Tag Archives: consitpation

IBS Subtypes in Pediatrics

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A recent study (Clin Gastroenterol Hepatol 2014; 12: 1468-73) examined irritable bowel syndrome (IBS) subtypes among 129 subjects ages 7 to 18 who met Pediatric Rome III IBS criteria.  These children were part of larger studies of functional gastrointestinal disorders and recruited from primary and tertiary care centers.  Participants completed pain and stool diaries.

Key finding:

  • IBS with constipation (IBS-C) was the most common subtype (58.1%); in the other categories IBS unsubtyped (IBS-U) was next at 34.1%, then IBS with diarrhea (IBS-D) at 5.4%, and least common was mixed IBS (IBS-M) at 2.3%

The authors note that in adults with IBS studies tend to yield a more even distribution among the subtypes IBS-C, IBS-D, and IBS-U along with smaller numbers in IBS-M.

Take-home message: IBS with constipation is common in pediatrics.  Among patients who have been labelled as having isolated constipation, many in fact have IBS-C and may have persistent gastrointestinal symptoms despite the use of laxatives.

Related blog post:

Mechanisms of irritable bowel syndrome | gutsandgrowth

Will Lubiprostone Help Children with Functional Constipation?

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A recent open-label study of lubiprostone examined its use in children younger than 18 years (2007-2008) at 22 U.S. centers (JPGN 2014; 58: 283-91).

Lubiprostone (Amitiza) activates chloride-channel protein-2 in the gastrointestinal epithelium and promotes secretion of chloride ions and fluid.  This results in more frequent bowel movements (BMs) and improved motility.  To determine its safety and effectiveness in the pediatric population, the investigators enrolled 127 patients (124 were treated and analyzed and 109 completed the 4-week study).  After a 2-week observation period, several doses of lubiprostone were compared: 12 μg QD, 12 μg BID, 24 μg BID.  There was no placebo group.  The mean age of the participants was 10.2 years.

Results:

  • Mean spontaneous BM frequency increased from baseline: 3.1/week versus 1.5/week.  Overall, at each week in treatment ≥ 43% achieved ≥ 3 spontaneous BMs/week.
  • 62% experienced a spontaneous BM within 48 hours of starting treatment.
  • Common adverse reactions: Nausea (18.5%), vomiting (12.1%), diarrhea (8.1%), abdominal pain (7.3%) and headache (5.6%). Overall, 65% of patients experienced ≥ 1 adverse effect and this was highest (78%) in the subset of patients receiving the highest dosage

Bottomline: Current guidelines recommend osmotic agents like polyethylene glycol (PEG) (Miralax) as first-line treatment.  This short-term study shows lubiprostone may be an alternative in nonresponders, though more data on long-term outcomes are needed.

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