P318 The effectiveness of a constipation pamphlet in improving outcomes among pediatric patients with functional constipation: a single-blinded randomized controlled trial

Background and relevance

Constipation is distressful to the patient, parents and pediatrician. The ESPGHAN/NASPGHAN have recommended therapy for functional constipation, however, studies have shown that constipation is still prevalent among children and accounts for at least 3% of visits to the general pediatric clinic and as much as 30% of visits to the pediatric gastroenterologist. The use of a ‘Constipation Pamphlet’ may be effective in alleviating symptoms and recurrence of constipation.

Objective

To determine the effectiveness of ‘Constipation Pamphlet’ in improving outcomes among children with functional constipation.

Methods

Patients include 2 to 18 years old, fulfilling the ROME IV Criteria for functional constipation, or with Blethyn grade 2 or 3 on abdominal radiograph, seen at the University of Santo Tomas Hospital. The Control Group was given the recommendations of ESPGHAN/NASPGHAN in the management of functional constipation; the Experimental Group was given a ‘Constipation Pamphlet’, which in addition to the above recommendations, the following were recorded daily in a stool calendar: consumption of fruits, vegetables, and water; bowel movement, stool consistency; and laxative intake. Both groups were followed-up every 2 weeks, and outcomes were assessed after 8 weeks.

Results

There were a total of 90 patients. All patients had less than 3 bowel movements per week (100%), painful bowel movement, and hard stools (93.33%). Abdominal radiograph revealed fecal stasis (73.33%). More consumption of fruits, vegetables and water was noted in the Experimental Group (P<0.001, P<0.001, and P=0.007); Regular daily bowel movement and normal stool consistency of Bristol type 4–5 was observed in the Experimental Group (P=0.009, P<0.001)); Acceptable toilet habits were established by the 4^th week (P=0.002) and maintained in the Experimental Group. (P=0.015). A greater proportion of patients in the Experimental Group ceased lactulose intake by the 4^th week (P=0.045) in contrast to the Control Group which continued until the 8^th week of the study period. The Experimental Group were already symptom-free by the 2^nd week, and sustained up to the end of the 8^th week (P<0.001).

Conclusion

The use of a ‘Constipation Pamphlet’ is effective in alleviating symptoms and preventing recurrences of constipation among pediatric patients.