ABSTRACT
Justification: Management practices of functional constipation are far from satisfactory in developing countries like India; availableguidelines do not comprehensively address the problems pertinent to our country.Process: A questionnaire-based survey was conducted among selected practising pediatricians and pediatric gastroenterologists inIndia, and the respondents agreed on the need for an Indian guideline on the topic. A group of experts were invited to present thepublished literature under 12 different headings, and a consensus was developed to formulate the practice guidelines, keeping in viewthe needs in Indian children.Objective: To formulate practice guidelines for the management of childhood functional constipation that are relevant to Indian children.Recommendations: Functional constipation should be diagnosed only in the absence of red flags on history and examination. Thosewith impaction and/or retentive incontinence should be disimpacted with polyethylene glycol (hospital or home-based). Osmoticlaxatives (polyethylene glycol more than 1 year of age and lactulose/lactitol less than 1 year of age) are the first line of maintenancetherapy. Stimulant laxatives should be reserved only for rescue therapy. Combination therapies of two osmotics, two stimulants or twoclasses of laxatives are not recommended. Laxatives as maintenance therapy should be given for a prolonged period and should betapered off gradually, only after a successful outcome. Essential components of therapy for a successful outcome include counselling,dietary changes, toilet-training and regular follow-up.
Subject(s)
Celiac Disease/diagnosis , Edible Grain , Glutens/administration & dosage , Humans , IndiaABSTRACT
We report a 32-year-old who lady when presented with anemia and was detected to have Peutz-Jegher syndrome. She had malignancies of the colon and ovary over a 2-year follow up and was successfully managed. On screening the family two more members were confirmed to have Peutz-Jeghers syndrome and have been put on surveillance.
Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Adenomatous Polyps/diagnosis , Adult , Colectomy , Colonic Neoplasms/diagnosis , Endoscopy, Gastrointestinal , Female , Gynecologic Surgical Procedures , Humans , Intraoperative Care , Laparotomy , Ovarian Neoplasms/diagnosis , Peutz-Jeghers Syndrome/diagnosisABSTRACT
Triple A syndrome (Allgrove syndrome) is an autosomal recessive disorder consisting of achalasia, alacrima and Addison insufficiency. We report an 11-year-old girl with predominant symptom of achalasia who was diagnosed as Triple A syndrome almost 3 years after initial presentation.