Arzu Meltem DEMIR, Zarife KULOĞLU, Aydan KANSU

Çocukluk Çağında Fonksiyonel Kabızlık Tedavisi: Senna, Trimebutin ve Laktülozun Karşılaştırılması

Amaç: Çocukluk çağında kabızlık yaygın olup sıklıkla fonksiyoneldir. Çocuklarda fonksiyonel kabızlık tedavisinde kullanılan ilaçlarla ilgili bilgiler sınırlıdır. Amacımız fonksiyonel kabızlık (FK) veya fonksiyonel fekal inkontinans (FFİ) olan çocuklarda senna, trimebutin ve laktülozun etkinliğini değerlendirmektir. Gereç ve Yöntemler: Roma III kriterlerine göre fonksiyonel kabızlık (FK) veya fonksiyonel fekal inkontinans (FFI) tanısı koyulan, laktüloz (n=36), senna (n=29) ve trimebutin (n=33) tedavisi alan hastalar (2-18 yaş) alındı. Hastalar semptomlarıyla ilgili 0-5 Likert anket ölçeğini doldurdular. Dışkı kıvamı (DK) Bristol Dışkı Skalasına göre değerlendirildi. Tedaviye uyum, tolerans ve yan etkiler kaydedildi. Klinikteki düzelme (KD) değerlendirildi, farmakoekonomik inceleme yapıldı. Bulgular: Senna grubundaki KD anlamlı ölçüde yüksekti (p=0.036). Senna DK'da en fazla iyileşme sağladı (p<0.001) ve fekal inkontinansı azalttı (p=0.039). Karında distansiyon, karın ağrısı, bulantı/kusma ve anal fissür trimebutinle düzeldi (p<0.05). Senna ve trimebutin ağrılı defekasyonu ve dışkı tutmayı azalttı. Laktüloz iştahsızlık ve anal fissürü iyileştirdi. Senna en fazla maliyet etkinliği olan ilaçtı. Tartışma: Kabızlık için tedavi seçenekleri ağırlıklı görülen semptoma göre dizayn edilmelidir. Senna obesite ve/veya fekal inkontinans olan çocuklarda başlangıç tedavisi olarak önerilebileceği gibi, trimebutin karında distansiyon, karın ağrısı, bulantı/kusma veya anal fissür olanlarda, laktüloz iştahsızlık veya anal fissür olanlarda ayrı olarak seçilebilir.

Anahtar Kelimeler:

Kabızlık, Laktüloz, Senna, Trimebutin

Treatment of Childhood Functional Constipation: Comparison of Senna, Trimebutine and Lactulose

Objective: Childhood constipation is common and usually functional. Data for the drugs used in maintenance therapy of functional constipation is limited in childhood. Our aim was to evaluate the efficacy of senna, trimebutine and lactulose in children with functional constipation (FC) or functional fecal incontinence (FFI). Material and Methods: Patients (2-18 years old) diagnosed as FC or FFI according to Rome III criteria who were treated with lactulose (n=36), senna (n=29) and trimebutine (n=33)were included. Patients completed a 0-5 Likert scale questionnaire about their symptoms. Stool consistency (SC) was evaluated by Bristol Stool Chart. Compliance and tolerance to treatment and side effects were recorded. Clinical improvement (CI) and pharmacoeconomic evaluation were performed.Results: CI in the senna group was significantly higher (p=0.036). Senna showed the highest improvement in SC (p<0.001) and decreased fecal incontinence (p=0.039). Abdominal distention, abdominal pain, nausea/vomiting and anal fissure were improved by trimebutine (p<0.05). Both senna and trimebutine decreased painful defecation and stool witholding. Lactulose improved anorexia and anal fissure. Senna was the most cost-effective drug. Conclusion: Treatment options for constipation should be tailored according to the predominant symptom. Senna may be recommended as the initial treatment for children with obesity and/or fecal incontinence, trimebutine in patients with abdominal distention, abdominal pain, nausea/vomiting or anal fissure, lactulose in patients with anorexia or anal fissure, respectively.

Keywords:

Constipation, Lactulose, Senna, Trimebutin,

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