Skip Navigation LinksHome > April 2002 - Volume 34 - Issue 4 > Polyethylene Glycol Without Electrolytes for Children With C...
Journal of Pediatric Gastroenterology & Nutrition:
Original Articles

Polyethylene Glycol Without Electrolytes for Children With Constipation and Encopresis

Loening-Baucke, Vera

Free Access
Article Outline
Collapse Box

Author Information

Department of Pediatrics, University of Iowa, Iowa City, Iowa, U.S.A.

Received July 3, 2001; accepted January 7, 2002.

Presented in part at the American Gastroenterological Association Meeting, Atlanta, GA, May 22, 2001, and published as an abstract in Gastroenterology 2001;120(suppl 1):642A.

Dr. Loening-Baucke is currently the recipient of grant support from Braintree Pharmaceuticals, Braintree, MA, U.S.A., for continuing studies on childhood constipation.

Address correspondence and reprint requests to Dr. Vera Loening-Baucke, University of Iowa Hospitals and Clinics, Pediatrics, JCP 2555, 200 Hawkins Drive, Iowa City, IA 52242, U.S.A. (e-mail: vera-loening-baucke@uiowa.edu).

Collapse Box

Abstract

Background: Children with functional constipation and encopresis benefit from behavior modification and from long-term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists.

Methods: Twenty-eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long-term treatment of functional constipation and encopresis. Children were rated as “doing well,” “improved,” or “not doing well,” depending on resolution of constipation and encopresis.

Results: At the 1-, 3-, 6-, and 12-month follow-ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1-month follow-up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3- and 6-month follow-ups, both groups had similarly improved. At the 12-month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 ± 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects.

Conclusions: Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis.

Functional constipation and fecal soiling (encopresis) are common problems in childhood. Many disorders can cause constipation. In children, functional disorders usually cause constipation. Constipation is rarely caused by organic and anatomical causes or by intake of medication. Practice guidelines of the North American Society for Pediatric Gastroenterology and Nutrition define constipation as a delay or difficulty in defecation severe enough to cause distress to the patient (1). Often encopresis accompanies long-standing constipation. Encopresis is defined as the involuntary loss of formed, semiformed, or liquid stool into the child's underwear after the child has reached a developmental age of 4 years (2).

Children with chronic constipation and encopresis benefit from a precise, well-organized treatment plan, designed to clear fecal retention, prevent future fecal retention, and promote regular bowel habits (1,3–9). After the bowel is cleaned out initially, patients begin taking increased dietary fiber, make several defecation trials daily, and often begin long-term laxative medication to achieve daily defecation and to prevent soiling. Osmotic laxatives, such as milk of magnesia (MOM), lactulose, or sorbitol, and the lubricant mineral oil, are used most commonly. The actual choice of medication is determined by the child's taste preference, and is not as important as an adequate dosage and the child's and parent's compliance with the treatment regimen. Milk of magnesia and mineral oil are unpalatable, and lactulose and sorbitol are too sweet. Therefore, children often refuse to take these medications for an extended period.

Polyethylene glycol electrolyte solutions are iso-osmotic and have been used in large quantities to cleanse the gastrointestinal tract for diagnostic and surgical procedures (10,11). They have been used daily in low volumes to treat chronic constipation in adults (12,13). However, these medications can lead to problems because of absorption of the electrolytes (14). Therefore, a new polyethylene glycol 3350 without added electrolytes (MiraLax; Braintree Laboratories, Inc., Braintree, MA, U.S.A.) has been developed and tested for daily use as a laxative in adults (15–17). MiraLax is a chemically inert polymer in powder form. It is tasteless, odorless, colorless; has no grit; and can be mixed in juice, Kool-Aid and water. Bacteria do not degrade MiraLax, and the drug is not readily absorbed and therefore acts as an excellent osmotic agent. The Food and Drug Administration has approved MiraLax for short-term treatment of constipation in adults. Abstracts and one manuscript have been published about the use of MiraLax for functional constipation in children for 2 weeks to 3 months (18–20).

In this study, we determined the efficiency, acceptability, and treatment dosage of MiraLax during a 12-month treatment period in children with functional constipation and encopresis.

