Update Chronische Obstipation im Kindes- und Jugendalter

Zusammenfassung

Die chronische Obstipation gehört zu den häufigsten Vorstellungsgründen beim Kinder-arzt. In über 95 % der Fälle liegt eine funktionelle Obstipation (keine organische Erkrankung) vor, die Genese ist meist multikausal. Die Differenzialdiagnostik sollte sich nach den Befunden einer gezielten und strukturierten Anamnese und Untersuchung richten, um ressourcensparend strukturelle, endokrine und metabolische Ursachen auszuschließen. Der Ausschluss organischer Erkrankungen ist unerlässlich, um umgehend eine adäquate Therapie durch entsprechende Spezialisten zu initiieren. Alle Kinder und Jugendlichen mit einer (funktionellen) Obstipation profitieren von einer prompten und sorgfältigen therapeutischen Intervention. Eine verzögerte oder inadäquate Behandlung kann zu einem Stuhlvermeidungsverhalten mit konsekutiver Verschlechterung der Obstipation und ernst-haften psychosozialen Konsequenzen führen. Die besten Ergebnisse hinsichtlich des lang-fristigen Therapieerfolges werden durch eine multimodale Therapie erreicht.

Summary

Chronic constipation is one of the most common reasons for presentation at pediatric practice. Functional constipation accounts for about 95 % of these patients and pathogenesis is multicausal. A structured and focused evaluation of the patient’s medical history as well as the physical examination facilitates the exclusion of anatomical, endocrinological and metabolical causes of constipation. Differential diagnosis of organic diseases is essential for an early referral to a respective specialist. In case of functional constipation children benefit from immediate and comprehensive therapeutic intervention. Delayed therapy of constipation may result in behavioral avoidance of defecation, consecutive deterioration of chronic constipation, and subsequently severe psychosocial consequences. Multimodal therapy is the key to a successful treatment of chronic constipation.

Schlüsselwörter

Obstipation - Morbus Hirschsprung - Laxanzien

Keywords

Constipation - Hirschsprung disease - laxatives

• Literatur

• 1 Belsey J. et al. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther 2010; 31: 938-949.
• 2 Brazzelli M. et al. Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev. 2011: CD002240.
• 3 de Araujo Sant’Anna AM. et al. Constipation in school-aged children at public schools in Rio de Janeiro, Brazil. J Pediatr Gastroenterol Nutr 1999; 29: 190-193.
• 4 De Lorijn F. et al. Diagnosis of Hirschsprung’s disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146: 787-792.
• 5 Hatori R. et al. Fecal retention in childhood: Evaluation on ultrasonography. Pediatr Int 2017; 59: 462-466.
• 6 Hyams J. et al. Functional gastrointestinal disorders: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2002; 35 (Suppl. 02) 110-117.
• 7 Hyams JS. et al. Functional Disorders: Children and Adolescents. Gastroenterology 2016; 150: 1456-1458.
• 8 Iacono G. et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 2005; 37: 432-438.
• 9 Kiefte-de Jong JC. et al. Infant nutritional factors and functional constipation in childhood: the Generation R study. Am J Gastroenterol 2010; 105: 940-945.
• 10 Lewis SJ. et al. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997; 32: 920-924.
• 11 Loening-Baucke V. Chronic constipation in children. Gastroenterology 1993; 105: 1557-1564.
• 12 Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatr 2005; 146: 359-363.
• 13 Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child 2007; 92: 486-489.
• 14 Michaud L. et al. Outcome of functional constipation in childhood: a 10-year follow-up study. Clin Pediatr (Phila) 2009; 48: 26-31.
• 15 Miele E. et al. Functional gastrointestinal disorders in children: an Italian prospective survey. Pediatrics 2004; 114: 73-78.
• 16 Procter E. et al. A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev 2003; 29: 103-109.
• 17 Rajindrajith S. et al. Childhood constipation as an emerging public health problem. World J Gastroenterol 2016; 22: 6864-6875.
• 18 Roma E. et al. Diet and chronic constipation in children: the role of fiber. J Pediatr Gastroenterol Nutr 1999; 28: 169-174.
• 19 Rubin GP. Childhood constipation. Am Fam Physician 2003; 67: 1041-1042.
• 20 Santos-Jasso KA. et al. Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation. J Pediatr Surg 2017; 52: 84-88.
• 21 Tabbers MM. et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58: 258-274.
• 22 van den Berg MM. et al. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101: 2401-2409.