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Richard B Colletti - One of the best experts on this subject based on the ideXlab platform.
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guideline for the diagnosis and treatment of celiac disease in children recommendations of the north american society for Pediatric Gastroenterology hepatology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2005Co-Authors: Ivor D Hill, Gregory S Liptak, Richard B Colletti, Stefano Guandalini, Alessio Fasano, Edward J Hoffenberg, Martha H Dirks, Karoly Horvath, Joseph A Murray, Mitchell PivorAbstract:Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in children and adolescents with gastrointestinal symptoms, dermatitis herpetiformis, dental enamel defects, osteoporosis, short stature, delayed puberty and persistent iron deficiency anemia and in asymptomatic individuals with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, selective immunoglobulin (Ig)A deficiency and first degree relatives of individuals with celiac disease. The Celiac Disease Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnosis and treatment of Pediatric celiac disease based on an integration of a systematic review of the medical literature combined with expert opinion. The Committee examined the indications for testing, the value of serological tests, human leukocyte antigen (HLA) typing and histopathology and the treatment and monitoring of children with celiac disease. It is recommended that children and adolescents with symptoms of celiac disease or an increased risk for celiac disease have a blood test for antibody to tissue transglutaminase (TTG), that those with an elevated TTG be referred to a Pediatric gastroenterologist for an intestinal biopsy and that those with the characteristics of celiac disease on intestinal histopathology be treated with a strict gluten-free diet. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the diagnosis and treatment of celiac disease in children and adolescents.
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guideline for the evaluation of cholestatic jaundice in infants recommendations of the north american society for Pediatric Gastroenterology hepatology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2004Co-Authors: Virginia Moyer, Richard B Colletti, Deborah K Freese, Peter F Whitington, Alan D Olson, Fred Brewer, Melvin B HeymanAbstract:For the primary care provider, cholestatic jaundice in infancy, defined as jaundice caused by an elevated conjugated bilirubin, is an uncommon but potentially serious problem that indicates hepatobiliary dysfunction. Early detection of cholestatic jaundice by the primary care physician and timely, accurate diagnosis by the Pediatric gastroenterologist are important for successful treatment and a favorable prognosis. The Cholestasis Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnostic evaluation of cholestatic jaundice in the infant. The Cholestasis Guideline Committee, consisting of a primary care Pediatrician, a clinical epidemiologist (who also practices primary care Pediatrics), and five Pediatric gastroenterologists, based its recommendations on a comprehensive and systematic review of the medical literature integrated with expert opinion. Consensus was achieved through the Nominal Group Technique, a structured quantitative method. The Committee examined the value of diagnostic tests commonly used for the evaluation of cholestatic jaundice and how those interventions can be applied to clinical situations in the infant. The guideline provides recommendations for management by the primary care provider, indications for consultation by a Pediatric gastroenterologist, and recommendations for management by the Pediatric gastroenterologist. The Cholestasis Guideline Committee recommends that any infant noted to be jaundiced at 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin. However, breast-fed infants who can be reliably monitored and who have an otherwise normal history (no dark urine or light stools) and physical examination may be asked to return at 3 weeks of age and, if jaundice persists, have measurement of total and direct serum bilirubin at that time. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the evaluation of cholestatic jaundice in infants. The American Academy of Pediatrics has also endorsed these recommendations. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all patients with this problem.