Back to Top | Article Outline

PATIENTS AND METHODS

Patients

This observational study evaluated prospectively the effectiveness, acceptability, and dosage requirement of MiraLax in treating functional constipation with encopresis in children. Study subjects were children 4 years of age or older, who had been referred to and newly evaluated by the author for functional constipation and encopresis at the University of Iowa Hospitals and Clinics in Iowa City, Iowa, during September 1999 to May 2000. All children had functional constipation defined as delay or difficulty in defecation (1) and encopresis (≥1/week) for more than 1 year. The study began in September 1999 because the author first prescribed MiraLax at that time, and the study ended in May 2000 to allow evaluation of the medication after at least 12 months of treatment. Children younger than 4 years of age; children who refused the toilet for stooling but who had no constipation (21); or children with Hirschsprung disease, chronic intestinal pseudo-obstruction, or previous surgery of the colon or anus were excluded.

Twenty-eight children (20 boys and 8 girls) received MiraLax. Their ages ranged from 4.1 to 17.5 years, mean ± SD was 8.7 ± 3.6 years. These children started treatment with MiraLax after the initial evaluation. The results of these 28 children treated with MiraLax were compared with the results of all children who fit the entry criteria and who had initial evaluations during the same period. The comparison group consisted of 21 children (17 boys and 4 girls; 4.0 to 13.9 years of age, mean ± SD was 7.3 ± 3.0 years) who started treatment with MOM.

The Institutional Review Board of the University of Iowa approved the study.

Back to Top | Article Outline
Treatment

Treatment was not randomized. Twenty-eight children received MiraLax. The parents of six of these children had reported the children's refusal to take MOM during previous treatment trials. MiraLax was given as a beverage, 17 g dissolved in 240 mL of a beverage such as juice or Kool-Aid. An initial dose of 0.5 g/kg daily was suggested for children whose rectums were loaded with stool but who had no fecal abdominal masses at the initial physical examination and no history of long intervals between huge bowel movements. Those with palpable abdominal fecal masses or history of infrequent huge bowel movements were started on 1 g/kg daily.

During the same time period, 21 children received MOM. Milk of Magnesia was given if the family could afford only the use of a cheaper laxative or if the child had previously received MOM without refusal. For these children, MOM was simply reintroduced or adjusted to an adequate dosage. Milk of Magnesia comes in various flavors, and parents were told how to improve the taste by mixing the child's preferred flavoring with plain MOM. An initial daily dosage of 1 mL/kg body weight was suggested for children with rectal fecal masses only at initial evaluation and if they had no history of infrequent large bowel movements. A dosage of 2.5 mL/kg was prescribed for those with fecal abdominal masses at the initial evaluation or history of huge, infrequent bowel movements.

Large laxative dosages were divided into two daily doses. Parents were told to adjust the dose of medication by 30 mL for MiraLax and by 7.5 mL (one-half tablespoon) for MOM every 3 days to a dosage that resulted in one to two soft bowel movements per day and prevented soiling and abdominal pain.

Regular stool sittings for 5 minutes after each meal were required for the initial months. The patients and their parents were provided with diary sheets to record each bowel movement, consistency of stools, soiling episodes, abdominal pain episodes, medication use, and daytime or nighttime urinary incontinence. A global assessment of whether the child was “doing well,” “improved,” or “not doing well” was recorded. Doing well, was defined as 3 or more bowel movements/week and 2 or fewer soiling episodes / month. Improved, was defined as 3 or more bowel movements / week and a more than 75% decrease in soiling but not more than 1 soiling / week. Not doing well was defined as fewer than 3 bowel movements / week, a less than 75% decrease in soiling frequency, use of senna, or refusal to take the assigned laxative. Recovered was defined as 3 or more bowel movements / week and 2 or fewer soiling episodes / month while not taking laxatives.

Children were reevaluated 1, 3, 6, and 12 months after the initial visit. If the child did not come to the follow-up visit, the information was obtained by telephone. At each visit, interim history was assessed, stool diaries were collected and discussed, and a physical examination that included a rectal examination was performed. If the child retained stools despite compliance with the assigned laxative, daily senna was added to the treatment.

During the initial follow-up visit, children were asked whether the MiraLax was tasteless, tasted okay, or tasted bad.

Back to Top | Article Outline
Statistics

Data were entered into the software PC info (Retriever Data Systems, Seattle, WA), an analysis program for clinical data. Statistical analysis included the Wilcoxon 2-group rank sum test and signed rank test, and the Fisher exact test with significance accepted at the 5% level. Results were expressed as mean ± SD or percentage.

Back to Top | Article Outline

RESULTS

Patient Characteristics

Table 1 shows the initial characteristics of the 28 children who received MiraLax and of the 21 children who received MOM. There were no differences between children who received MiraLax and MOM (P > 0.08). The frequency of bowel movements each week was higher than expected in both groups, but children often came to our clinic while taking some form of treatment.

