Elsevier

The Journal of Pediatrics

Volume 139, Issue 3, September 2001, Pages 428-432
The Journal of Pediatrics

Original Articles
Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children,☆☆

https://doi.org/10.1067/mpd.2001.117002Get rights and content

Abstract

Objective: To determine efficacy, safety, and optimal dose of a laxative, polyethylene glycol (PEG) 3350, in children with chronic constipation. Study design: Children with chronic constipation (n = 24) were treated with PEG for 8 weeks at an initial dose of 1 g/kg/d. The dose was adjusted every 3 days as required to achieve 2 soft stools per day. A diary was kept to monitor dose, stool frequency and consistency, soiling, and other symptoms. Stool consistency was rated from 1 (hard) to 5 (watery). Subjects were examined for fecal retention. The Student t test and the Fisher exact test were used for data analysis. Results: All 20 children who completed the study found PEG to be palatable and were satisfied with the treatment. There were no significant adverse effects. Weekly stool frequency increased from 2.3 ± 0.4 to 16.9 ± 1.6 (P < .0001) during treatment and stool consistency from 1.2 ± 0.1 to 3.3 ± 0.1 (P < .0001). In 9 children with soiling, weekly soiling events declined from 10.0 ± 2.4 to 1.3 ± 0.7 (P = .003). The mean effective dose was 0.84 g/kg/d (range, 0.27-1.42 g/kg/d). Conclusion: Daily administration of PEG at a mean dose of 0.8 g/kg is an effective, safe, and palatable treatment for constipation. (J Pediatr 2001;139:428-32)

Section snippets

Study population

This study was approved by the institutional review board of the University of Iowa College of Medicine. Constipated children (n = 24) between the ages of 18 months and 12 years from the clinics at the University of Iowa Hospitals were enrolled. The diagnosis of chronic constipation was based on symptoms of at least 3 months' duration including at least 2 of the following: hard stools, painful defecation, withholding of stools, fecal soiling, palpable fecal mass, and fewer than 3 bowel

Effect of PEG on stool frequency, stool consistency, and soiling frequency

All 20 patients reported rapid improvement of bowel habits during PEG treatment; 12 patients noted improvement of stool frequency and consistency within 1 week, and the remaining 8 patients reported significant improvement during the second week. Fig 1 shows comparison of the stool frequency in 16 patients (excluding 4 patients with exclusive soiling) at enrollment with the stool frequency during the last 2 weeks of PEG therapy.

. Improvement in number of stools per week during last 2 weeks of PEG

Discussion

The exact mechanism of constipation in children may vary among patients. Most cases are classified as “functional fecal retention” as described by the Rome II criteria.11 In such cases, pain caused by large, hard stools leads to fear of defecation and to voluntary stool withholding behavior.1 This results in prolonged fecal stasis in the colon and fecal impaction and may ultimately lead to overflow incontinence. Guidelines of the North American Society for Pediatric Gastroenterology and

Acknowledgements

We thank Dawyn Sawyer, PA, and Judith Heckman, PA, for their assistance in the study.

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Supported by Braintree Laboratories, Braintree, Massachusetts.

☆☆

Reprint requests: Warren P. Bishop, MD, Associate Professor of Pediatrics, Division of Gastroenterology, 2869 JPP, Children's Hospital of Iowa, 200 Hawkins Dr, Iowa City, IA 52242-1083.

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