GUT MOTILITY

PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial

W Voskuijl¹, F de Lorijn¹, W Verwijs², P Hogeman³, J Heijmans¹, W Mäkel⁴, J Taminiau¹, M Benninga¹

¹ Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, the Netherlands
² Department of Paediatrics, Hofpoort Ziekenhuis, Woerden, the Netherlands
³ Department of Paediatrics, Meander Medisch Centrum, Amersfoort, the Netherlands
⁴ MediServ BV/Clinical Research facilities BV, Schaijk, the Netherlands

Correspondence to:
Correspondence to:
Dr W P Voskuijl
Department of Paediatric Gastroenterology and Nutrition, Room C2-312, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; w.p.voskuijl{at}amc.nl

Background: Recently, polyethylene glycol (PEG 3350) has been suggested as a good alternative laxative to lactulose as a treatment option in paediatric constipation. However, no large randomised controlled trials exist evaluating the efficacy of either laxative.

Aims: To compare PEG 3350 (Transipeg: polyethylene glycol with electrolytes) with lactulose in paediatric constipation and evaluate clinical efficacy/side effects.

Patients: One hundred patients (aged 6 months–15 years) with paediatric constipation were included in an eight week double blinded, randomised, controlled trial.

Methods: After faecal disimpaction, patients <6 years of age received PEG 3350 (2.95 g/sachet) or lactulose (6 g/sachet) while children 6 years started with 2 sachets/day. Primary outcome measures were: defecation and encopresis frequency/week and successful treatment after eight weeks. Success was defined as a defecation frequency 3/week and encopresis 1 every two weeks. Secondary outcome measures were side effects after eight weeks of treatment.

Results: A total of 91 patients (49 male) completed the study. A significant increase in defecation frequency (PEG 3350: 3 pre v 7 post treatment/week; lactulose: 3 pre v 6 post/week) and a significant decrease in encopresis frequency (PEG 3350: 10 pre v 3 post/week; lactulose: 8 pre v 3 post/week) was found in both groups (NS). However, success was significantly higher in the PEG group (56%) compared with the lactulose group (29%). PEG 3350 patients reported less abdominal pain, straining, and pain at defecation than children using lactulose. However, bad taste was reported significantly more often in the PEG group.

Conclusions: PEG 3350 (0.26 (0.11) g/kg), compared with lactulose (0.66 (0.32) g/kg), provided a higher success rate with fewer side effects. PEG 3350 should be the laxative of first choice in childhood constipation.

Abbreviations: PEG 3350, polyethylene glycol 3350

Keywords: constipation; children; lactulose; polyethylene glycol; randomised controlled trial

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