Table 1
Table 1
Image Tools
Back to Top | Article Outline
Follow-up at 1 Month

One-month follow-up occurred as visits in 90% and by telephone contact in 10% of both groups. Figures 1 through 3 and Table 2 show results of the 1-month follow-up. Twelve children (43%) were doing well, 6 (21%) were improved, and 10 (36%) were not doing well. Three children (one pair of siblings) were not receiving the MiraLax daily. They continued to soil and had abdominal fecal masses present on examination. They received enemas for disimpaction, restarted MiraLax, and began taking daily senna. Frequency of bowel movements / week increased significantly (P < 0.001), and soiling episodes / week (P < 0.001) and abdominal pain decreased significantly (P < 0.01).

Table 2
Table 2
Image Tools
Fig. 1
Fig. 1
Image Tools
Fig. 2
Fig. 2
Image Tools
Fig. 3
Fig. 3
Image Tools

All children answered that MiraLax was tasteless or okay when stirred well into Kool-Aid, fruit juice, or soft drinks.

All 21 children in the MOM group were followed at 1 month (1.1 ± 0.1 month). Fourteen children (67%) were doing well; 6 (29%) were improved; and one child (5%), who did not take the MOM, was not doing well. Frequency of bowel movements / week increased significantly and soiling episodes / week decreased significantly (P < 0.002).

A similar percentage of children in both groups did well, but significantly fewer children in the MiraLax group (64%) were improved compared with the MOM group (95%, P < 0.01; see Fig. 1). Significantly more soiling episodes occurred in children in the MiraLax group than in the MOM group (P < 0.01; see Fig. 3).

Back to Top | Article Outline
Follow-up at 3 Months

The 3-month follow-up occurred as visits in 76% of children and by telephone contact in 22%. One child did not return for follow-up and could not be reached by phone. In the 27 children receiving MiraLax, this follow-up occurred at 3.3 ± 0.8 months. Figures 1 through 3 and Table 2 show the results of the 3-month follow-up. Fifteen children (56%) were doing well, six (22%) were improved, and six (22%) were not doing well. One patient had relapsed. Four patients were taking senna daily, two of them were improved and two were not doing well; all four were rated as not doing well. Their data were excluded from Fig. 2 and 3 and Table 2.

All 21 children in the MOM group were followed up at 3.4 ± 0.8 months. A total of 16 children (76%) were doing well, 4 (19%) were improved, and 1 (5%) was not doing well. One patient was taking daily senna and was not doing well (data excluded from Fig. 2 and 3 and Table 2). The 3-month outcome data did not differ significantly between the two groups (P > 0.1).

Back to Top | Article Outline
Follow-up at 6 Months

The 6-month follow-up occurred with visits in 73% of children and by phone contact in 27%. Figures 1 through 3 and Table 2 show results of the 6-month follow-up. All 28 children in the MiraLax group had follow-up at 6 months (6.6 ± 1.2 months). Fifteen children (54%) were rated as doing well, 4 of whom (14%) had recovered; 5 (18%) were improved; and 8 (29%) were not doing well. Two of the 4 children who were not doing well were siblings from a chaotic family in which compliance was poor. Two more children also required daily senna, neither of whom was doing well or had improved. The data of children on senna are excluded in Fig. 2 and 3 and Table 2.

All 21 children in the MOM group were observed at 6 months (6.9 ± 1.7 months). A total of 14 children (67%) were doing well with 7 (33%) having recovered, one (5%) was improved, and 6 (29%) were not doing well, including 2 children who were switched to MiraLax before the 6-month follow-up visit because of continued refusal to take MOM. At the 6-month follow-up visit, 3 more parents reported that their children refused to take MOM during the past months. These 3 children were switched to MiraLax at the 6-month visit. Therefore, a total of 5 children (24%) in the MOM group had refused MOM during the first 6 months of the study.

Six-month outcome data did not differ significantly between the two treatment groups (P > 0.1).

Back to Top | Article Outline
Follow-up at 12 Months

The 12-month follow-up occurred as visits in 55% of the children and by telephone in 45%. Figures 1 through 3 and Table 2 show results of the 12-month follow-up. All 28 children in the MiraLax group were observed at 11.9 ± 0.9 months. Seventeen children (61%) were doing well, 6 (21%) had recovered, and 11 (39%) were not doing well. Five children also received daily senna; none was doing well or had improved. Their data were excluded from Figs. 2 and 3 and Table 2.

All 21 children in the MOM group were observed at 12.4 ± 0.8 months. Fourteen children (67%) were doing well, 12 (57%) had recovered, and 7 children (33%) were rated as not doing well because they were taking MiraLax after having refused MOM (data excluded from Fig. 2 and 3 and Table 2).

