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Concept: Enema


BACKGROUND: PEG-based laxatives are considered today the gold standard for the treatment of constipation in children. PEG formulations differ in terms of composition of inactive ingredients which may have an impact on acceptance, compliance and adherence to treatment. We therefore compared the efficacy, tolerability, acceptance and compliance of a new PEG-only formulation compared to a reference PEG-electrolyte (PEG-EL) formulation in resolving faecal impaction and in the treatment of chronic constipation. METHODS: Children aged 2–16 years with functional chronic constipation for at least 2 months were randomized to receive PEG-only 0.7 g/kg/day in 2 divided doses or 6.9 g PEG-EL 1–4 sachets according to age for 4 weeks. Children with faecal impaction were randomized to receive PEG-only 1.5/g/kg in 2 divided doses until resolution or for 6 days or PEG-EL with an initial dose of 4 sachets and increasing 2 sachets a day until resolution or for 7 days. RESULTS: Ninety-six children were randomized into the study. Five patients withdrew consent before starting treatment. Three children discontinued treatment for refusal due to bad taste of the product (1 PEG-only, 2 PEG-EL); 1 (PEG-EL) for an adverse effect (abdominal pain). Intent-to-treat analysis was carried out in 49 children in the PEG-only group and 42 in the PEG-EL group.No significant differences were observed between the two treatment groups at baseline.Adequate relief of constipation in terms of normalized frequency and painless defecation of soft stools was achieved in all patients in both groups. The number of stools/week was 9.2 +/- 3.2 (mean +/- SD) in the PEG-only group and 7.8 +/- 2.4 in the PEG-EL group (p = 0.025); the number of days with stool was 22.4 +/- 5.1 in the PEG-only group and 19.6 +/- 7.2 in the PEG-EL group (p = 0.034).In the PEG-only group faecaloma resolution was observed in 5 children on the second day and in 2 children on the third day, while in the PEG-EL group it was observed in 2 children on the second day, in 3 children on the third day and in 1 child on the fifth day.Only 2 patients reported mild treatment-related adverse events: 1 child in the PEG-only group had diarrhoea and vomiting and 1 child in the PEG-EL group had abdominal pain requiring treatment discontinuation. The PEG-only preparation was better tolerated as shown by the lower frequency of nausea than in the PEG-EL group.In the PEG-only group, 96% of patients did not demonstrate any difficulties associated with treatment, as compared with 52% of patients in the PEG-EL group (p < 0.001). Also, the PEG-only formulation taste was better than that of PEG-EL (p < 0.001). The difference between the percentage of subjects who took > 80% of the prescribed dose was in favour of the PEG-only group (98% vs. 88%), though it did not reach a conventional statistical level (p = 0.062). CONCLUSION: PEG-only was better tolerated and accepted than PEG-EL in children with chronic constipation. At the higher PEG doses recommended by the manufactures children in the PEG-only group had higher and more regular soft stool frequency than PEG-EL.Trial NCT01592734.

Concepts: Randomized controlled trial, Constipation, Gastroenterology, Irritable bowel syndrome, Feces, Polyethylene glycol, Fecal impaction, Enema


Malone antegrade continence enemas are used in the management of neurogenic bowel to attain fecal continence. Several different irrigation solutions have been described but glycerin, an osmotic laxative that promotes peristalsis, has rarely been mentioned or studied. We assessed clinical outcomes in our patients with a Malone antegrade continence enema using glycerin based irrigation.

Concepts: Constipation, Gastroenterology, Enema, Suppository, Laxative, Laxatives


5-Aminosalicylic acid (5-ASA) is a first-line therapy for inducing and maintaining remission of mild and moderately active ulcerative colitis (UC). When the proximal margin of inflammation is distal to the splenic flexure, 5-ASA therapy can be delivered as a rectal suppository, foam or liquid enema.

Concepts: Ulcerative colitis, Crohn's disease, Colon, Rectum, Mesalazine, Sulfasalazine, Enema, Suppository


The primary aim of this study was to determine if there is a change in the quality of life in pediatric patients with unremitting functional constipation and/or encopresis after undergoing a MACE procedure.

Concepts: Life, Constipation, Enema, Mitrofanoff appendicovesicostomy, Malone antegrade continence enema


Rationale and key points This article aims to help nurses to undertake the administration of enemas in a safe, effective and patient-centred manner, ensuring privacy and dignity. The administration of an enema is a common healthcare procedure, which can be used to deliver medication or aid bowel evacuation. ▶ The administration of an enema should be undertaken by a competent nurse. ▶ An enema is a liquid preparation inserted into the rectum. ▶ The nurse must explain the procedure to the patient and should assist the individual before, during and after the procedure. ▶ The nurse should document all care given. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you felt performing this intimate procedure. 2. The positive elements of care delivery and those that could be enhanced. Subscribers can upload their reflective accounts at: .

