The effect of lactulose in the treatment of chronic functional constipation in children

The reslult suggest that frequency and consistency of defecation, as well as clinical symptoms were improved significantly when using lactulose with 2 ml/ kg/day. The mean weekly stool frequency improved from 1.9 ± 0.8 times to 4.9 ± 1.8 times after 1 month and to 5.9 ± 1.4 times after 3 months of treatment (p < 0.01).
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The effect of lactulose in the treatment of chronic functional constipation in childrenJOURNAL OF MEDICAL RESEARCHTHE EFFECT OF LACTULOSE IN THE TREATMENT OFCHRONIC FUNCTIONAL CONSTIPATION IN CHILDRENDo Thi Minh Phuong, Nguyen Thi Viet HaDepartment of Pediatrics, Hanoi Medical UniversityConstipation is a common gastrointestinal problem in children. The aim of the present study was toevaluate the beneficial effects of lactulose in the management of functional constipation in children. Anopen clinical trial was conducted in 140 children aged 1 – 5 years at the National Children Hospital, Hanoi,Vietnam with a diagnosis of functional constipation. The reslult suggest that frequency and consistencyof defecation, as well as clinical symptoms were improved significantly when using lactulose with 2 ml/kg/day. The mean weekly stool frequency improved from 1.9 ± 0.8 times to 4.9 ± 1.8 times after 1 monthand to 5.9 ± 1.4 times after 3 months of treatment (p < 0.01). The rate of effective treatment (the weeklystool frequency ≥ 3 times and fecal incontinence ≤ 1 time every two weeks) was 68% after 1 month andincreased to 72.8% after 2 and 3 months of treatment. In addition to using laxatives, fiber and fluid intakeper day > 80% standard recommendation improve the effect in the treatment. In conclusion, lactuloseis a safe, effective and well-tolerated long-term treatment for constipation. Regular supplement of fiberand fluid in children with constipation is important to improve the effect in the treatment of constipation.Keywords: chronic functional constipation, lactulose, children, Rome IIII. INTRODUCTIONConstipation is one of the mast commonconstipation digestive complaints in children, and has recently grown into a disproportionate public health problem. A recentsystematic review of pediatric patents ofthe sample reported constipation in 0.7% to29.6% of the sample [1]. Functional constipation was recognized as a separate clinicalentity by combining features of functionalCorresponding author: Do Thi Minh Phuong, Department of Pediatrics, Hanoi Medical UniversityEmail: dominhphuong@hmu.edu.vnReceived: 13 August 2017Accepted: 16 November 2017JMR 111 E2 (2) - 2018fecal retention and functional constipation.The North American Society for PediatricGastroenterology, Hepatology and Nutritiondefine constipation as a delay or difficulty indefecation, present for 2 or more week [2].The occurrence of chronic functional constipation in children can lead to significant abdominal pain, anal fissure, loss of appetite,faecal incontinence and social isolation.The aim of constipation management isto produce soft, painless stools and to prevent the re-accumulation of feces, whichcan be achieved through dietary modification, behavioral interventions, fecal disimpaction and the use of laxatives, or a combination thereof [6]. Lactulose is considered61JOURNAL OF MEDICAL RESEARCHto be safe and recommended for all ages inthe management of constipation by NASPGHAN and ESPGHAN [3]. Many studieshave demonstrated that lactulose improvedfrequency and consistency of defecationand clinical symptoms [4; 5; 7; 8]. To ourknowledge, however, no large studies evaluat the effect of lactulose in childhood constipation have been published in Vietnam.The primary objective of the present studywas to evaluate the beneficial effects of lactulose in the treatment of chronic functionalconstipation in children.II. MATERIALS AND METHODS1. Subjects140 children aged 1 - 5 years recruitedfrom the sample consisted of the NationalChildren Hospital, Hanoi, Vietnam with a diagnosis of functional constipationStudy designThe treatment trial was performed in Hanoi, Vietnam from 1/10/2013 to 31/11/2014.The Rome III guideline was used to diagnose patients with chronic functional constipation [9]. According to the guideline, inthe absence of organic pathology, patientsmust meet two or more of the following criteria: 1) Two or fewer defecations in the toilet per week. 2) At least one episode of fecalincontinence per week after the acquisitionof toileting skills. 3) History of retentive posturing or excessive volitional stool retention.4) History of painful or hard bowel movements. 5) Presence of a large fecal mass inthe rectum. 6) The history of large diameterstools which may obstruct the toilet. Infantsup to 4 years have to fulfill ≥ 2 of the crite-62ria for at least 1 month, whereas those > 4years need to fulfill ≥ 2 of the criteria for atleast 2 months and have insufficient criteriafor irritable bowel syndrome. A total of 140children from ages 1 - 5 years old presenting with constipation based on a modification of the Rome III criteria were eligible forthe trial.Evaluation of treatment outcomeAll patients were examined, advised tochange dietary, adherence to daily toilettraining, used lactulose with 2 ml/kg/day. Ifpatients have diarrhea, the ...