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Item Constipation and GI diagnoses in children with solid tumours: prevalence and management(BMJ, 2022-08-30) Belsky, Jennifer; Stanek, Joseph; Yeager, Nicholas; Runco, Daniel; Pediatrics, School of MedicineObjectives Despite continued development of targeted therapies for children with cancer, patients continue to experience an array of unwanted side effects. Children with solid tumours may experience constipation as a result of vinca alkaloid therapy, psychological stressors, periods of inactivity and opioid use. Our objective was to investigate the prevalence and treatment of constipation in hospitalised children with solid tumours treated with chemotherapy. Methods We retrospectively analysed data from 48 children’s hospitals in the Pediatric Health Information System, extracting patients 0–21 years of age with a solid tumour diagnosis hospitalised from October 2015 through December 2019. Results We identified 13 375 unique patients with a solid tumour diagnosis receiving chemotherapy. Constipation was the most common gastrointestinal complaint with 8658 (64.7%; 95% Cl: 63.9% to 65.5%) having a constipation diagnosis or having received at least two laxatives during admission. Bone cancers had the highest percentage (69.9%) of patients with constipation, while Hodgkin’s lymphoma had the lowest, although 52.1% of patients were affected. A total of 44% (n=35 301) of encounters received an opioid at some point during admission. Of patients receiving constipation medications, the most commonly prescribed was polyethyl glycol (n=25 175, 31.7%), followed by docusate (n=11 297, 14.2%), senna (n=10 325, 13.0%) and lactulose (n=5501, 6.9%). Conclusions Constipation is the most common gastrointestinal issue that children with solid tumours experience while receiving chemotherapy in the inpatient setting. Increased attention should be given to constipation prophylaxis and treatment in children with solid tumours undergoing chemotherapy, particularly those identified as high risk.Item Effect of Octreotide on the Colonic Motility in Pediatric Patients with Chronic Recalcitrant Constipation(Lippincott, Williams, and Wilkins, 2015-12) Parashette, Kalyan Ray; Waseem, Shamaila; Horn, Debra; Shah, Aali; Croffie, Joseph; Department of Pediatrics, IU School of MedicineObjective: The aim of the present study was to study the effect of octreotide on colonic motility in pediatric patients with recalcitrant chronic constipation/encopresis and other suspected colonic motility disorders. Methods: This was a nonrandomized, single-center, open-label, prospective study evaluating the effect of a single subcutaneous dose of octreotide on colonic motility. Results: Thirteen patients (5 boys) were enrolled in the study. The age range was 4.6 to 16.2 years. Eleven patients (84%) had normal colonic manometry and 2 patients (16%) had colonic neuropathy. Motility Index (MI) (mmHg) for the 15 minutes before and after octreotide infusion was 6.03 ± 1.26 (95% confidence interval [CI] 5.35–6.72) and 5.32 ± 1.66 (95% CI 4.42–6.23), respectively, with P value of 0.08. MI for the 30 minutes before and after octreotide infusion was 6.89 ± 1.37 (95% CI 6.14–7.64) and 6.71 ± 1.47 (95% CI 5.91–7.52), respectively, with P value of 0.55. MI for the 45 minutes before and after octreotide infusion was 7.73 ± 1.32 (95% CI 7.01–8.45) and 7.53 ± 1.38 (95% CI 6.78–8.28), respectively, with P value of 0.8. Conclusion: Our study showed that the administration of octreotide resulted in no significant changes in colonic MI in pediatric patients with chronic recalcitrant constipation.Item Sacral Neuromodulation in Children(Springer, 2015-12) Strine, Andrew C.; Keenan, Alison C.; King, Shelly; Whittam, Benjamin M.; Department of Urology, IU School of MedicineSacral neuromodulation (SNM) has emerged as a treatment option for refractory lower urinary tract and bowel dysfunction in children. SNM is typically reserved for a select population of children who have failed an extended period of behavioral modification, biofeedback, and pharmacologic therapy. The surgical techniques for SNM in children are analogous to those in adults and include both one- and two-stage procedures as well as a peripheral nerve evaluation with the InterStim® system (Medtronic, Minneapolis, MN). Most studies have observed not only an improvement in symptoms and quality of life in children undergoing SNM for non-neurogenic and neurogenic lower urinary tract dysfunction but also a much higher reoperative rate than in adults. Further high-quality research is necessary to corroborate the results of earlier studies and to better define the indications for SNM in children.