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Glucomannan) Is Beneficial in the Treatment of Childhood Constipation

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Glucomannan) Is Beneficial in the Treatment of Childhood Constipation Fiber (Glucomannan) Is Beneficial in the Treatment of Childhood Constipation Vera Loening-Baucke, MD*; Erasmo Miele, MD‡; and Annamaria Staiano, MD‡ ABSTRACT. Objective. Constipation and encopresis States (70%) and Italy (71%). Successful treatment (phy- are common problems in children. Still today, the role of sician rating) and improvement (parent rating) were in- fiber in the treatment of chronic constipation in child- dependent of low or acceptable initial fiber intake. The hood is controversial. The aim of our study was to eval- duration of chronic constipation ranged from 0.6 to 10 uate whether fiber supplementation is beneficial in the years (mean: 4.0 ؎ 2.5 years). Duration of constipation treatment of children with functional constipation with did not predict response to fiber treatment. Children or without encopresis. We used glucomannan as the fiber with constipation only were significantly more likely to supplement. be treated successfully with fiber (69%) than those with Methods. We evaluated the effect of fiber (glucoman- constipation and encopresis (28%). nan, a fiber gel polysaccharide from the tubers of the Conclusion. We found glucomannan to be beneficial Japanese Konjac plant) and placebo in children with in the treatment of constipation with and without enco- chronic functional constipation with and without enco- presis in children. Symptomatic children who were al- presis in a double-blind, randomized, crossover study. ready on laxatives still benefited from the addition of After the initial evaluation, the patients were disim- fiber. Therefore, we suggest that we continue with the pacted with 1 or 2 phosphate enemas if a rectal impaction recommendation to increase the fiber in the diet of con- was felt during rectal examination. Patients continued stipated children with and without encopresis. Pediatrics with their preevaluation laxative. No enemas were given 2004;113:e259–e264. URL: http://www.pediatrics.org/cgi/ during each treatment period. Fiber and placebo were content/full/113/3/e259; fiber, glucomannan, constipation, given as 100 mg/kg body weight daily (maximal 5 g/day) encopresis, children. with 50 mL fluid/500 mg for 4 weeks each. Parents were asked to have children sit on the toilet 4 times daily after meals and to keep a stool diary. Age, frequency of bowel ABBREVIATION. BM, bowel movement. movements into the toilet and into the undergarment, presence of abdominal pain, dietary fiber intake, medi- cations, and the presence of an abdominal and/or a rectal onstipation and encopresis are common prob- fecal mass were recorded on a structured form at the time lems in children. Constipation is a symptom of recruitment and 4 weeks and 8 weeks later. Children Cand not a disease. As a symptom, constipation were rated by the physician as successfully treated when can be caused by many different disorders. In chil- they had >3 bowel movements/wk and <1 soiling/3 dren, constipation is mostly attributable to functional weeks with no abdominal pain in the last 3 weeks of each constipation, which is constipation not attributable to 4-week treatment period. Parents made a global assess- organic and anatomic causes or intake of medication. ments to whether they believed that the child was better Often constipation is combined with encopresis. En- during the first or second treatment period. Results. Forty-six chronically constipated children copresis is the involuntary loss of formed, semi- were recruited into the study, but only 31 children com- formed, or liquid stool into the child’s underwear in pleted the study. These 31 children (16 boys and 15 girls) the presence of functional constipation after the child were 4.5 to 11.7 years of age (mean: 7 ؎ 2 years). All has reached the age of 4 years.1 children had functional constipation; in addition, 18 had The common clinical history of children with encopresis when recruited for the study. No significant chronic constipation and encopresis includes a pro- side effects were reported during each 4-week treatment longed period, often of many years’ duration, of period. Significantly fewer children complained of ab- infrequent and abnormal stools. The frequency of dominal pain and more children were successfully encopresis can range from several times a week to treated while on fiber (45%) as compared with placebo Ͼ treatment (13%). Parents rated significantly more chil- 10 times a day. Encopresis is, in most children, a dren (68%) as being better on fiber versus 13% as being complication of long-standing constipation. A prev- better on placebo. The initial fiber intake was low in 22 alence rate of 34% for constipation has been reported (71%) children. There was no difference in the percentage from Great Britain.2 Most often constipation is short- of children with low fiber intake living in the United lived and of little consequence; however, chronic constipation most often follows an inadequately From the *University of Iowa, Iowa City, Iowa; and ‡University of Naples, managed acute problem. Five percent of the other- Federico II, Naples, Italy. wise healthy 4- to 11-year-old school children in Received for publication Nov 20, 2003; accepted Dec 1, 2003. Great Britain had chronic constipation lasting for Ͼ6 Reprint requests to (V.L.