Why Is PEG Superior to Lactulose in Treating Pediatric Constipation?, Muout, Docvidya, Paediatrician, General Practitioner, Consultant Physician, Treating Pediatric Constipation, Muout, PEG,
Polyethylene glycol (PEG) and lactulose are the most widely prescribed drugs for the management of functional constipation in children. However, not all laxatives are created equal. Let us explore the distinct advantages of PEG that make it the preferred/better choice for managing functional constipation in children.Polyethylene glycol (PEG) and lactulose are the most widely prescribed drugs for the management of functional constipation in children. However, not all laxatives are created equal. Let us explore the distinct advantages of PEG that make it the preferred/better choice for managing functional constipation in children.
Understanding the Mechanism: Why Does PEG Outperform Lactulose?
Lactulose is a synthetic disaccharide fermented by colonic bacteria, resulting in a decrease in colonic pH. This fermentation expands fecal volume and accelerates colonic transit. However, the action of lactulose relies heavily on colonic microflora, leading to significant gas production, which can cause bloating and abdominal pain. Over time, lactulose can also alter the bacterial flora in the colon, thereby decreasing its efficacy with long-term use. 1
In contrast, PEG is a water-soluble, nonabsorbed polymer. Its osmotic effect on the intestinal membrane, due to its high water-binding capacity, leads to fluid retention and stool softening without the need for colonic flora metabolism.2
This difference in mechanism means PEG is less likely to cause bloating and abdominal pain, offering a more comfortable and effective treatment option.
Faster Relief: How Does PEG Provide Quicker Results?
The speed of relief is crucial when managing constipation in children. In a study comparing PEG and lactulose, 65 patients were analyzed (33 for the lactulose group and 32 for the PEG group). As shown in Figure 1, by day 2 of treatment, only 27.2% of children in the lactulose group experienced fecal disimpaction, compared with 59.3% in the PEG group. 3
Figure 1. Success of disimpaction related to days of therapy.
This significant difference highlights PEG's ability to provide faster relief, which is critical for improving the quality of life of young patients.
The Advantage of Shorter Colonic Transit Time (CTT)
Constipated children often suffer from prolonged CTT, leading to discomfort and other complications.4 As shown in Figure 2, PEG significantly decreased total CTT compared with lactulose. Specifically, there was a notable reduction in transit time in the right colon during treatment with PEG. 5
Figure 2. Comparison of transit times
This improvement in CTT underscores PEG's effectiveness in managing functional constipation.
Superior Clinical Outcomes: The Benefits of Choosing PEG
Clinical outcomes are a key consideration when choosing a treatment for pediatric constipation. In a 12-week study, 95% of children treated with PEG had good clinical outcomes, compared with 77.3% of those treated with lactulose. The stool frequency per week was also significantly increased by PEG, as shown in Figure 3.2
Figure 3. Comparison of defecation frequency per week.
In summary, PEG offers a higher success rate, a lower relapse rate, and fewer side effects than lactulose, making it the superior choice for treating pediatric constipation. Its consistent performance and rapid relief provide a better quality of life for young patients, solidifying PEG’s place as the preferred treatment option among healthcare professionals.2
PEG is the Optimal Choice for Pediatric Constipation
1. Voskuijl W, de Lorijn F, Verwijs W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: A double blind, randomised, controlled, multicentre trial. Gut. 2004;53(11):1590–1594.
2. Mansour HA, Ibrahim A, Mohamed A. Effectiveness of polyethylene glycol 3350 versus lactulose in management of functional constipation in children. Int J Pediatr Res. 2022;8:089.
3. Shatnawi MS, Alrwalah MM, Ghanma AM, et al. Lactulose versus polyethylene glycol for disimpaction therapy in constipated children, a randomized controlled study. Sudan J Paediatr. 2019;19(1):31–36.
4. Rajindrajith S, Devanarayana NM, Benninga MA. Delayed or not delayed? That is the question in Indian children with constipation. Indian J Gastroenterol. 2018;37(5):385–387.
5. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila). 2002;41(4):225–229.