The 12-month outcome data for the MiraLax and MOM groups did not differ significantly, except that the frequency of soiling was significantly higher in the MiraLax group (P < 0.01) (Fig. 3).

In the MiraLax group, the percentage of children complaining of abdominal pain had decreased significantly at each follow-up visit (P < 0.01), and none of the children in the MOM group reported abdominal pain at the 6-month and 12-month follow-ups (Table 2).

In both groups, the percentage of children with daytime wetting decreased (Table 2), but not significantly because of the small number of subjects in each patient group. The percentage of children with daytime wetting decreased significantly at 3-, 6-, and 12-month follow-ups when children in both groups were combined (P < 0.03, P < 0.03, and P < 0.01, respectively).

The percentage of children with nighttime wetting did not change significantly over time (Table 2).

Back to Top | Article Outline
Treatment Dosage

The mean MiraLax dosage at 1 month for children who were doing well or improved was 0.6 ± 0.2 g/kg (range, 0.3 to 1.1 g/kg) and at 3 months was 0.6 ± 0.3 g/kg (range, 0.3 to 1.4 g/kg). The mean dosage did not differ significantly between children with or without initial palpable abdominal fecal masses. The mean MiraLax treatment dosage at 12 months for the 13 children who were doing well or improved and who still required MiraLax was 0.4 ± 0.1 g/kg (range, 0.1 to 0.7). None of the patients required an increased MiraLax dosage over time.

The mean MOM treatment dosage at 1 month for children who were doing well or improved was 1.4 ± 0.6 mL/kg (range, 0.6 to 2.6 mL/kg) and at 3 months was 1.2 ± 0.5 mL/kg (range, 0.6 to 2.4 mL/kg). The mean MOM dosage did not differ significantly between children with or without initial palpable abdominal fecal masses. At 12 months, only two children who were doing well still required MOM. Their dosages were 0.4 and 1.6 mL/kg, both less than the initial treatment dosage. None of the patients required an increased MOM dosage over time.

Five children received a stimulant laxative in addition to MiraLax, and one child received a stimulant laxative in addition to MOM (P > 0.2).

Back to Top | Article Outline
Clinically Significant Side Effects

MiraLax did not cause any significant clinical side effects. Some of the children in the MiraLax group had diarrhea, which may have been responsible for the more frequent soiling episodes as compared with the MOM group. None of the children in the MiraLax group became dehydrated. Children in both groups continued to grow in weight and height during the 12 months. Children receiving MiraLax and their parents did not report increased flatus, abdominal distention, or new onset of abdominal pain.

Back to Top | Article Outline
Noncompliance

Noncompliance by children or their caregivers has been a well-known problem in children with functional constipation and encopresis. None of the children reported disliking the taste of MiraLax, and none of the parents reported that a child refused to take the MiraLax in juice or Kool-Aid, whereas 33% of children refused to take MOM. Children's noncompliance with other aspects of the treatment plan is more difficult to assess. Parental noncompliance with administering the laxative and supervising toilet use was a problem in 14% of children in the MiraLax group and in 4% of children in the MOM group.

Back to Top | Article Outline

DISCUSSION

In this prospective, observational study, we found that MiraLax was palatable, well tolerated, and efficient in the long-term treatment of children with functional constipation and encopresis. At the 1-month, 3-month, 6-month, and 12-month follow-ups, we saw significant improvement in the MiraLax and MOM groups (increased bowel movement frequency and decreased soiling frequency). At the 1- and 12-month follow-ups, children in the MiraLax group reported more soiling than did those in the MOM group (P < 0.01). At 12 months, 61% of children in the MiraLax and 67% of children in the MOM group were doing well (P = 1).

We have no explanation for why children in the MiraLax group had a significantly greater number of soiling episodes at the 1-month and 12-month follow-ups compared with the MOM group. We had observed a few children who developed diarrhea while receiving high doses of MiraLax. Similar observations have been made in initial study weeks when polyethylene glycol was compared with lactulose in constipated adults (22,23).

Abdominal pain decreased significantly, and daytime wetting decreased. Contrary to previous observations (24,25), we did not see a significant decrease in the percentage of children with nighttime wetting.

Recently, polyethylene glycol electrolyte lavage solutions have received increased attention for use as laxatives. Taken rapidly in large volumes, they do not cause net absorption or secretion of electrolytes (26,27). No intestinal absorption occurs at molecular weights exceeding 3,000 (28). No adaptation with consequent flatus or loss of efficiency occurred because no intestinal enzymatic degradation or bacterial metabolism occurred with polyethylene glycol (28). When taken daily in low volumes, polyethylene glycol electrolyte solution is effective, safe, well tolerated, and has no significant side effects in short-term (12) and long-term treatment (13) of constipation in adults. No net absorption or secretion was presumed for the use of smaller volumes, but recent work has shown that low-volume administration resulted in nearly complete absorption of the salt component of the solution, which could potentially lead to dangerous sequelae, especially for patients with renal impairment or congestive heart disease (14,15).

