A de Geus et al. Lancet Child Adolesc Health 2025 https://doi.org/10.1016/S2352-4642(25)00219-6. Open Access! Efficacy and safety of pharmacological therapies for functional constipation in children: a systematic review and meta-analysis

Thanks to Ben Gold for sharing this reference

Methods: In this systematic review and meta-analysis, the authors identified “4595 articles, of which 59 randomised controlled trials were included, representing 7045 participants with functional constipation. Interventions included polyethylene glycol (n=36 studies), lactulose (n=18), magnesium oxide or magnesium hydroxide (n=7), picosulfate (n=1), liquid paraffin (n=4), prucalopride (n=1), lubiprostone (n=2), linaclotide (n=3), plecanatide (n=1), enemas (n=2), and domperidone (n=1).”

Key findings:

• Meta-analyses for treatment success showed that polyethylene glycol was probably more effective than placebo (RR 1·74, moderate certainty of evidence) and may be more effective than lactulose (1·35], low certainty of evidence)
• Linaclotide probably leads to higher defecation frequency than placebo
• Prucalopride is probably not more effective than placebo
• “Most other therapies provided evidence that was of very low certainty, due to methodological limitations and insufficient information to assess the risk of bias, precluding any evidence-based conclusions”

The discussion reviews the problems with trial design, problems with underpowered studies, and “pervasive issues with heterogeneity.  The use of concomitant therapeutics or permitted interventions and the disease severity of the patient populations varied greatly from study to study.”

My take: This study outlines what is needed to improve future research for pediatric constipation. For now, there is little certainty regarding the effectiveness of most constipation medications.

Related blog posts:

• Position Paper: Pediatric Refractory Constipation Management
• ANMS Virtual Symposia on Constipation
• Pictographic Constipation Action Plan
• New Data on Bisacodyl for Pediatric Constipation
• Safety of Senna-Based Laxatives
• Constipation Action Plan: Better Instructions, Fewer Phone Calls
• Does It Make Sense to Look for Celiac Disease in Children with Functional Constipation?
• You Can Do Anorectal Manometry in Your Sleep, But Should You?
• More than Two Years of Constipation Before Specialty Help
• Is There a Residual Impact of a Tethered Cord on Colonic Motility
• AGA Constipation Guidelines
• Radiographs and Constipation -Bad Practice and Good Study
• Quality Improvement: Fewer Xrays for Constipation
• Long Term Use of Polyethylene Glycol (PEG 3350)
• Is It a ‘Waste’ to Do Colonic Manometry in Kids with Autism?
• Reliability of colonic manometry