目的:对于患有顽固性功能性便秘(FC)的儿童,后续评估和治疗没有循证指南.我们的目标是评估大型企业的实践模式,国际儿童胃肠病学家队列。
方法:我们对参加在哥伦布举行的第二届世界小儿神经胃肠病学和运动性大会的医生进行了一项调查,俄亥俄州(美国),2023年9月。调查包括29个关于诊断测试的问题,非药物和药物治疗,以及难治性FC患儿的手术选择。
结果:来自18个国家的90名医生完成了调查。对于患有棘手FC的儿童,肛门直肠测压是最常用的诊断检查.北美响应者比欧洲人更有可能使用刺激性泻药(97%vs.77%,p=0.032),Prosecretory药物(69%vs.8%,p<0.001),和顺行失禁灌肠(ACE;83%vs.46%,p=0.009)用于管理。欧洲人比北美人更有可能在手术前要求进行结肠运输测试(85%vs.30%,p<0.001)。我们发现美国人和世界其他地区的管理实践存在重大差异,包括使用口服药物(73%vs.7%,p<0.001),肛门肉毒杆菌毒素注射(81%vs.58%,p=0.018),ACE(81%vs.58%p=0.018),转移回肠造口术(56%vs.26%,p=0.006),和结肠切除术(42%vs.16%,p=0.012)。当受访者根据多年的经验进行比较时,没有发现差异。
结论:儿童难治性FC的评估和治疗的实践模式在世界各地的儿科胃肠病学家之间差异很大。需要有关诊断测试和手术决策的临床指南。
OBJECTIVE: For children with intractable functional constipation (FC), there are no evidence-based guidelines for subsequent evaluation and treatment. Our objective was to assess the practice patterns of a large, international cohort of pediatric gastroenterologists.
METHODS: We administered a survey to physicians who attended the 2nd World Congress of Pediatric Neurogastroenterology and Motility held in Columbus, Ohio (USA) in September 2023. The survey included 29 questions on diagnostic testing, nonpharmacological and pharmacological treatment, and surgical options for children with intractable FC.
RESULTS: Ninety physicians from 18 countries completed the survey. For children with intractable FC, anorectal manometry was the most commonly used diagnostic test. North American responders were more likely than Europeans to use stimulant laxatives (97% vs. 77%, p = 0.032), prosecretory medications (69% vs. 8%, p < 0.001), and antegrade continence enemas (ACE; 83% vs. 46%, p = 0.009) for management. Europeans were more likely than North Americans to require colonic transit testing before surgery (85% vs. 30%, p < 0.001). We found major differences in management practices between Americans and the rest of the world, including use of prosecretory drugs (73% vs. 7%, p < 0.001), anal botulinum toxin injections (81% vs. 58%, p = 0.018), ACE (81% vs. 58% p = 0.018), diverting ileostomies (56% vs. 26%, p = 0.006), and colonic resections (42% vs. 16%, p = 0.012). No differences were found when respondents were compared by years of experience.
CONCLUSIONS: Practice patterns in the evaluation and treatment of children with intractable FC differ widely among pediatric gastroenterologists from around the world. A clinical guideline regarding diagnostic testing and surgical decision-making is needed.