For many years, observational studies were believed to report stronger treatment effects than randomized, controlled trials. Recently, two studies found little evidence that estimates of treatment effects are either consistently larger than or qualitatively different from those obtained in randomized, controlled trials (29,30). However, a randomized, controlled trial comparing these two laxatives has been started, and electrolyte concentrations and hemograms will be checked regularly to evaluate further the efficacy and safety of polyethylene glycol in children with functional constipation and encopresis.

Our observational study shows that polyethylene glycol without electrolytes is a reasonable alternative in the long-term treatment of children with chronic constipation and encopresis. MiraLax did not cause any clinical significant side effects, there was no loss of efficiency during the 12-month study, and none of the children refused the medication because of taste. Soiling episodes decreased significantly over time. At the 12-month follow-up, soiling was more frequently observed in patients treated with MiraLax than in those treated with MOM. This may be because of differences in the patient groups, overtreatment, or noncompliance with all aspects of the treatment plan.

Back to Top | Article Outline

REFERENCES

1. Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment—a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Ped Gastroenterol Nutr 1999; 29:612–26.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.

3. Loening-Baucke V. Chronic constipation in children. Gastroenterology 1993; 105:1557–64.

4. Nolan TM, Debelle G, Oberklaid F, et al. Randomised trial of laxatives in treatment of childhood encopresis. Lancet 1991; 338:523–7.

5. Clayden GS. Management of chronic constipation. Arch Dis Child 1992; 67:340–4.

6. Staiano A, Andreotti MR, Greco L, et al. Long-term follow-up of children with chronic constipation. Dig Dis Sci 1994; 39:561–4.

7. Lewis LG, Rudolph CD. Practical approach to defecation disorders in children. Pediatr Ann 1997; 26:260–8.

8. Abi-Hanna A, Lake AM. Constipation and encopresis in childhood. Pediatr Rev 1998; 19:23–30.

9. Felt B, Wise CG, Olson A, et al. Guidelines for the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med 1999; 153:380–5.

10. Sondheimer JM, Sokol RJ, Taylor SF, et al. Safety, efficiency and tolerance of intestinal lavage in pediatric patients undergoing diagnostic colonoscopy. J Pediatr 1991; 119:148–52.

11. Dashan A, Lin CH, Peters J, et al. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol 1999; 98:11–6.

12. Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol 1990; 85:261–5.

13. Corazziari E, Badiali D. Bazzocchi G, et al. Long term efficacy, safety, and tolerability of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut 2000; 46:522–6.

14. Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84:1056–62.

15. DiPalma JA, DeRidder PH, Orlando RC, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of new polyethylene glycol laxative. Am J Gastroentero 2000; 95:446–50.

16. DiPalma JA, MacRae DH, Reichelderfer M, et al. Braintree polyethylene glycol laxative for ambulatory and long-term care facility constipation patients: report of randomized cross-over trials. Accessed 10/18/99. Available at:http://www.miraLax.com/physician/ clinconte.html.

17. Williams SG, DiPalma JA. Constipation in the long-term care facility. Gastrointestinal Nursing 1990; 12:179–82.

18. Minor ML, Gleghorn EE. A new polyethylene glycol based, small volume medication for constipation/encopresis in children. J Pediatr Gastroenterol Nutr 2000;31:125A(suppl 2).

19. Gremse DA, Hixon J. Comparison of polyethylene glycol 3350, NF powder and lactulose for treatment of chronic constipation in children. J Gastroenterol Nutr 2000; 31(suppl 2):131A.

20. Pashankar D, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of chronic constipation and encopresis in children. J Pediatr 2001; 139:428–3.

21. Taubman B. Toilet training and toileting refusal for stool only: a prospective study. Pediatrics 1997; 99:54–8.

22. Freedman MD, Schwartz HJ, Roby R, Fleisher S. Tolerance and efficacy of polyethylene glycol 3350/electrolyte solution versus lactulose in relieving opiate induced constipation: a double-blinded placebo-controlled trial. J Clin Pharm 1997; 37:904–7.

23. Attar A, Lemann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999; 44:226–30.

24. Loening-Baucke V. Balloon defecation as a predictor of outcome in children with functional constipation and encopresis. J Pediatr 1996; 128:336–40.

25. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997; 100:228–32.

26. Davis GR, Santa Ana CA, Morawski SG, et al. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 1980; 78:991–5.

27. Fordtan JS, Santa Ana CA, Cleveland MVB. A low sodium solution free gastrointestinal lavage. Gastroenterology 1990; 98:11–6.

28. Hammer HF, Hammer J, Gasche C. Polyethylene glycol (Macrogol)—an overview of its use in diagnosis and therapy of gastrointestinal diseases. Wiener Klin Wochenschrift 2000; 112:53–60.

29. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000; 342:1878–86.

30. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research design. N Engl J Med 2000;1887–92.

Cited By:

This article has been cited 42 time(s).

Archives of Pediatrics & Adolescent Medicine
Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children
Pashankar, DS; Loening-Baucke, V; Bishop, WP
Archives of Pediatrics & Adolescent Medicine, 157(7): 661-664.

Journal of Family Practice
What is the most effective way for relieving constipation in children aged > 1 year?
Torres, M; McGregor, T; Wilder, L
Journal of Family Practice, 53(9): 744-746.

Update Gastroenterology 2004: New Developments in the Management of Benign Gastrointestinal Disorders
Constipation in childhood
Benninga, MA
Update Gastroenterology 2004: New Developments in the Management of Benign Gastrointestinal Disorders, (): 201-215.

Archives of Disease in Childhood
Is polyethylene glycol safe and effective for chronic constipation in children?
Arora, R; Srinivasan, R
Archives of Disease in Childhood, 90(6): 643-646.
10.1136/adc.2005.072918
CrossRef
Journal of Pediatrics
PEG3350 in the treatment of childhood constipation: A multicenter, double-blinded, placebo-controlled trial
Nurko, S; Youssef, NN; Sabri, M; Langseder, A; McGowan, J; Cleveland, M; Di Lorenzo, C
Journal of Pediatrics, 153(2): 254-261.
10.1016/j.jpeds.2008.01.039
CrossRef
Indian Journal of Pediatrics
Management of Functional Constipation in Children
Srivastava, A
Indian Journal of Pediatrics, 75(): S48-S52.

Clinical Pediatrics
Variability in the management of childhood constipation
Focht, DR; Baker, RC; Heubi, JE; Moyer, MS
Clinical Pediatrics, 45(3): 251-256.

Archives of Disease in Childhood
Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures
Pijpers, MAM; Tabbers, MM; Benninga, MA; Berger, MY
Archives of Disease in Childhood, 94(2): 117-131.
10.1136/adc.2007.127233
CrossRef
Journal of Consulting and Clinical Psychology
An Internet intervention as adjunctive therapy for pediatric encopresis
Ritterband, LM; Cox, DJ; Walker, LS; Kovatchev, B; McKnight, L; Patel, K; Borowitz, S; Sutphen, J
Journal of Consulting and Clinical Psychology, 71(5): 910-917.
10.1037/0022-006X.71.5.910
CrossRef
Archives of Disease in Childhood
Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study
Thomson, MA; Jenkins, HR; Bisset, WM; Heuschkel, R; Kalra, DS; Green, MR; Wilson, DC; Geraint, M
Archives of Disease in Childhood, 92(): 996-1000.
10.1136/adc.2006.115493
CrossRef
Journal of Paediatrics and Child Health
Chronic constipation in children: Organic disorders are a major cause
Southwell, BR; King, SK; Hutson, JM
Journal of Paediatrics and Child Health, 41(): 1-15.

Gastroenterologie Clinique Et Biologique
Polyethylene glycol and prevalence of colorectal adenomas - Population-based study of 1165 patients undergoing colonoscopy
Dorval, E; Jankowski, JM; Barbieux, JP; Viguier, J; Bertrand, P; Brondin, B; Bougnoux, P; Corpet, DE
Gastroenterologie Clinique Et Biologique, 30(): 1196-1199.

Journal of Paediatrics and Child Health
Macrogol 3350 plus electrolytes for chronic constipation in children: A single-centre, open-label study
Hardikar, W; Cranswick, N; Heine, RG
Journal of Paediatrics and Child Health, 43(): 527-531.
10.1111/j.1440-1754.2007.01116.x
CrossRef
Patient Education and Counseling
Chronic childhood constipation: A review of the literature and the introduction of a protocolized behavioral intervention program
van Dijk, M; Benninga, MA; Grootenhuis, MA; Onland-van Niettwenhuizen, AM; Last, BF
Patient Education and Counseling, 67(): 63-77.
10.1016/j.pec.2007.02.002
CrossRef
Iranian Journal of Pediatrics
Polyethylene Glycol versus Paraffin for the Treatment of Childhood Functional Constipation
Karami, H; Khademloo, M; Niari, P
Iranian Journal of Pediatrics, 19(3): 255-261.

