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

• Published in: Journal of Korean medical science Vol. 34; no. 26; p. e183
• Main Authors: Jang, Hyo Jeong, Chung, Ju Young, Seo, Ji Hyun, Moon, Jin Soo, Choe, Byung Ho, Shim, Jung Ok
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 08-07-2019; 대한의학회
• Subjects: Child, Preschool; Colonic Diseases; Constipation - diagnosis; Constipation - drug therapy; Female; Health Surveys; Humans; Infant; Laxatives - therapeutic use; Male; Original; Pediatricians - psychology; Practice Patterns, Physicians; Probiotics - therapeutic use; Republic of Korea; 의학일반; Republic of Korea; Colonic Diseases, Functional; Questionnaire; Management; Child; Constipation
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2019.34.e183

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.
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).
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 (
< 0.001). Treatment duration was longer among PGs for > 6 months (63.8%) than < 3 months among general pediatricians (59.2%,
< 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 (
< 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 (
= 0.002).
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.