Objective

To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation.

Study design

Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation.

Results

We included 52 RCTs with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow’s milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow’s milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao’er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture.

Conclusions

More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.

中文翻译：

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功能性便秘儿童的非药物治疗：系统评价和荟萃分析

客观的

评估非药物干预治疗儿童功能性便秘的有效性和安全性。

学习规划

评估功能性便秘儿童的非药物治疗的随机对照试验 (RCT) 报告了功能性便秘儿童核心结果集的至少 1 个结果。

结果

我们纳入了 52 项 RCT，涉及 4668 名儿童，年龄在 2 周至 18 岁之间，其中 47% 为女性。研究的干预措施包括肠道微生物组指导干预、其他饮食干预、口服补充剂、盆底干预、电刺激、干拔罐和按摩疗法。在大多数研究中发现总体偏倚风险很高。治疗成功和/或排便频率的荟萃分析，包括 20 项随机对照试验，显示腹部电刺激（n = 3）、决明子瘘乳液（n = 2）和牛奶排除饮食（n = 2 在便秘可能是牛奶过敏表现的亚群中）可能有效。未纳入荟萃分析的随机对照试验的证据表明，一些益生元和纤维混合物、中草药（消儿便通颗粒）和腹部按摩是有前景的疗法。相比之下，研究表明使用益生菌、合生元、增加饮水量、干拔罐或额外的生物反馈或行为疗法没有益处。我们没有发现关于身体运动或针灸的随机对照试验。

结论

在指示改变当前指南之前，需要设计更多关于功能性便秘儿童非药物治疗的高质量 RCT。