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guidelines for evaluation and treatment of gastroesophageal reflux in infants and children recommendations of the north american society for Pediatric Gastroenterology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2001Co-Authors: Colin D Rudolph, Lynnette Mazur, Gregory S Liptak, Robert D Baker, John T Boyle, Richard B Colletti, William T Gerson, Steven L WerlinAbstract:Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common Pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. The GER Guideline Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated a clinical practice guideline for the management of Pediatric GER. The GER Guideline Committee, consisting of a primary care Pediatrician, two clinical epidemiologists (who also practice primary care Pediatrics) and five Pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. The Committee examined the value of diagnostic tests and treatment modalities commonly used for the management of GERD, and how those interventions can be applied to clinical situations in the infant and older child. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management and indications for consultation by a specialist. The guideline also provides recommendations for management by the Pediatric gastroenterologist. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology and Nutrition on the evaluation and treatment of gastroesophageal reflux in infants and children. The American Academy of Pediatrics has also endorsed these recommendations. The recommendations are summarized in a synopsis within the article. This review and recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
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constipation in infants and children evaluation and treatment a medical position statement of the north american society for Pediatric Gastroenterology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 1999Co-Authors: Susan S Baker, Gregory S Liptak, Richard B Colletti, Carlo Di Lorenzo, Joseph M Croffie, Walton L Ector, Samuel NurkoAbstract:Background Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common Pediatric problem encountered by both primary and specialty medical providers. Methods The Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated clinical practice guidelines for the management of Pediatric constipation. The Constipation Subcommittee, consisting of two primary care Pediatricians, a clinical epidemiologist, and Pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. Results The Subcommittee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than 1 year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management, and indications for consultation by a specialist. The Constipation Subcommittee also provided recommendations for management by the Pediatric gastroenterologist. Conclusions This report, which has been endorsed by the Executive Council of the North American Society for Pediatric Gastroenterology and Nutrition, has been prepared as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. It is not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
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a position paper of the north american society for Pediatric Gastroenterology and nutrition Pediatric Gastroenterology workforce survey and future supply and demand
Journal of Pediatric Gastroenterology and Nutrition, 1998Co-Authors: Richard B Colletti, Harland S Winter, William J Klish, Ronald J Sokol, Frederick J Suchy, Peter R DurieAbstract:Background: The North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) performed a Workforce Survey to determine the current number and distribution of Pediatric gastroenterologists in the United States and Canada and to estimate the supply and demand in the future in the United States. Methods: The response rate was more than 90%. There were 624 Pediatric gastroenterologists in the United States, and 48 in Canada. Results: There were 2.4 Pediatric gastroenterologists per million population in the United States, ranging from 3.1 per million in the Northeast to 1.9 per million in the West, and 1.6 per million in Canada. In the United States, fewer than 5 Pediatric gastroenterologists retire each year, but more than 40 fellows per year complete training. In the United States, 30% of Pediatric gastroenterologists believe there is already an excess supply ; only 12% believe there is a shortage (p < 0.001). Conclusions: If the number of fellows who complete training each year remains unchanged, in 10 years there will be more than 950 Pediatric gastroenterologists in the United States (3.3 per million population). At the same time, if the demand for Pediatric gastroenterologists remains 2.4 per million population, there will be a demand for only 675. If these assumptions are correct, it is necessary to reduce the number of fellows to be trained. Although it is difficult to predict future workforce needs reliably, we recommend that the number of fellowship positions in training programs in the United States be reduced by 50% to 75%. Changes in health care in the coming years will be challenging, and effective planning is necessary for Pediatric gastroenterologists to achieve their clinical, research, and educational missions.
Jeffery D Lewis - One of the best experts on this subject based on the ideXlab platform.
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medical child abuse munchausen syndrome by proxy multidisciplinary approach from a Pediatric Gastroenterology perspective
Current Gastroenterology Reports, 2017Co-Authors: Andrea Z Alipanzarella, Tamika J Bryant, Hannah Marcovitch, Jeffery D LewisAbstract:We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the Pediatric gastroenterologist many months before the diagnosis is made. Recent literature on medical child abuse, mostly case reports, is markedly limited, highlighting a need for increased research on this topic. Articles agree on the value of a multidisciplinary approach to these cases and the importance of involving professionals outside the hospital setting. Given the technology-dependent nature of our current society, the use of social media to aid in making the diagnosis has emerged. Review of the literature shows that there are almost no data on long-term outcomes of the victims or perpetrators of MSP. Making the diagnosis of MSP involves a complicated process of piecing together inconsistencies among the history, examination, and clinical presentation. The diagnosis remains difficult and is not often considered during early presentation of symptoms. Once MSP is suspected, it is important that a multidisciplinary process is used, incorporating input from various sources: the outpatient care structure, the hospital, non-hospital agencies such as school and child protective services, and non-traditional sources such as social media. In our experience, a multidisciplinary approach augmented by thoughtful inpatient surveillance provides the greatest opportunity for confirming or excluding MSP. Pediatric Gastroenterology is one of the most common services consulted prior to diagnosis and presents an opportunity for early intervention.
