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INTRODUCTION Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection. METHODS From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire. RESULTS After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively). DISCUSSION BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia.

Functional constipation (FC) and Gastroesophageal Reflux Disease (GERD) are common gastrointestinal disorders in children. The aim of this study is to investigate the correlation between functional constipation and GERD in children.In this cross-sectional study, a total of 82 children aged16 years who referred to the pediatric gastroenterology clinic of (XXX) and were diagnosed with functional constipation according to ROME III criteria, and gastroesophageal reflux disease according to clinical history and DeMeester Score. Questionnaire was used to obtain the data regarding age, sex, cause of the visit, presence or absence of any symptom was noted, clinical examinations and difficulty in defecation.Of the 82 children with FC and GERD, 45 were boys and 37 were girls. Among children with FC and GERD, FC was reported in 50 (61%) cases prior to the onset of GERD, whereas 32 (39%) of the children had reflux before FC. The mean age of participants presented with FC was 5.66 ± 3.52 and that of GERD was 5.24 ± 2.83. The difference in mean age was not statistically significant. Of the children with gastroesophageal reflux disease, there were 13 (40.6%) males and 19 females while 32 (64%) males and 18 females had FC and the gender-based difference was statistically significant between the 2 groups.The prevalence of functional constipation in children was higher than gastroesophageal reflux disease. Gastroesophageal reflux disease and functional constipation should be simultaneously considered for therapeutic interventions and patients with functional digestive diseases should be monitored and followed-up.

Objectives The aim of the study was to compare the quality of sedation with 3 different sedation regimens in upper gastrointestinal endoscopy (UGIE) in pediatric patients. Methods One hundred fifty consecutive children who underwent UGIE were randomly assigned to 1 of the 3 medication regimens. Patients in group A (n = 49) received placebo. Forty-five minutes after the placebo was given, repeated intravenous (IV) doses of 0.1 mg/kg midazolam were administered titrated to achieve a level of deep sedation. Patients in group B (n = 51) received oral ketamine instead of placebo, and patients in group C (n = 50) received oral fentanyl instead of placebo with the same methodology and sedation endpoint. Results The mean dose of midazolam administered in group B patients was remarkably lower compared with that of groups A and C. Patients in group B showed less distress in IV line placement and separation from parents, higher comfort level, more endoscopist satisfaction, and higher sedation depth compared with groups A and C. The recovery time was significantly shorter in group B. All of the 3 regimens were safe. All of the complications were managed successfully. Conclusions Our data suggest that synergistic sedation with oral ketamine and IV midazolam for UGIE in children is a suitable and safe sedation. The higher rate of vomiting in group B in contrast to previous studies must be caused mainly by the oral route of ketamine administration.