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Probiotic failed to relieve pediatric constipation
Tabbers M. Pediatrics. 2011;127:e1392-e1399.
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There is currently not enough evidence to recommend fermented dairy products containing probiotics for pediatric patients with constipation, but recently published study results indicate that this may be an area of future research, according to a study published online.
Merit M. Tabbers, MD, PhD, and colleagues from the department of pediatric gastroenterology and nutrition at Emma’s Children’s Hospital, Academic Medical Centre, in Amsterdam, conducted a prospective, randomized, double blind clinical trial that involved 159 children with constipation.
The researchers analyzed data on 74 children who received a fermented dairy product that contained Bifidobacterium lactis DN-173 010 and 74 children who received a control product.
The researchers said there were increases in stool frequency from baseline to 3 weeks after continued product consumption, but the difference was not statistically significant.
“In contrast with our study, in recent studies in adults, it has been shown that the same fermented dairy product that contains B. lactis DN-173 010 significantly reduced colonic transit times in young and elderly healthy adults and in constipation predominant irritable bowel syndrome patients,” the researchers wrote. “The difference in efficacy of the fermented dairy product that contains B. lactis DN-173 010 between adults and children underscores the hypothesis that constipation in children differs considerably from that in constipated adults with regard to its prevalence, onset, etiology, symptoms, treatment and prognosis.”
Disclosure: The study was funded by Paris-based Danone (Dannon in the US). Two co-researchers on the study work for the company.
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The prevalence of constipation in children may be less frequent (2%) than in adults (20%), but it can be serious if their constipation is prolonged. Studies of standard treatments (such as laxatives) for prolonged constipation in children have shown no benefits. Some probiotic strains are effective for the treatment of pediatric diarrhea and some strains show promise for pediatric constipation. One probiotic strain, Bifidobacteria lactis DN 173 000, has been studied in healthy volunteers and adults with constipation resulting in an increase in colonic transit times. The authors of this study demonstrated that this strain was not effective compared to controls for the treatment of prolonged constipation in children. This is the first time this probiotic strain has been studied in children with prolonged diarrhea and one negative study should not rule out the possibility that it may be effective. The lesson from this study is that a modified study protocol may be required to show efficacy. This strain may be effective in less severe pediatric diarrhea, or a higher daily dose may be needed (studies in adults used higher doses), or a longer duration of treatment may be needed to observe an effect (although studies in adults showed efficacy after 2 weeks). The value of this study is that it may help to design a more targeted study for children with prolonged diarrhea. However, the bottom line is that this strain may simply not be effective for this disease indication. Certainly, more studies are needed.
Lynne V. McFarland, PhD
VA Research Health
Science Specialist
Health Services Research and Development, Puget Sound
VA
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