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Intrarectal Electromotive Botulinum Toxin Type a Administration in Children With Intractable Constipation: A Randomized Clinical Trial Publisher Pubmed



Kajbafzadeh AM1 ; Sharifirad L2 ; Nabavizadeh B1 ; Ladiseyedian SS1 ; Alijani M1 ; Farahmand F3 ; Motamed F3 ; Alimadadi H3 ; Fallahi A3 ; Fallahi GH3
Authors
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Authors Affiliations
  1. 1. Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Physical Therapy, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Pediatric Gastroenterology and Hepatology Research Center, Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran

Source: American Journal of Gastroenterology Published:2020


Abstract

INTRODUCTION:Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection.METHODS:From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire.RESULTS:After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively).DISCUSSION:BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia. © 2020 Wolters Kluwer Health. All rights reserved.