Abstracts: 38th Annual Meeting of the European Society for Pediatric Gastroentrology, Hepatology and Nutrition: Porto, Portugal, June 1-4, 2005
Functional non-retentive faecal soiling (FNRFS), encopresis in the absence of signs of faecal retention, is a frustrating phenomenon in children and difficult to treat. It is assumed that FNRFS will resolve spontaneously beyond puberty, however no data on long-term outcome are available.
To investigate the very long-term outcome of FNRFS patients after intensive medical treatment.
Between 1990 and 1999, 119 patients (96 boys) with FNRFS were enrolled in 2 prospective, randomised trials investigating the effect of biofeedback training and/or laxative treatment. Thereafter, follow-up (FU) was performed at 6 months, 1 year and thereafter annually until the end of data collection in September 2004. A standardised questionnaire was used, either during clinical visit or by telephone, to evaluate symptoms. Success was defined as having less than 1 encopresis episode in 2 weeks while not using medication for more than 1 month.
Median age at entry (25th-75th percentiles) was 9.2 (7.9-11.6) years and the median duration of symptoms before intake (25th-75th percentiles) was 4.4 (3.0-6.7) years. A 90% follow-up was achieved at all stages of the study. After 2 years of intensive behavioural and medical therapy, 33 out of 112 (29.5%) patients were successfully treated. The cumulative success percentage after 7 years of FU was 80%. At the biological ages of 12 and 18 years, 49.4% (40/81) and 15.5% (9/58) of the patients still had encopresis, respectively. Age at intake younger than 6 years in combination with secondary encopresis was associated with a lower chance of achieving success (HR: 0.51 (95% CI: 0.27-0.98), P = 0.04). Relapse occurred in 37% of patients (cumulative percentage after 7 years), and occurred most likely in the first two years after an initial success.
Only 29% of the patients with FNRFS are successfully treated after two years of intensive treatment. Thereafter, a steady increase in success is observed. Nevertheless, at the age of 18 years, 15% still have encopresis.