Clinical Pediatrics
Long-term efficacy of polyethylene glycol 3350 for the treatment of chronic constipation in children with and without encopresis
Pashankar, DS; Bishop, WP; Loening-Baucke, V
Clinical Pediatrics, 42(9): 815-819.

Journal of Pediatrics
Polyethylene glycol 3350 without electrolytes: A new safe, effective, and palatable bowel preparation for colonoscopy in children
Pashankar, DS; Uc, A; Bishop, WP
Journal of Pediatrics, 144(3): 358-362.
10.1016/j.jpeds.2003.11.033
CrossRef
Pediatrics
A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence
Loening-Baucke, V; Pashankar, DS
Pediatrics, 118(2): 528-535.
10.1542/peds.2006-0220
CrossRef
Alimentary Pharmacology & Therapeutics
Polyethylene glycol 4000 vs. lactulose for the treatment of neurogenic constipation in myelomeningocele children: a randomized-controlled clinical trial
Rendeli, C; Ausili, E; Tabacco, F; Focarelli, B; Pantanella, A; Di Rocco, C; Genovese, O; Fundaro, C
Alimentary Pharmacology & Therapeutics, 23(8): 1259-1265.
10.1111/j.1365-2036.2006.02872.x
CrossRef
Revista Medica De Chile
Prospective evaluation of safety and tolerance of colonoscopy in children
Gana, JC; Glenz, C; Marchant, P; Vaca, C; Garcia, X; Larrain, F; Harris, P
Revista Medica De Chile, 134(5): 613-622.

Gut
PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial
Voskuijl, W; de Lorijn, F; Verwijs, W; Hogeman, P; Heijmans, J; Makel, W; Taminiau, J; Benninga, M
Gut, 53(): 1590-1594.
10.1136/gut.2004.043620
CrossRef
Asian Biomedicine
Polyethylene glycol 4000 without electrolytes versus milk of magnesia for the treatment of functional constipation in infants and young children: a randomized controlled trial
Ratanamongkol, P; Lertmaharit, S; Jongpiputvanich, S
Asian Biomedicine, 3(4): 391-399.

Wcpghan 3: World Congress of Pediatric Gastroenterology, Hepatology and Nutrition
Polyethylene Glycol 4000 without Electrolytes for Childhood Constipation
Gomes, PB; Melo, MCB; Xavier, AT; Duarte, MA; Torres, MRF
Wcpghan 3: World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, (): 71-74.

Annals of Pharmacotherapy
Pediatric constipation therapy using guidelines and polyethylene glycol 3350
Bell, EA; Wall, GC
Annals of Pharmacotherapy, 38(4): 686-693.
10.1345/aph.1D297
CrossRef
Journal of Pediatrics
Use of Rome II criteria in childhood defecation disorders: Applicability in clinical and research practice
Voskuijl, WP; Heijmans, J; Heimans, HSA; Taminiau, JAJM; Benninga, MA
Journal of Pediatrics, 145(2): 213-217.
10.1016/j.jpeds.2004.04.050
CrossRef
Praxis Der Kinderpsychologie Und Kinderpsychiatrie
Encopresis
Von Gontard, A
Praxis Der Kinderpsychologie Und Kinderpsychiatrie, 56(6): 492-510.

Advances in Clinical and Experimental Medicine
Constipation in children - Causes, diagnostics and treatment
Reich, M; Iwanczak, B
Advances in Clinical and Experimental Medicine, 16(3): 443-456.

Pediatrics in Review
Consultation with the specialist: Encopresis: Assessment and management
Schonwald, A; Rappaport, L
Pediatrics in Review, 25(8): 278-283.

Life Science Journal-Acta Zhengzhou University Overseas Edition
Comparison of the Low Dose Polyethylene Glycol with Lactulose and Magnesium Hydroxide in Constipated Children. A Multicentric Randomized Clinical trial
Gheibi, S; Imanieh, MH; Haghighat, M; Niknahad, H; Sayyafan, MS; Moatamed, F; Saneian, MH; Karami, H; Dooki, MRE
Life Science Journal-Acta Zhengzhou University Overseas Edition, 9(4): 5344-5350.

Current Opinion in Pediatrics
Encopresis
Loening-Baucke, V
Current Opinion in Pediatrics, 14(5): 570-575.

