title: Need for Rectal Biopsy for Childhood Constipation Predicts Severity of Illness and Need for Laxatives.
abstract: This study aimed to examine the long-term clinical outcomes of children with severe constipation, as defined by need for rectal biopsy (RB), and to determine which baseline characteristics were predictors of successful outcome.
  
  
  
  Children with severe constipation who underwent RB for evaluation of Hirschsprung disease at a tertiary medical center were eligible. A cohort of children with constipation without a history of RB served as controls (matched 2:1 by sex and age). Retrospective chart review of clinic visits was performed at baseline, 3, 6, 12, 18, and 24 months. Successful clinical outcomes were defined as ≥3 bowel movements weekly for ≥4 weeks, with ≤2 fecal incontinence episodes monthly, irrespective of laxative use.
  
  
  
  A total of 175 RB children (90 boys, mean age: 6.7 years) were matched to 350 controls. Mean duration of constipation symptoms before intake in the RB group was significantly longer compared with controls (3.7 vs 0.4 years, P < 0.001). By 24 months, the cumulative percentage of children achieving at least 1 period of successful outcome was significantly higher in the control group compared with RB population (73% vs 24%, P < 0.001). Multivariate analysis revealed that younger age (P = 0.001, odds ratio 0.87) and shorter duration of constipation before RB (P = 0.03, odds ratio 0.45) were significant predictors of successful outcome.
  
  
  
  Only one-quarter of patients with severe constipation achieved successful outcome during 2-year follow-up. Younger age and shorter duration of constipation at time of biopsy were predictors of successful outcomes, emphasizing the importance of early diagnosis and initiation of treatment in this population.
authors.affiliation: *Division of Pediatric Gastroenterology, Floating Hospital for Children at Tufts Medical Center and Tufts Medical School †Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School ‡Biostatistics Unit, Massachusetts General Hospital §Division of Pediatric Surgery, Massachusetts General Hospital for Children and Harvard Medical School ||Division of Pediatric GI and Harvard Medical School, Massachusetts General Hospital for Children ¶Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Khoa
authors.initials: K
authors.lastname: Tran
authors.forename: Kyle
authors.initials: K
authors.lastname: Staller
authors.forename: Eric
authors.initials: E
authors.lastname: Macklin
authors.forename: Allan
authors.initials: A
authors.lastname: Goldstein
authors.forename: Jaime
authors.initials: J
authors.lastname: Belkind-Gerson
authors.forename: Braden
authors.initials: B
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D054368:Laxatives / Q000627:therapeutic use*; D008297:Male; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D054368:Laxatives