Table 2 Lactulose

Voskuijl et al (2004) [51]

100 patients

Study type :1b

Methods: 8 wk double blinded, multi-centre RCT: PEG 3350 vs lactulose.

Results: Success greater for PEG group (56%) vs. lactulose group (29%) (less pain/straining). PEG significantly less palatable

Van Ginkel (2000) [52]

48 children

Study type :2b

Methods: RCT: Biofeedback+ lactulose vs. biofeedback for 7 weeksResults: Both groups had improved encopresis (group 2 significantly better (86%) than group 1 (53%) p < 0.01).

Gremse et al (2002) [59]

44 children

Study type :1b

Methods: Unblinded Crossover RCT Lactulose vs PEG 3350: 2 weeks

Results: Lactulose had a significantly longer mean transit time compared to PEG 3350 (55.3 vs. 47.6 hrs, p = 0.038). Stool form, frequency, and ease of passage were similar for each laxative.

Perkin (1977) [53]

21 children

Study type :2b

Methods: Randomised unblinded crossover study lactulose vs senna:3 weeks Results: Lactulose more likely to give greater number of days when normal stools were passed (p < 0.01). Side-effects significantly higher (p < 0.001) for senna.

Dupont et al (2005) [54]

96 children

Study type :2b

Method: Random allocation, open label cohort study

Results: More than 90% of children recovered normal bowel habits. Faecal mass in the rectum and abdominal pain were markedly reduced and appetite improved.

Keuzen-kamp et al (1996) [55]

244 patients

Study type :4

Methods: Case series over 25y: median follow up of 4 years

3 phases: 1) evacuation with lactulose/bisacodyl

2)maintenance: regular toileting + wean laxatives to ensure soft stools daily

3) introduce high fibre diet +wean laxatives.

Results: 66% cured, 34% still symptomatic, 12 had persistent symptoms. Of all 39% had at least one recurrence.

Connolly et al (1974) [56]

164 patients

Study type :4

Methods: Open-label cross-over study: lactulose vs. irritant laxatives: (Senna/bisacodyl) 7 days

Results: 58% of lactulose group vs 42% of stimulant group had normal stool.