Saccharomyces boulardii and Lactulose for Childhood Functional Constipation: A Multicenter Randomized Controlled Trial

• Published in: Journal of neurogastroenterology and motility Vol. 28; no. 3; pp. 454 - 462
• Main Authors: Lee, Kyung Jae, Ryoo, Eell, Lee, Yoo Min, Yoon, Jung Min, Jang, Hyo-Jeong, Choi, So Yoon, Choi, You Jin, Kim, Hyun Jin, Chung, Ju Young, Shim, Jung Ok
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Neurogastroenterology and Motility 30.07.2022; 대한소화기 기능성질환∙운동학회
• Subjects: Original; 내과학; Pediatrics; Probiotics; Microbiota; Constipation
• ISSN: 2093-0879; 2093-0887
• DOI: 10.5056/jnm21130

The effects of probiotics in children vary based on diseases and probiotic strains. We aim to investigate the effectiveness of Saccharomyces boulardii and lactulose for treating childhood functional constipation. This open-label randomized controlled trial was conducted at 10 university hospitals in Korea. Children who were diagnosed with functional constipation were allocated to 3 groups (lactulose monotherapy, combination therapy, and monotherapy). The primary outcome was treatment success rate that was accordingly defined as ≥ 3 bowel movements without incontinence at week 12. The cumulative successful maintenance and drug maintenance rates without drug changes were calculated throughout the study period. We compared stool frequency, incontinence, consistency, and painful defecation at week 2 among the 3 groups. Overall, 187 children were assigned to the lactulose monotherapy (n = 69), combination therapy (n = 68), or monotherapy (n = 50) groups. The primary outcome was significantly higher in the lactulose monotherapy group (26.1%) or combination therapy group (41.2%) than in the monotherapy group (8.0%). The monotherapy group showed a significantly lower cumulative successful maintenance and drug maintenance rate than the other 2 groups. There were no significant intergroup differences in the frequency of defecation, incontinence, painful defecation, or stool consistency during the follow-up at week 2. monotherapy was not superior to lactulose monotherapy or combination therapy and showed a higher drug change rate, supporting the current recommendation of probiotics in the treatment of childhood functional constipation.