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medical child abuse munchausen syndrome by proxy multidisciplinary approach from a Pediatric Gastroenterology perspective
Current Gastroenterology Reports, 2017Co-Authors: Andrea Z Alipanzarella, Tamika J Bryant, Hannah Marcovitch, Jeffery D LewisAbstract:Purpose of Review We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the Pediatric gastroenterologist many months before the diagnosis is made.
Berthold Koletzko - One of the best experts on this subject based on the ideXlab platform.
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european society for Pediatric Gastroenterology hepatology and nutrition syllabus for subspecialty training moving towards a european standard
Journal of Pediatric Gastroenterology and Nutrition, 2014Co-Authors: Lorenzo Dantiga, Alexandra Papadopoulou, Yvan Vandenplas, M L Mearin, Emanuele Nicastro, Christos Tzivinikos, Hans Van Goudoever, Ulrich Baumann, Riccardo Troncone, Berthold KoletzkoAbstract:The requirements for and conditions of subspecialty training in paediatric Gastroenterology, hepatology, and nutrition (PGHN) are rather variable across European countries. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) agreed on a training syllabus aimed to foster a harmonised European PGHN curriculum and to support national PGHN societies and governmental bodies to promote and establish high-quality training programmes and levels of certification in the field. The document provides PGHN training prerequisites and objectives and the basic knowledge elements to acquire the clinical, technical, and management skills needed. Guidelines and instruments for self-monitoring and appraisal are proposed, and a logbook is available online. These training standards are a first step towards a European certification and recognition as a specialist in PGHN.
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public private collaboration in clinical research during pregnancy lactation and childhood joint position statement of the early nutrition academy and the european society for Pediatric Gastroenterology hepatology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2014Co-Authors: Berthold Koletzko, Sanja Kolacek, Marc A Benninga, Keith M Godfrey, Peter J Hornnes, Sibylle Koletzko, Michael J Lentze, Silke Mader, Fionnuala M Mcauliffe, Dick OepkesAbstract:This position statement summarises a view of academia regarding standards for clinical research in collaboration with commercial enterprises, focussing on trials in pregnant women, breast-feeding women, and children. It is based on a review of the available literature and an expert workshop cosponsored by the Early Nutrition Academy and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Clinical research collaborations between academic investigators and commercial enterprises are encouraged by universities, public funding agencies, and governmental organisations. One reason is a pressing need to obtain evidence on the effects, safety, and benefits of drugs and other commercial products and services. The credibility and value of results obtained through public-private research collaborations have, however, been questioned because many examples of inappropriate research practice have become known. Clinical research in pregnant and breast-feeding women, and in infants and children, raises sensitive scientific, ethical, and societal questions and requires the application of particularly high standards. Here we provide recommendations for the conduct of public-private research collaborations in these populations. In the interest of all stakeholders, these recommendations should contribute to more reliable, credible, and acceptable results of commercially sponsored trials and to reducing the existing credibility gap.
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obesity in children and adolescents working group report of the second world congress of Pediatric Gastroenterology hepatology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2004Co-Authors: Mauro Fisberg, Louise A Baur, Walter Chen, Alison G Hoppin, Berthold Koletzko, David Lau, Luis A Moreno, Tony Nelson, Richard S Strauss, Ricardo UauyAbstract:Latin American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (M.F., R.U.); Commonwealth Association of Paediatric Gastroenterology and Nutrition (L.B., T.N.); Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (W.C., D.L.); North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (A.H., R.S.); and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (B.K., L.M.).
