Systematic literature review and meta-analysis on therapeutic management of faecal impaction in the paediatric population.

Background: To date, there is no universally accepted or standardised protocol for management of faecal impaction (FI) in paediatric population. If left untreated, it can lead to serious consequences for the health and well-being of the child. We set out to determine the effectiveness and safety of existing therapeutic interventions for FI in children and identify any gaps occurring in current research.

Methods: We have performed a systematic literature review on treatment of FI in paediatric population in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We have included randomised controlled trials (RCTs) on all interventions for children (0-18 years old) with FI on background of functional constipation and excluded children with organic causes of FI. Our primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. We have performed a meta-analysis of the data.

Results: Out of 13 341 records identified, only eight RCTs met our inclusion criteria with a total of 513 participants randomised. The diagnosis of functional constipation was mainly made using ROME III criteria. The diagnosis of FI varied from study to study. We identified several intervention groups based on our search. Our analysis has shown that there is no difference probably between PEG (Polyethylene Glycol).and PEG with sodium picosulphate, and there may be no difference between PEG and rectal enema for treatment success, but enema may lead to greater stool frequency. No other studies produced anything other than very low certainty evidence.

Conclusions: No therapeutic approach was superior to others, with evidence limited by significant clinical heterogeneity related to varying patient and clinical factors, different outcome measures and limited study numbers. More high-quality research is needed to determine effective strategies for FI. Moreover, a consensus should be reached regarding the definition and diagnosis of FI as based on that a standardised approach to patient's care can be determined.