Probiotics in Children with Chronic Constipation

Purpose: To evaluate the efficacy of probiotics (Lactobacillus casei rhamnosus, Lcr35) for treating children with chronic constipation and to compare its effect with magnesium oxide (MgO) and placebo.

Methods: This double-blind placebo-controlled, randomized study enrolled forty-five children under 10 years old with chronic constipation. Children with organic causes of constipation were excluded. They were randomly assigned to receive Lcr35 (8x108 CFU/day)(n=18), MgO (50mg/kg/day)(n=18) or placebo (n=9) orally twice daily for 4 weeks. Lactulose (1 cc/kg/day) was allowed to use when no stool passage was noted for 3 days. Glycerin enema was used only when no defecation was noted for above 5 days or abdominal pain was suffered due to stool impaction. Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora. Comparisons of the frequency of defecation, consistence of stool and the use of lactulose or enema were made among the three groups.

Results: The patients who received MgO or probiotics had a higher defecation frequency (p=0.03), less use of glycerin enema (p=0.04) and less hard stool or bloody stool (p=0.01) than placebo group. There was no difference between MgO and probiotics groups in the above three comparisons. Abdominal pain was less occurred in probiotics group than in both the MgO and the placebo groups (p=0.03). There was no significant difference among the three groups in the use of lactulose, episodes of fecal soiling, and change of appetite.

Conculsion: Lcr35 was effective to treat children with chronic constipation. There is no difference in efficacy between MgO and Lcr35, but less abdominal pain
occurs when using Lcr35.