Marc A Benninga - One of the best experts on this subject based on the ideXlab platform.
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evaluation and treatment of functional constipation in infants and children evidence based recommendations from espghan and naspghan
Journal of Pediatric Gastroenterology and Nutrition, 2014Co-Authors: Merit M Tabbers, Yvan Vandenplas, Samuel Nurko, Carlo Dilorenzo, Marjolein Y Berger, Christophe Faure, Miranda W Langendam, Annamaria Staiano, Marc A BenningaAbstract:Background: Constipation is a Pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. Methods: Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. Results: This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. Conclusions: This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
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public private collaboration in clinical research during pregnancy lactation and childhood joint position statement of the early nutrition academy and the european society for Pediatric Gastroenterology hepatology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 2014Co-Authors: Berthold Koletzko, Sanja Kolacek, Marc A Benninga, Keith M Godfrey, Peter J Hornnes, Sibylle Koletzko, Michael J Lentze, Silke Mader, Fionnuala M Mcauliffe, Dick OepkesAbstract:This position statement summarises a view of academia regarding standards for clinical research in collaboration with commercial enterprises, focussing on trials in pregnant women, breast-feeding women, and children. It is based on a review of the available literature and an expert workshop cosponsored by the Early Nutrition Academy and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Clinical research collaborations between academic investigators and commercial enterprises are encouraged by universities, public funding agencies, and governmental organisations. One reason is a pressing need to obtain evidence on the effects, safety, and benefits of drugs and other commercial products and services. The credibility and value of results obtained through public-private research collaborations have, however, been questioned because many examples of inappropriate research practice have become known. Clinical research in pregnant and breast-feeding women, and in infants and children, raises sensitive scientific, ethical, and societal questions and requires the application of particularly high standards. Here we provide recommendations for the conduct of public-private research collaborations in these populations. In the interest of all stakeholders, these recommendations should contribute to more reliable, credible, and acceptable results of commercially sponsored trials and to reducing the existing credibility gap.
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use of complementary and alternative medicine by Pediatric patients with functional and organic gastrointestinal diseases results from a multicenter survey
Pediatrics, 2008Co-Authors: Arine M Vlieger, Marjolein Blink, E Tromp, Marc A BenningaAbstract:OBJECTIVES. Many Pediatric patients use complementary and alternative medicine, especially when facing a chronic illness for which treatment options are limited. So far, research on the use of complementary and alternative medicine in patients with functional gastrointestinal disease has been scarce. This study was designed to assess complementary and alternative medicine use in children with different gastrointestinal diseases, including functional disorders, to determine which factors predicted complementary and alternative medicine use and to assess the willingness of parents to participate in future studies on complementary and alternative medicine efficacy and safety. PATIENTS AND METHODS. The prevalence of complementary and alternative medicine use was assessed by using a questionnaire for 749 children visiting Pediatric Gastroenterology clinics of 9 hospitals in the Netherlands. The questionnaire consisted of 35 questions on the child9s gastrointestinal disease, medication use, health status, past and future complementary and alternative medicine use, reasons for its use, and the necessity of complementary and alternative medicine research. RESULTS. In this study population, the frequency of complementary and alternative medicine use was 37.6%. A total of 60.3% of this group had used complementary and alternative medicine specifically for their gastrointestinal disease. This specific complementary and alternative medicine use was higher in patients with functional disorders than organic disorders (25.3% vs 17.2%). Adverse effects of allopathic medication, school absenteeism, age ≤11 years, and a low effect of conventional treatment were predictors of specific complementary and alternative medicine use. Almost all (93%) of the parents considered it important that Pediatricians initiate complementary and alternative medicine research, and 51% of parents were willing to participate in future complementary and alternative medicine trials. CONCLUSIONS. Almost 40% of parents of Pediatric Gastroenterology patients are turning to complementary and alternative medicine for their child. Lack of effectiveness of conventional therapy, school absenteeism, and adverse effects of allopathic medication are more important predictors of complementary and alternative medicine use than the type of gastrointestinal disease. Because evidence on most complementary and alternative medicine modalities in children with gastrointestinal disorders is lacking, there is an urgent need for research in this field.
