TREATMENT OF INTRACTABLE CONSTIPATION IN CHILDREN - EXPERIENCE WITH CISAPRIDE

To establish whether cisapride is beneficial in children with intracta ble constipation, an open trial was performed. Chronically constipated children who had failed at least 12 weeks of medical therapy received cisapride at a dose of 0.2 mg/kg/dose TID for 12 weeks. Children with pelvic floor dyssynergia were excluded. Patients were followed prospe ctively for at least 12 months. Thirty children were initially enrolle d, and 27 (14 boys, 13 girls) completed the study. At the end of 12 we eks of cisapride treatment, there was a significant increase in the nu mber of bowel movements per week (1.43 +/- 0.52 to 6.48 +/- 4.16; p < 0.05) and significant decreases in the number of accidents per day (2. 86 +/- 2.71 to 0.52 +/- 1.23; p < 0.05) and doses of laxatives used pe r week (14.33 +/- 5.84 to 3.37 +/- 7.10; p < 0.05). Encopresis disappe ared in 65.2% of cases (p < 0.0001) and improved in 26%. Sixty-nine pe rcent of the patients stopped using laxatives (p < 0.001). After 12 we eks 18 patients (66.6%) were asymptomatic, seven (25.9%) showed some i mprovement in bowel movement frequency and number of accidents, and tw o (7.4%) showed no improvement. The cisapride was well tolerated. Afte r long-term follow-up (20 +/- 9.8 months), 37% of patients had recover ed (asymptomatic and off laxatives and cisapride) and 29.6% were still asymptomatic but were using laxatives or cisapride. There were no dif ferences in baseline characteristics between recovered and nonrecovere d patients. We conclude that cisapride is effective in the treatment o f some children with intractable constipation without pelvic floor dys synergia.