PDF (298)
Current Opinion in Pediatrics
Recent advances in chronic constipation
Walia, R; Mahajan, L; Steffen, R
Current Opinion in Pediatrics, 21(5): 661-666.
10.1097/MOP.0b013e32832ff241
PDF (299) | CrossRef
Journal of Pediatric Gastroenterology and Nutrition
Childhood Constipation: Is There New Light in The Tunnel?
Benninga, MA; Voskuijl, WP; Taminiau, JA
Journal of Pediatric Gastroenterology and Nutrition, 39(5): 448-464.

PDF (167)
Journal of Pediatric Gastroenterology and Nutrition
Polyethylene Glycol for Constipation in Children Younger Than Eighteen Months Old
Michail, S; Gendy, E; Preud’Homme, D; Mezoff, A
Journal of Pediatric Gastroenterology and Nutrition, 39(2): 197-199.

PDF (58)
Journal of Pediatric Gastroenterology and Nutrition
Polyethylene Glycol 3350 Without Electrolytes for the Treatment of Functional Constipation in Infants and Toddlers
Loening-Baucke, V; Krishna, R; Pashankar, DS
Journal of Pediatric Gastroenterology and Nutrition, 39(5): 536-539.

PDF (62)
Journal of Pediatric Gastroenterology and Nutrition
A Dose Determination Study of Polyethylene Glycol 4000 in Constipated Children: Factors Influencing the Maintenance Dose
Dupont, C; Leluyer, B; Amar, F; Kalach, N; Benhamou, P; Mouterde, O; Vannerom, P; and a Multicenter Group,
Journal of Pediatric Gastroenterology and Nutrition, 42(2): 178-185.
10.1097/01.mpg.0000189349.17549.a9
PDF (195) | CrossRef
Journal of Pediatric Gastroenterology and Nutrition
A Dietary Fiber Mixture versus Lactulose in the Treatment of Childhood Constipation: A Double-blind Randomized Controlled Trial
Kokke, FT; Scholtens, PA; Alles, MS; Decates, TS; Fiselier, TJ; Tolboom, JJ; Kimpen, JL; Benninga, MA
Journal of Pediatric Gastroenterology and Nutrition, 47(5): 592-597.
10.1097/MPG.0b013e318162c43c
PDF (112) | CrossRef
Journal of Pediatric Gastroenterology and Nutrition
Author's Reply to Dr. Geraint
Loening-Baucke, V
Journal of Pediatric Gastroenterology and Nutrition, 35(5): 707-708.

Journal of Pediatric Gastroenterology and Nutrition
Evaluation and Treatment of Constipation in Children: Summary of Updated Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Journal of Pediatric Gastroenterology and Nutrition, 43(3): 405-407.
10.1097/01.mpg.0000232574.41149.0a
PDF (60) | CrossRef
Journal of Pediatric Gastroenterology and Nutrition
Constipation: Is There a New Approach?
Sondheimer, J
Journal of Pediatric Gastroenterology and Nutrition, 34(4): 357-358.

Journal of Pediatric Gastroenterology and Nutrition
Functional Fecal Retention With Encopresis in Childhood
Loening-Baucke, V
Journal of Pediatric Gastroenterology and Nutrition, 38(1): 79-84.

PDF (277)
Journal of Pediatric Gastroenterology and Nutrition
Double-Blind Randomized Evaluation of Clinical and Biological Tolerance of Polyethylene Glycol 4000 Versus Lactulose in Constipated Children
Abdelatif, A; Baranes, C; Benoît, S; Benssoussan, A; Boussioux, JL; Boyer, P; Brunet, E; Delorme, J; François-Cecchin, S; Gottrand, F; Grassart, M; Hadji, S; Kalidjian, A; Languepin, J; Leissler, C; Lejay, D; Livon, D; Lopez, JP; Mougenot, JF; Risse, JC; Rizk, C; Roumaneix, D; Schirrer, J; Thoron, B; Kalach, N; Dupont, C; Leluyer, B; Maamri, N; Morali, A; Joye, J; Fiorini, J
Journal of Pediatric Gastroenterology and Nutrition, 41(5): 625-633.

PDF (249)
Journal of Pediatric Gastroenterology and Nutrition
Letter to the Editor
Geraint, M
Journal of Pediatric Gastroenterology and Nutrition, 35(5): 707.

Back to Top | Article Outline
Keywords:

Polyethylene glycol; Functional constipation; Encopresis; Children; Long-term treatment

© 2002 Lippincott Williams & Wilkins, Inc.

Login

Article Tools

Images

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.

Connect With Us

 

 

Twitter

twitter.com/JPGNonline

 

Visit JPGN.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.