Samuel Nurko - One of the best experts on this subject based on the ideXlab platform.
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development of entrustable professional activities and standards in training in Pediatric neuroGastroenterology and motility north american society for Pediatric Gastroenterology hepatology and nutrition and american neuroGastroenterology and motilit
Journal of Pediatric Gastroenterology and Nutrition, 2021Co-Authors: Julie Khlevner, Sarah Shrager Lusman, John M Rosen, Rachel Rosen, Lusine Ambartsumyan, Desale Yacob, Hayat Mousa, Samuel Nurko, Carlo Di Lorenzo, Mary BorutaAbstract:ABSTRACT NeuroGastroenterology and motility (NGM) disorders are common in childhood and are often very debilitating. Although Pediatric Gastroenterology fellows are expected to obtain training in the diagnosis and management of patients with these disorders, there is an ongoing concern for unmet needs and lack of exposure and standardized curriculum. In the context of tailoring training components, outcome and expressed needs of Pediatric Gastroenterology fellows and programs, members of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and American NeuroGastroenterology and Motility Society (ANMS) developed guidelines for NGM training in North America in line with specific expectations and goals of training as delineated through already established entrustable professional activities (EPAs). Members of the joint task force applied their expertise to identify the components of knowledge, skills, and management, which are expected of NGM consultants. The clinical knowledge, skills and management elements of the NGM curriculum are divided into domains based on anatomic regions including esophagus, stomach, small bowel, colon and anorectum. In addition, dedicated sections on Pediatric functional gastrointestinal (GI) disorders, research and collaborative approach, role of behavioral health and surgical approaches to NGM disorders and transition from Pediatric to adult neuroGastroenterology are included in this document. Members of the NASPGHAN-ANMS task force anticipate that this document will serve as a resource to break existing barriers to pursuing a career in NGM and provide a framework towards uniform training expectations at 3 hierarchical tiers corresponding to EPA levels.
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evaluation and treatment of functional constipation in infants and children evidence based recommendations from espghan and naspghan
Journal of Pediatric Gastroenterology and Nutrition, 2014Co-Authors: Merit M Tabbers, Yvan Vandenplas, Samuel Nurko, Carlo Dilorenzo, Marjolein Y Berger, Christophe Faure, Miranda W Langendam, Annamaria Staiano, Marc A BenningaAbstract:Background: Constipation is a Pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. Methods: Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. Results: This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. Conclusions: This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
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constipation in infants and children evaluation and treatment a medical position statement of the north american society for Pediatric Gastroenterology and nutrition
Journal of Pediatric Gastroenterology and Nutrition, 1999Co-Authors: Susan S Baker, Gregory S Liptak, Richard B Colletti, Carlo Di Lorenzo, Joseph M Croffie, Walton L Ector, Samuel NurkoAbstract:Background Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common Pediatric problem encountered by both primary and specialty medical providers. Methods The Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated clinical practice guidelines for the management of Pediatric constipation. The Constipation Subcommittee, consisting of two primary care Pediatricians, a clinical epidemiologist, and Pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. Results The Subcommittee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than 1 year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management, and indications for consultation by a specialist. The Constipation Subcommittee also provided recommendations for management by the Pediatric gastroenterologist. Conclusions This report, which has been endorsed by the Executive Council of the North American Society for Pediatric Gastroenterology and Nutrition, has been prepared as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. It is not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
