Table 3 Macrogols (Polyethylene Glycol)

Thomson et al (2007) [57]

51 children

Study type : 1b

Methods: Double-blind crossover RCT PEG+E or placebo for 2 weeks

Results: Mean number of defaecations higher for PEG+E group vs placebo (p < 0.001). Also PEG+E reduced pain on defaecation (p = 0.041), straining on defaecation (p < 0.001), stool consistency (p < 0.001) and percentage of hard stools (p = 0.001). Adverse events were all mild or moderate and were similar for those children on PEG+E and placebo.

Candy et al (2006) [58]

63 children

Study type : 2b

Methods: Initial open cohort study of PEG+E (disimpaction) then double-blind RCT of PEG+E (Movicol) vs. lactulose (maintenance)

Results: Disimpaction) successful in 92% children. Maximum dose = 4 sachets -4 yr old) or 6 sachets (5-11 yr olds); median time to disimpaction was 6 days.

Maintenance: Greater mean stool frequency in PEG + E group (p = 0.007).

Dupont et al (2005) [54] - Study described in the 'Lactulose section' - table

PEG 3350

Gremse et al (2002) [59] Study described in the 'Lactulose section' - table

Loening-Baucke et al (2006) [60]

79 children

Study type : 2b

Methods: Double blind RCT PEG 3350 vs. magnesium hydroxide

Results: Significant improvement in both groups, (frequency of bowel movements, reduced frequency of incontinence, and resolution of abdominal pain). Compliance = 95% (PEG) vs. 65% = milk of magnesia. At 12 months, 62% of PEG-treated children and 43% of MoM-treated children improving:.

Youssef et al (2002) [61]

40 children

Study type : 1b

Methods: Prospective double-blind, parallel RCT 4 doses of PEG 3350

Results: Disimpaction in 75% of children overall but significant difference between two higher doses vs. lower doses (95% vs. 55%, P < .005). All groups had an increased number of bowel movements during the 5-day study versus baseline.

Michail et al

(2004) [62]

28 patients

Method: Cohort study with PEG. Mean duration 6 months

Results: Mean effective maintenance dose was 0.78 g/kg/day. PEG relieved constipation in 97.6% of patients.

Voskuijl et al (2004) [51] Study described in the 'Lactulose section' - table

Ingebo (1988) [63]

24 patients

Study type : 4

Methods: Case series: PEG+E given at 14-40ml/kg/hr until clear fluid obtained.

Results: children with encopresis required an average of 11L over 22 h. PEG+E successful in all children, and was safe.

Miller et al (2007) [64]

121 patients

Study type : 4

Methods: Case series: single-site: All children over 6 month period diagnosed with 'constipation' from an Emergency Department.

Results: 2/3 had had pain for less than 1 week. 70% received an AXR. 1/3 received an enema in the ED. 74% received laxatives on discharge (80% given PEG). At follow-up, 35% were using laxatives, and 27% had sought additional care.

After an enema, 28% discharged without laxatives.

Pashankar et al (2003) [66]

83 children

Study type : 2b

Methods: Cohort study for at least 3 m PEG given at 0.8 g/kg/day then adjusted to give 2 soft painless stools/day

Results: Mean duration = 8.7 months. Mean PEG dose was 0.75 g/kg daily. No major adverse effects. All children preferred PEG to other laxatives, Good daily compliance in 90% of children

Pashankar et al (2003) [65]

74 children

Study type :4

Methods: Case series: All given PEG 3350 for > 3 months.

Results: mean duration of PEG therapy = 8.4 m (3-30 m). Weekly stool frequency, stool consistency, and soiling improved significantly with PEG therapy in all patients.

Pashankar et al (2001) [67]

24 children

Study type : 4

Cohort study: PEG for 8 weeks starting at 1 g/kg/d: adjusted every 3 days aiming: 2 soft stools/d.

Results: Weekly stool frequency increased from 2.3 to 16.9 (p < .0001) with treatment. Stool consistency improved (p < .0001). Mean effective dose was 0.84 g/kg/d (range, 0.27-1.42 g/kg/d)

Erickson (2003) [68]

46 patients

Study type : 4

Method: Retrospective review of PEG 3350, aiming for 2 soft stools a day.

Results: PEG caused significant increase in frequency of bowel movements (p = 0.0001). Average final dose was 0.63 gm/kg. Diarrhoea in 9 patients. 18 became dry, 26 had decreased wetting (2 no improvement).

Hanson (2006) [69]

23 children

Study type : 4

Method: Case series: 7 day disimpaction then maintenance PEG.

Results: 23 questioned on their children's experiences. 96% 'more than happy' with PEG+E. Prior to PEG+E treatment, 57 per cent of children were admitted to hospital and 26 per cent required home visits for constipation treatment. After treatment, no child visited hospital/needed home visit.

Loening-Baucke et al (2004) [70]

75 constipated

children < 2 years

Study type : 4

Method: Retrospective case series: PEG.

Results: Mean effective short-term PEG dose was 1.1 g/kg/day and the mean long-term dose was 0.8 g/kg/day. Constipation was relieved in 85% with short-term and in 91% with long-term PEG therapy.