Concepts: Health care, Clinical trial, Constipation, Gastroenterology, Route of administration, Sigmoidoscopy, Enema, Suppository


The oral route is compromised for nearly all patients approaching death. When agitation, seizures, or other intractable symptoms occur, a quick, discreet, comfortable and effective alternate route for medication delivery that is easy to administer in the home setting is highly desirable.

Concepts: Pharmacology, ADME, Enema, Grammy Award for Album of the Year


OBJECTIVES:: Colonic dysbiosis contributes to the development of colonic inflammation in ulcerative colitis (UC). Fecal microbial transplantation (FMT) is being proposed as a novel treatment for UC as it can eliminate dysbiosis. However, no prospective data exists. We initiated a pilot study to evaluate feasibility and safety of FMT in children with UC. METHODS:: Ten children, 7 to 21 years of age, with mild to moderate UC (pediatric ulcerative colitis activity index [PUCAI] between 15 and 65) received freshly prepared fecal enemas daily for 5 days. Data on tolerability, adverse events and disease activity were collected during FMT and weekly for 4 weeks after FMT. Clinical response was defined as decrease in PUCAI by >15 and decrease in PUCAI to <10 was considered clinical remission. RESULTS:: No serious adverse events were noted. Mild (cramping, fullness, flatulence, bloating, diarrhea and blood in stool) to moderate (fever) adverse events were self-limiting. One subject could not retain fecal enemas. Average tolerated enema volume by remaining nine subjects was 165 mL/day. After FMT, seven out of the nine (78%) subjects showed clinical response within 1 week, six out of the nine (67%) subjects maintained clinical response at 1 month, and three out of the nine (33%) subjects achieved clinical remission at 1 week after FMT. Median PUCAI significantly improved after FMT (p = 0.03) compared to the baseline. CONCLUSIONS:: Fecal enemas were feasible and tolerated by children with UC. Adverse events were acceptable, self-limiting and manageable by subjects. FMT indicated efficacy in the treatment of UC.

Concepts: Ulcerative colitis, Crohn's disease, Colon, Constipation, Gastroenterology, Feces, Mesalazine, Enema


Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate our non-operative reduction rate of intussusception using multiple interval barium enemas and second to investigate or discuss an audit cycle, providing evidence and validating the modification of clinical practice. Materials and methods This five-year retrospective study performed at one of two institutions at which a paediatric surgical service is offered. Individuals included were all patients under 12-years of age who were diagnosed with intussusception. Factors considered to be influential in the reduction of the intussusception were collected. End points were defined as successful barium enema reduction or surgical intervention. Results were compared with similar research published in 2010. Results Overall prevalence was found to be 12 cases/year, with a sample size of 60 patients, the mean age at presentation of 13.6 months. Barium enema reduction was attempted in 56/60 patients, while 4/60 patients had operative management as a first intervention. Overall reduction rate was 66% (37/56), 78% occurring on first attempt and 22% on the second attempt. There was no evidence of intussusception in 3/19 patients who had operative management as a second intervention. Delayed interval barium enema reduction demonstrated an improved reduction rate of 66% compared with single-use barium enema reduction of 41% (chi square 0.02). Conclusion A significant benefit was achieved by performing delayed interval enema reduction, which contributed to a 61% increased reduction rate, the actual reduction rate approaches 71%. The audit cycle remains of paramount importance to ensure optimum patient care.

Concepts: Medicine, Patient, Hospital, Surgery, Physician, Arithmetic mean, Enema, Reduction to practice


Maternal rectal enemas may reduce neonatal bacterial exposure during labour; this may reduce the risk of neonatal colonization with Clostridium difficile. The aim of this study was to determine the effectiveness of a saline enema during the first stage of labour in reducing neonatal colonization with C. difficile.

Concepts: Infant, Gut flora, Randomized controlled trial, Breastfeeding, Clostridium difficile, Clostridium, Clostridia, Enema


This case report presents an old hemiparetic male admitted to hospital from nursing home due to dark-coloured emesis. Transdermal buprenorphine 5 mcg/h had been instigated without laxatives in the preceding month. Upon arrival, an enlarged tense abdomen was found. A CT-scan dem-on-strated a 19 cm wide faecal colon impaction. Limited effect of enemas and endoscopic disimpaction resulted in surgery. The patient died shortly after discharge. The case stresses the prevention of constipation when using opioids; in particular in immobilized patients.

Concepts: Patient, Hospital, Constipation, Gastroenterology, Opioid, Buprenorphine, Fecal impaction, Enema