Constipation in children and young people: diagnosis and management

Evidence

We found 20 studies in a search for randomised controlled trials, systematic reviews and diagnostic studies published between 14 March 2014 and 2 February 2017.

We also considered evidence identified in previous surveillance 2 and 4 years after publication of the guideline. This included 64 studies identified by the searches.

From all sources, we considered 84 studies to be relevant to the guideline.

We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.

See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline.

Views of stakeholders

Stakeholders commented on the decision not to update the guideline. Overall, 13 stakeholders commented. See appendix B for stakeholders' comments and our responses.

Thirteen stakeholders including NHS foundation trusts, charities, royal colleges and government organisations commented on the proposal to not update the guideline: 5 agreed with the decision, 7 disagreed with the decision, and 1 noted that they had no comments on the proposals. Consultees suggested new evidence that was related to the use of transanal irrigation for children and young people with constipation, which is not currently covered in the guideline. The relevant evidence was added to appendix A but was not felt to impact on guideline recommendations. Most of the evidence on transanal irrigation was based on studies with small sample sizes and no comparator groups, which limited the impact on the guideline at this point. This area will be considered again at the next surveillance review of the guideline.

Thirteen stakeholders commented on the proposal to put the guideline on the static list: 4 agreed with the decision, 7 disagreed with the decision, and 2 noted that they had no comments on the proposals. Many consultees felt that it was not appropriate to place this guideline on the static list because of the growing evidence base on transanal irrigation. This feedback was taken into account and it was decided that the guideline would not be placed on the static list.

A national cohort study was highlighted post-consultation by a topic expert. The study described the clinical characteristics of infants with Hirschsprung's disease, indicating that nearly half of the study population passed meconium within 48 hours of birth. Although the data was considered to be insufficient to impact the NICE guideline on constipation at this point, it was recognised that the NICE guideline on postnatal care (CG37, published June 2006) covers a similar area and there is currently discrepancy across recommendations. Therefore, this issue will be referred to the guideline developers and this evidence will be formally reviewed during the scheduled update of NICE guideline CG37. Depending on the outcome of the committee discussions, the NICE guideline on constipation will be amended accordingly.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

NICE Surveillance programme project team

Kay Nolan
Associate Director

Phillip Alderson, and Martin Allaby (from March 2017)
Consultant Clinical Advisers

Emma McFarlane
Technical Adviser

Alice Murray
Technical Analyst

The NICE project team would like to thank the topic experts who participated in the surveillance process.

ISBN: 978-1-4731-2451-6