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International Journal of Colorectal Disease

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Open Access 01-08-2016 | Original Article

Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment

Authors: Aart A. van der Wilt, Bart P. W. van Wunnik, Rosel Sturkenboom, Ingrid J. Han-Geurts, Jarno Melenhorst, Marc A. Benninga, Cor G. M. I. Baeten, Stephanie O. Breukink

Published in: International Journal of Colorectal Disease | Issue 8/2016

Abstract

Purpose

Functional constipation in children and adolescents is a common and invalidating condition. In a minority of patients, symptoms persist despite optimal conservative therapy. The aim of this study was to evaluate whether the short-term effects of sacral neuromodulation (SNM) in children and adolescents with constipation are sustained over prolonged period of time.

Methods

Patients aged 10–20 years, with refractory constipation, fulfilling the Rome III criteria, were included in our study. If SNM test treatment showed >50 % improvement in defecation frequency, a permanent stimulator was implanted. Primary outcome measure was defecation frequency during 3 weeks. Secondary endpoints were abdominal pain and Wexner score. To assess sustainability of treatment effect, a survival analysis was performed. Cross-sectional quality of life was assessed using the EQ-5D VAS score.

Results

Thirty girls, mean age 16 (range 10–20), were included. The mean defecation frequency increased from 5.9 (SD 6.5) in 21 days at baseline to 17.4 (SD 11.6) after 3 weeks of test treatment (p < 0.001). During test treatment, abdominal pain and Wexner score decreased from 3.6 to 1.5 and 18.6 to 8.5 (p < 0.001), respectively. Improvement of symptoms sustained during a median follow-up of 22.1 months (12.2–36.8) in 42.9 % of patients. On a scale from 0 to 100, quality of life was 7 points lower than the norm score (mean 70 vs. 77).

Conclusion

SNM is a therapeutic option for children with chronic constipation not responding to intensive oral and/or laxative therapy, providing benefits that appear to be sustained over prolonged period of time.

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Title: Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment
Authors: Aart A. van der Wilt
Bart P. W. van Wunnik
Rosel Sturkenboom
Ingrid J. Han-Geurts
Jarno Melenhorst
Marc A. Benninga
Cor G. M. I. Baeten
Stephanie O. Breukink
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 8/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2604-8

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Springer Medicine

Sacral neuromodulation in children and adolescents with chronic constipation refractory to conservative treatment

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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