-B.) University of Iowa Hospitals and Clinics, months.2 At the time of diagnosis, most children Department of Pediatrics, JCP 2555, 200 Hawkins Dr, Iowa City, IA 52242. E-mail: [email protected] present with a very large amount of stool in a dilated PEDIATRICS (ISSN 0031 4005). Copyright © 2004 by the American Acad- rectal ampulla. Approximately half of the patients emy of Pediatrics. have an abdominal fecal mass present, a physical http://www.pediatrics.org/cgi/content/full/113/3/Downloaded from www.aappublications.org/newse259 byPEDIATRICS guest on OctoberVol. 1, 2021 113 No. 3 March 2004 e259 finding that indicates a more severe form of stool able to accomplish this. Stool consistency was assessed rating the stool consistency as hard like rocks, pellets ϭ 0, firm ϭ 1, soft like retention. ϭ ϭ ϭ In the early 1970s, Burkitt et al3 had observed a banana 2, loose like milkshake 3, and watery 4. relationship between stool volume and fiber inges- Treatment tion in Africans. Burkitt speculated that the frequent After the initial evaluation, the patients were disimpacted with occurrence of constipation among Western societies 1 or 2 phosphate enemas if a rectal impaction was felt during rectal was the result of reduced dietary fiber intake.3 There- examination. Patients continued with their preevaluation laxative. fore, treatment programs for the majority of children After informed consent was signed, patients were randomized by with chronic constipation with or without encopresis envelope into 1 of 2 treatment arms for the double-blind, random- ized, crossover study. Blinding was done by having the medica- have included increase in dietary fiber, in addition to tion labeled glucomannan A and glucomannan B with the code 4–10 scheduled toilet sittings and daily laxatives. kept by the company until the study was completed and analyzed. Usual advise for dietary changes has been reduction Glucomannan A was a capsule containing maltodextrins as pla- in milk intake and increase in dietary fiber intake. cebo. Glucomannan B was a capsule containing glucomannan, a Dietary fiber treatments have ranged from raw foods polysaccharide of d-glucose and d-mannose, equal to 450 mg of alimentary fiber. Group 1 received placebo first for 4 weeks and such as fruits and vegetables, to synthetic prepara- then glucomannan for 4 weeks. Group 2 received glucomannan tions such as guar gum and pectin fiber. However, to first and then placebo. Placebo and glucomannan (DicoFarm, be effective, these fiber agents have to be ingested in Rome, Italy) were given as 100 mg/kg body weight daily (maxi- large quantities, which most children find unaccept- mal 5 g/day), rounded to the nearest 500 mg, because each cap- able. Recent reports have shown that glucomannan, a sule contained 500 mg. Each capsule was either opened and sprin- ␤ kled on food given with 50 mL of fluid per capsule; given as a fiber gel polysaccharide (composed of -1,4-linked solution, whereby the content of each 500-mg capsule was mixed d-glucose and d -mannose) prepared from the tubers with 50 mL of fluid of the child’s choice; or swallowed as a capsule of the Japanese Konjac plant, is a soluble fiber, can be with 50 mL of fluid for each capsule. In addition, parents were taken in much smaller quantities than guar gum or instructed to have the child sit on the toilet 4 times daily after 11,12 meals and to keep a stool diary. pectin, and has no unpleasant smell or taste. Dry The patients and their parents kept diary sheets during the 8 glucomannan powder is hygroscopic and forms a weeks of study. They recorded daily each BM, soiling episode, pectin-like gel in contact with water. abdominal pain episode, and medication used and reported at the The aim of our study was to evaluate whether fiber end of each treatment period the associated subjective symptoms such as stool consistency, new occurrence of abdominal pain, supplementation is beneficial in the treatment of chil- bloating, abdominal distention, excessive gas, or diarrhea. No dren with functional constipation. We used gluco- enemas were given during each treatment period. mannan as the fiber supplement. Follow-up Visits METHODS At the 4-week and 8-week visits, the interim history was as- Subjects sessed; stool diaries were collected and evaluated; and a physical examination, including a rectal examination, was performed. En- Ն Children who had chronic functional constipation for 6 ema treatment was given when a rectal impaction was felt during Ͼ months with or without encopresis and were 4 years of age were the rectal examination.
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