) (n = 14) or to conventional medical treatment alone (n = 15). All but one child were able to learn relaxation of the external anal sphincter on attempted defecation. At six months'' follow up, laxative free remission had been sustained in two of 14 patients in the BFT group and in two of 15 controls (95% confidence interval (CI) on difference, −24% to 26%). Remission or improvement occurred in four of 14 patients in the BFT group and six of 15 controls (95% CI on difference, −46% to 23%). Of subjects available for repeat anorectal manometry and EMG at six months, six of 13 in the BFT group still demonstrated anismus v 11 of 13 controls (95% CI on difference, −75% to −1%). Of the four patients in full remission at six months, only one (in the BFT group) did not exhibit anismus. Rectal hyposensitivity was not associated with remission or improvement in either of the groups. Mean CBCL total behaviour problem scores were not significantly different between the BFT and control groups, but there was a significant improvement in CBCL school scale scores in the BFT group, and this improvement was significantly greater than that seen in the control group.
CONCLUSIONS—The result of this study, together with those reported in other controlled trials, argues against using biofeedback training in children with encopresis.

     

Child behaviour after anaesthesia: association of socioeconomic factors and child behaviour checklist to the Post-Hospital Behaviour Questionnaire

AIM: In the process of validation of the Swedish translation of the Post-Hospital Behaviour Questionnaire (PHBQ) to assess its relation to the Child Behaviour Checklist (CBCL) and to describe its relation to sociodemographic factors. METHOD: Three hundred and forty children 2-13 years studied in connection with elective procedures which included anaesthesia. Parents completed the CBCL forms before and after hospitalization as well as the PHBQ 2 weeks after hospitalization. RESULTS: In multivariate analysis of PHBQ total score independent risk factors were: age <5 (OR 2.4; CI 1.4-4.0), living in a one parent family (OR 4.4; CI: 1.6-12.6) and not living in a rural area (OR 1.6; CI: 1.0-2.6). The correlation between the total scores for PHBQ and CBCL for children aged 2-4 was moderate: (r = 0.38; p < 0.005). For children aged 4-7 there were significant correlations between PHBQ sleep anxiety and CBCL Other problems (r = 0.4; p < 0.01), PHBQ eating disturbances and CBCL total score (r = 0.3; p < 0.01), though none of these significant correlations were observed for children above 7 years of age. CONCLUSION: There is an association between PHBQ and CBCL which is weaker for older children. The reason for this might be that PHBQ is more sensitive in the younger age group and to minor changes in behaviour. Children younger than 5 years of age or living in a one parent family or not living in rural areas appear to have higher incidence of problematic behaviour in a 2 week follow up after anaesthesia.     

The behavior profile of children and adolescents with short stature

The relation between behavior profiles and short stature was assessed in 311 children and adolescents with various diagnoses. The mean Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) profile of the entire group of children with growth deficiency significantly exceeded population norms on all scales and scores. However, there were no significant differences between five major diagnostic groups across CBCL scales. Neither age, gender, socioeconomic status, nor severity of short stature had any effect on the various CBCL and YSR scores. Correlations between parent (CBCL) and child (YSR) scores were significant, though only at a low to medium level. It was concluded that probably short stature per se, rather than a specific diagnosis, has an impact on behavioral adaptation.     

Randomised trial of biofeedback training for encopresis

AIMS: To evaluate biofeedback training in children with encopresis and the effect on psychosocial function. DESIGN: Prospective controlled randomised study. PATIENT INTERVENTIONS: A multimodal treatment of six weeks. Children were randomised into two groups. Each group received dietary and toilet advice, enemas, oral laxatives, and anorectal manometry. One group also received five biofeedback training sessions. MAIN OUTCOME MEASURES: Successful treatment was defined as less than two episodes of encopresis, regular bowel movements, and no laxatives. Psychosocial function after treatment was assessed using the Child Behaviour Checklist. RESULTS: Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone (39% v 19%) at the end of the intervention period. At 12 and 18 months, however, approximately 50% of children in each group were successfully treated. Abnormal behaviour scores were initially observed in 35% of children. Most children had improved behaviour scores six months after treatment. Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles. CONCLUSIONS: Biofeedback training had no additional effect on the success rate or behaviour scores. Psychosocial problems are present in a subgroup of children with encopresis. The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis.     

Randomised trial of biofeedback training for encopresis.

AIMS: To evaluate biofeedback training in children with encopresis and the effect on psychosocial function. DESIGN: Prospective controlled randomised study. PATIENT INTERVENTIONS: A multimodal treatment of six weeks. Children were randomised into two groups. Each group received dietary and toilet advice, enemas, oral laxatives, and anorectal manometry. One group also received five biofeedback training sessions. MAIN OUTCOME MEASURES: Successful treatment was defined as less than two episodes of encopresis, regular bowel movements, and no laxatives. Psychosocial function after treatment was assessed using the Child Behaviour Checklist. RESULTS: Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone (39% v 19%) at the end of the intervention period. At 12 and 18 months, however, approximately 50% of children in each group were successfully treated. Abnormal behaviour scores were initially observed in 35% of children. Most children had improved behaviour scores six months after treatment. Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles. CONCLUSIONS: Biofeedback training had no additional effect on the success rate or behaviour scores. Psychosocial problems are present in a subgroup of children with encopresis. The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis.     

功能性便秘儿童的肛门直肠动力学特征和治疗的研究

目的研究功能性便秘患儿的直肠肛门动力学改变,观察便秘患儿对根据检测结果制定的相应方案的治疗反应。方法2004年5月至2005年6月采用多功能消化道测压仪观察便秘组即功能性便秘患儿[8例,年龄(11±5)岁]及对照组即排便习惯正常儿童[10例,年龄(11±4)岁]的肛门直肠动力学指标,并进行比较;对便秘组采用相应保守治疗方案,即结合肛门直肠动力学特征、口服双歧三联活菌制剂和益生元类制剂乳果糖(商品名杜秘克)、定时敦促排便,观察其疗效。结果便秘组和对照组的肛门括约肌有效长度、最大肛门括约肌主动收缩压(MSP)、>50%MSP时间比较差异无统计学意义,而便秘组的最低敏感量和最大耐受量大于对照组(t分别为2.178、1.574,P均<0.05);8例便秘患儿保守治疗,7例有效。结论功能性便秘患儿存在肛门直肠动力学异常;以动力学改变为依据的相应保守治疗方案有显著的临床疗效。