Elsevier

The Journal of Pediatrics

Volume 198, July 2018, Pages 121-130.e6
The Journal of Pediatrics

Original Articles
Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.jpeds.2018.02.029Get rights and content

Objective

To systematically review the literature regarding the epidemiology of functional constipation and functional nonretentive fecal incontinence (FNRFI) in children. Secondary objectives were to assess the geographical, age, and sex distribution of functional constipation and FNRFI and to evaluate associated factors.

Study design

The Cochrane Library, PubMed, and Embase databases were searched from 2006 until September 2017. The following inclusion criteria were applied: (1) prospective studies of population-based samples; (2) reporting on the prevalence of functional constipation or FNRFI according to the Rome III/IV criteria; (3) in children aged 0-18 years; and (4) published in full manuscript form. A quality assessment of included studies was conducted. Random effect meta-analyses with meta-regression analyses of study characteristics were performed.

Results

Thirty-seven studies were included, of which 35 reported on the prevalence of functional constipation and 15 of FNRFI. The reported prevalence of functional constipation ranged from 0.5% to 32.2%, with a pooled prevalence of 9.5% (95% CI 7.5-12.1). The prevalence of FRNFI ranged from 0.0% to 1.8%, with a pooled prevalence of 0.4% (95% CI 0.2-0.7). The prevalence of functional constipation was 8.6% in boys compared with 8.9% in girls (OR 0.99, 95% CI 0.9-1.4). Geographical location, dietary habits, and exposure to stressful life events were reported to be associated with the prevalence of functional constipation. Data on FNRFI were scarce and no associated factors were identified.

Conclusion

Functional constipation is common in childhood and is associated with geographical location, lifestyle factors, and stressful life events. FNRFI is rare, and no associated factors were identified.

Section snippets

Methods

The Cochrane Library, PubMed, and Embase databases were searched from 2006 (the year the Rome III criteria were published) up to September 2017. The protocol including the full search strategy is provided in Appendix 1 (available at www.jpeds.com). To identify additional studies, reference lists of review articles and included studies were searched manually. No language limits were used. This systematic review was not registered.

Articles were eligible for inclusion if they met the following

Results

A total of 4146 search results were identified (Figure). After we screened titles and abstracts, 218 full-text articles were assessed for eligibility and finally 37 articles were included.18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54 Reasons for exclusion are presented in the Figure. Of the 37 articles included in the qualitative analysis, 35 studies were included in the meta-analysis. One birth

Discussion

Our systematic review provides a meta-analysis that revealed a pooled functional constipation prevalence of 9.5% and a pooled FNRFI prevalence of 0.4% in children worldwide according to the Rome III criteria. No epidemiological stuies using the Rome IV criteria were identified. Pooled data analysis did not reveal a sex-related or age-related predominance for functional constipation; for FNRFI, this analysis was not performed because of scarcity of data. Significant geographic differences were

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    M.V. received financial support from the Catharine van Tussenbroek fund (Nell Ongerboer Fund). The other authors declare no conflicts of interest.

    *

    Contributed equally.

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