儿童功能性便秘的临床诊治进展

张妮妮; 王宝西; 江逊

doi:10.11852/zgetbjzz2024-0952

PDF(596 KB)

中国儿童保健杂志 ›› 2025, Vol. 33 ›› Issue (5) : 524-528. DOI: 10.11852/zgetbjzz2024-0952

综述

儿童功能性便秘的临床诊治进展

张妮妮, 王宝西, 江逊

作者信息 +

Advances in clinical diagnosis and treatment of functional constipation in children

ZHANG Nini, WANG Baoxi, JIANG Xun

Author information +

文章历史 +

摘要

功能性便秘(FC)是全世界儿童的常见疾病,严重影响患儿及其照护者的社会、身体和情感功能。目前FC的诊断基于罗马Ⅳ标准进行临床诊断。非药物治疗包括健康教育、生活方式建议和如厕训练。药物治疗包括解除粪便嵌塞、维持治疗及最终尽可能停药。聚乙二醇(PEG)是解除粪便嵌塞和维持治疗的首选泻剂。同时,不同的渗透性泻药、刺激性泻药、润滑剂和灌肠剂可作为替代药物治疗的选择。对于益生菌治疗及目前出现的新药,尚缺乏在儿童FC中广泛应用的证据,需要更多高质量的研究。本综述对目前可用的科学证据及临床经验进行总结,以促进儿科医师对FC患儿进行更好的临床管理。

Abstract

Functional constipation(FC) is a common disorder affecting children worldwide, significantly impacting the social, physical, and emotional functioning of both the affected children and their caregivers. Currently, the diagnosis of FC is clinically based on the Rome Ⅳ criteria. Non-pharmacological treatments include health education, lifestyle advice, and toilet training. Pharmacological interventions include disimpaction, maintenance therapy, and eventual withdrawal of medication if possible. Polyethylene glycol(PEG) is considered the first-choice laxative for disimpaction and maintenance therapy. Additionally, various osmotic laxatives, stimulant laxatives, lubricants, and enemas can serve as alternative therapeutic options. For probiotics and newly emerging drugs, there is a lack of evidence supporting their widespread use in childhood FC, necessitating more high-quality research. This review summarizes the currently available scientific evidence and clinical experience to facilitate better clinical management of FC in children by pediatricians.

导出引用

张妮妮, 王宝西, 江逊. 儿童功能性便秘的临床诊治进展[J]. 中国儿童保健杂志. 2025, 33(5): 524-528 https://doi.org/10.11852/zgetbjzz2024-0952

ZHANG Nini, WANG Baoxi, JIANG Xun. Advances in clinical diagnosis and treatment of functional constipation in children[J]. Chinese Journal of Child Health Care. 2025, 33(5): 524-528 https://doi.org/10.11852/zgetbjzz2024-0952

