J Korean Med Sci.  2019 Jul;34(26):e183. 10.3346/jkms.2019.34.e183.

Nationwide Survey for Application of ROME IV Criteria and Clinical Practice for Functional Constipation in Children

Affiliations
  • 1Department of Pediatrics, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 2Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 3Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National Institute of Health Science, Gyeonsang National University School of Medicine, Jinju, Korea.
  • 4Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 6Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. shimjo@korea.ac.kr

Abstract

BACKGROUND
This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians.
METHODS
A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea).
RESULTS
A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P < 0.001). Treatment duration was longer among PGs for > 6 months (63.8%) than < 3 months among general pediatricians (59.2%, P < 0.001). Fecal disimpaction and rectal enema were practiced among 78.8% and 58.5% of pediatricians, respectively. High dose medication for initial treatment phase was prescribed by 70.7% of pediatricians, primarily within the first 2 weeks (48.3%). The most commonly prescribed medications in children aged > 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002).
CONCLUSION
Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.

Keyword

Child; Constipation; Colonic Diseases, Functional; Questionnaire; Management
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