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June 4, 2026BMJ Paediatrics Open0 citationsOpen Access

Refractory/therapy-resistant/intractable constipation in children

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CVCarlos Alberto Velasco-BenítezWCWilson Daza CarreñoMCMichelle Higuera Carrillo

Key Points

  • The aim was to define intractable constipation as understood by Latin and Ibero-American paediatric gastroenterologists.
  • Administered a questionnaire to 429 paediatric gastroenterologists
  • Analyzed data with univariate and bivariate statistical methods
  • Calculated odds ratios (ORs) and 95% confidence intervals (CIs) for findings.
  • 94.6% of respondents defined intractable constipation based on lower bowel frequency despite optimal treatment.
  • 51.0% indicated a treatment failure period of 2–3 months; 43.1% selected tertiary care before diagnosis.
  • Spanish gastroenterologists preferred the term treatment-resistant constipation (OR=1.96; 95% CI 1.08 to 3.55; p=0.0157).

Abstract

Introduction A better understanding of key concepts is required to properly characterise intractable constipation (IC). We aimed to determine how IC is defined by Latin and Ibero-American paediatric gastroenterologists. Methods A questionnaire was administered to evaluate concepts supporting the definition and use of a unified term for IC. The collected data were analysed using univariate and bivariate analyses. ORs with their corresponding 95% CIs were calculated, p values <0.05 were statistically significant. Results A total of 429 paediatric gastroenterologists participated: 45.7% Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) members (group 1), 16.3% Ibero-American LASPGHAN members (group 2) and 38.0% non-LASPGHAN affiliates (group 3). Most respondents considered lower bowel frequency despite receiving ‘optimal medical treatment’ (94.6%), with 51.0% indicating a period of 2–3 months; defined ‘prior treatment failure’ as the use of two laxatives (51.7%); selecting the tertiary level care prior to diagnosis (43.1%); wished to include the term ‘optimal medical treatment’ for diagnostic criteria (93.0%); believed follow-up should be carried out by a paediatrician/specialist (86.7%) and preferred the term refractory constipation (86.7%). When comparing group 1 versus group 2, the Spanish group preferred the term ‘treatment-resistant constipation’ (OR=1.96; 95% CI 1.08 to 3.55; p=0.0157). Conclusions Latin and Ibero-American paediatric gastroenterologists prefer replacing the term ‘IC’ with ‘refractory/treatment-resistant constipation’ defined as a form of paediatric FC characterised by the persistence of clinically relevant symptoms despite optimal conventional medical treatment, appropriately prescribed, supervised and adhered to for a minimum period of 2–3 months, after structural, neurological and metabolic organic causes have been excluded.

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Cite This Study

Velasco-Benítez et al. (2026) studied this question.

synapsesocial.com/papers/6a21164cd499ed480b16f3eahttps://doi.org/10.1136/bmjpo-2026-004656
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