中图分类号： R179 R725

参考文献

[1] Fedele F, Fioretti MT, Scarpato E, et al. The ten "hard" questions in pediatric functional constipation[J]. Ital J Pediatr, 2024, 50(1):64.
[2] Hyams JS, Di Lorenzo C, Saps M,et al. Functional disorders: Children and adolescents[J]. Gastroenterology, 2016,S0016-5085(16): 00181-5.
[3] TabbersMM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN[J]. J Pediatr Gastroenterol Nutr, 2014, 58(2):258-274.
[4] 张妮妮,江逊.粪菌移植在儿童功能性便秘中的应用[J].中国妇幼健康研究, 2020, 31(8):1017-1020.
Zhang NN, Jiang X. Fecal microbiota transplantation in functional constipation of children[J]. Chin J Woman Child Health Res, 2020, 31(8):1017-1020.(in Chinese)
[5] van Dijk M, Benninga MA, Grootenhuis MA,et al. Prevalence and associated clinical characteristics of behavior problems in constipated children[J]. Pediatrics, 2010, 125(2):e309-e317.
[6] Vriesman MH, Rajindrajith S, Koppen IJN,et al. Quality of life in children with functional constipation: A systematic review and Meta-analysis[J]. J Pediatr, 2019, 214:141-150.
[7] Varni JW, Bendo CB, Nurko S,et al. Pediatric Quality of Life Inventory(PedsQL) gastrointestinal symptoms module testing study consortium. Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases[J]. J Pediatr, 2015,166(1):85-90.
[8] van der Plas RN, Benninga MA, Staalman CR,et al. Megarectum in constipation[J]. Arch Dis Child, 2000,83(1):52-58.
[9] Burgers RE, Mugie SM, Chase J,et al. Management of functional constipation in children with lower urinary tract symptoms: Report from the Standardization Committee of the International Children's Continence Society[J]. J Urol, 2013,190(1):29-36.
[10] Nurko S. Advances in the management of pediatric constipation[J]. Curr Gastroenterol Rep, 2000,2(3):234-240.
[11] van Ginkel R, Reitsma JB, Büller HA,et al. Childhood constipation: Longitudinal follow-up beyond puberty[J]. Gastroenterology, 2003, 125(2):357-363.
[12] Bongers ME, van Wijk MP, Reitsma JB,et al. Long-term prognosis for childhood constipation: Clinical outcomes in adulthood[J]. Pediatrics, 2010,126(1):e156-e162.
[13] McCague Y, Somanadhan S, Stokes D,et al. The psychosocial implication of childhood constipation on the children and family: A scoping review protocol[J]. HRB Open Res, 2024, 6:48.
[14] van Dijk M, de Vries GJ, Last BF,et al. Parental child-rearing attitudes are associated with functional constipation in childhood[J]. Arch Dis Child, 2015, 100(4):329-333.
[15] Vriesman MH, Koppen IJN, Camilleri M,et al. Management of functional constipation in children and adults[J]. Nat Rev Gastroenterol Hepatol, 2020, 17(1):21-39.
[16] Benninga MA, Nurko S, Faure C,等.儿童功能性胃肠病罗马Ⅳ标准[J].中华儿科杂志, 2017,55(1):4-14.
Benninga MA, Nurko S, Faure C, et al. Rome Ⅳ diagnostic criteria of childhood functional gastrointestinal disorders[J]. Chin J Pediatr, 2017,55(1):4-14.(in Chinese)
[17] Bardisa-Ezcurra L, Ullman R, Gordon J, et al. Diagnosis and management of idiopathic childhood constipation: Summary of NICE guidance[J]. BMJ, 2010, 340:c2585.
[18] Wegh CAM, Baaleman DF, Tabbers MM, et al. Nonpharmacologic treatment for children with functional constipation: A systematic review and Meta-analysis[J]. J Pediatr, 2022, 240:136-149.
[19] Dimidi E, Christodoulides S, Scott SM, et al. Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and constipation[J]. Adv Nutr, 2017, 8(3):484-494.
[20] Liu L, Wang A, Shi H,et al. Efficacy and safety of probiotics and synbiotics for functional constipation in children: A systematic review and meta-analysis of randomized clinical trials[J]. Clin Nutr, 2023, 42(10):1817-1826.
[21] Zhang Y, Li A, Qiu J,et al. Probiotics for functional constipation in children: An overview of overlapping systematic reviews[J]. Front Cell Infect Microbiol, 2024, 13:1323521.
[22] Lai H, Li Y, He Y, et al. Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: A double-blinded randomized placebo trial[J]. Gut Microbes, 2023, 15(1):2197837.
[23] Ishibashi R, Matsuhisa R, Nomoto M,et al. Effect of oral administration of polyethylene glycol 400 on gut microbiota composition and diet-induced obesity in mice[J]. Microorganisms, 2023, 11(8):1882.
[24] Borowitz SM, Cox DJ, Kovatchev B,et al. Treatment of childhood constipation by primary care physicians: Efficacy and predictors of outcome[J]. Pediatrics, 2005, 115(4):873-877.
[25] Wang Y, Wang B, Jiang X,et al. Polyethylene glycol 4000 treatment for children with constipation: A randomized comparative multicenter study[J]. Exp Ther Med, 2012, 3(5):853-856.
[26] Gordon M, MacDonald JK, Parker CE,et al. Osmotic and stimulant laxatives for the management of childhood constipation[J]. Cochrane Database Syst Rev, 2016, 2016(8):CD009118.
[27] de Geus A, Koppen IJN, Flint RB,et al. An update of pharmacological management in children with functional constipation[J]. Paediatr Drugs, 2023, 25(3):343-358.
[28] Baaleman DF, Rajindrajith S, Devanarayana NM,et al. Defecation disorders in children: Constipation and fecal incontinence[M]. Textbook of Pediatr Gastroenterol Hepatol Nutr. 2nd ed. Geneva: Springer Nature Switzerland, 2021:279-304.
[29] Wolfson S, Saps M. Recent advances in treating constipation in children[J]. Expert Rev Gastroenterol Hepatol, 2024,18(7):325-338.
[30] Bharucha AE, Linden DR. Linaclotide-a secretagogue and antihyperalgesic agent-what next?[J] Neurogastroenterol Motil, 2010, 22(3):227-231.
[31] Rao SS, Manabe N, Karasawa Y,et al. Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: A systematic literature review with meta-analysis and number needed to treat/harm[J]. BMC Gastroenterol, 2024, 24(1):12.
[32] Baaleman DF, Gupta S, Benninga MA,et al. The use of linaclotide in children with functional constipation or irritable bowel syndrome: A retrospective chart review[J]. Paediatr Drugs, 2021, 23(3):307-314.
[33] Di Lorenzo C, Khlevner J, Rodriguez-Araujo G,et al. Efficacy and safety of linaclotide in treating functional constipation in paediatric patients: A randomised, double-blind, placebo-controlled, multicentre, phase 3 trial[J]. Lancet Gastroenterol Hepatol, 2024, 9(3):238-250.
[34] Pijpers MA, Bongers ME, Benninga MA,et al. Functional constipation in children: A systematic review on prognosis and predictive factors[J]. J Pediatr Gastroenterol Nutr, 2010, 50(3):256-268.
[35] Michaud L, Lamblin MD, Mairesse S, et al. Outcome of functional constipation in childhood: A 10-year follow-up study[J]. Clin Pediatr(Phila), 2009, 48(1):26-31.
[36] 程伟伟,陈科,周丽,等.儿童功能性便秘症状复现率调查及其风险因素分析[J].中国实用儿科杂志, 2023, 38(2):114-118.
Cheng WW, Chen K, Zhou L, et al. Survey of the for recurrence of functional constipation in pediatric patients and analysis of the risk factors[J]. Chin J Pract Pediatr, 2023, 38(2):114-118.(in Chinese)
[37] 鲍文婷,李在玲,张华,等. 2～7岁儿童功能性便秘影响因素分析[J].中华实用儿科临床杂志, 2020, 35(12):917-921.
Bao WT, Li ZL, Zhang H, et al. Analysis of influential factors of functional constipation in children aged 2-7 years[J]. Chin J Appl Clin Pediatr, 2020, 35(12):917-921.(in Chinese)
[38] Santucci NR, Rein LE, van Tilburg MA,et al. Self-efficacy in children with functional constipation is associated with treatment success[J]. J Pediatr, 2020, 216:19-24.
[39] Taddeo D, Egedy M, Frappier JY. Adherence to treatment in adolescents[J]. Paediatr Child Health, 2008, 13(1):19-24.