TY - JOUR
T1 - Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation
T2 - A Prospective Cohort study
AU - Baaleman, Desiree F.
AU - Hallagan, Alexandra
AU - Halleran, Devin R.
AU - Orsagh-Yentis, Danielle K.
AU - Levitt, Marc A.
AU - Wood, Richard J.
AU - Benninga, Marc A.
AU - Bali, Neetu
AU - Vaz, Karla H.
AU - Yacob, Desale
AU - di Lorenzo, Carlo
AU - Lu, Peter L.
N1 - Publisher Copyright: © 2022 Georg Thieme Verlag. All rights reserved.
PY - 2022/5/2
Y1 - 2022/5/2
N2 - Introduction Anal sphincter botulinum toxin injections (BTIs) are used in the treatment of children with severe defecation disorders, including Hirschsprung disease (HD) and functional constipation (FC). Our objective was to evaluate the outcomes of BTI in these children. Materials and Methods We performed a prospective cohort study of children undergoing BTI from July 2018 to December 2018. We recorded perceived effect of the BTI, including effectiveness ranging from 0 (not at all effective) to 4 (extremely effective). In addition, we recorded symptoms and the Cleveland Clinic Constipation Score (CCCS). Data were collected at baseline and at 2 weeks, 2 months, and 4 months post-injection. Results Forty-two children (HD = 25, FC = 17) were included in the study (median age 4.3 years, IQR 2.4-7.2, 52% male). Twenty-two (88%) children with HD and eight (47%) children with FC had previously undergone a BTI. BTIs were perceived effective in 16 (76%) and 12 (71%) children with HD and eight (47%) and seven (47%) children with FC at 2 weeks and 2 months follow-up, respectively. Effectiveness was not rated differently between groups except at the 2-month follow-up, when patients with HD rated the BTI more effective compared to those with FC (median 2 [HD] vs. median 1 [FC], p = 0.022). Over the course of the study, 17/39 (44%) children reported self-limiting adverse effects such as fecal incontinence and pain at the injection site. Conclusion Anal sphincter BTIs can be effective in the treatment of constipation in both HD and FC patients.
AB - Introduction Anal sphincter botulinum toxin injections (BTIs) are used in the treatment of children with severe defecation disorders, including Hirschsprung disease (HD) and functional constipation (FC). Our objective was to evaluate the outcomes of BTI in these children. Materials and Methods We performed a prospective cohort study of children undergoing BTI from July 2018 to December 2018. We recorded perceived effect of the BTI, including effectiveness ranging from 0 (not at all effective) to 4 (extremely effective). In addition, we recorded symptoms and the Cleveland Clinic Constipation Score (CCCS). Data were collected at baseline and at 2 weeks, 2 months, and 4 months post-injection. Results Forty-two children (HD = 25, FC = 17) were included in the study (median age 4.3 years, IQR 2.4-7.2, 52% male). Twenty-two (88%) children with HD and eight (47%) children with FC had previously undergone a BTI. BTIs were perceived effective in 16 (76%) and 12 (71%) children with HD and eight (47%) and seven (47%) children with FC at 2 weeks and 2 months follow-up, respectively. Effectiveness was not rated differently between groups except at the 2-month follow-up, when patients with HD rated the BTI more effective compared to those with FC (median 2 [HD] vs. median 1 [FC], p = 0.022). Over the course of the study, 17/39 (44%) children reported self-limiting adverse effects such as fecal incontinence and pain at the injection site. Conclusion Anal sphincter BTIs can be effective in the treatment of constipation in both HD and FC patients.
KW - Hirschsprung disease
KW - child
KW - constipation
KW - fecal incontinence
UR - http://www.scopus.com/inward/record.url?scp=85134745411&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/s-0042-1751048
DO - https://doi.org/10.1055/s-0042-1751048
M3 - Article
C2 - 35853466
SN - 0939-7248
VL - 33
SP - 241
EP - 248
JO - European journal of pediatric surgery
JF - European journal of pediatric surgery
IS - 3
ER -