Acupuncture for Children with Functional Constipation (ACU-PILOT)

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Status: Not yet enrolling

Conditions: Functional Constipation (FC)

Treatments: Other: Acupuncture treatment

Study type: Interventional

Funder types: Other

Identifiers

NCT06836362

NL87083.018.24

Details and patient eligibility

About

Background of the study:

Functional constipation (FC) is common in children and poses a significant burden to patients, their families and the healthcare system. Pharmacological treatment mainly consists of oral osmotic laxatives. However, poor adherence to oral laxatives is known to be a common problem and patients often remain symptomatic despite pharmacological treatment. Many parents seek help in the form of complementary and integrative medicine. Acupuncture has been shown to relieve symptoms in adults with FC. However, published studies in children with FC are scarce and have important limitations.

Objective of the study:

To evaluate the feasibility, safety and potential efficacy of acupuncture in children with FC. The results of this study will be used to design a future randomized controlled trial (RCT).

Study design:

A prospective, non-randomized, multicenter, open-label pilot study.

Intervention: Children will receive 8 acupuncture sessions during 10 weeks (1 session per week during 6 weeks, followed by 1 session every other week during 4 weeks). Concurrent pharmacological treatment with polyethylene glycol ≥ 0.2 g/kg/day will be maintained as initiated prior to participation in the study.

Study population:

18 children (6-18 years old) with FC according to the Rome IV criteria.

Enrollment: 18 estimated patients

Sex: All

Ages: 6 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• In order to be eligible to participate in this study, a subject must meet all of the following criteria:

• 6-18 years of age

• meet the modified Rome IV criteria for FC (defined as meeting at least two of the following criteria during the 2-week run-in period despite receiving treatment with PEG with a minimum dose of 0.2 g/kg/day):

  1. Two or fewer spontaneous bowel movements (SBMs) per week (an SBM is defined as a bowel movement that occurs in the absence of laxative, enema, or suppository use in the preceding 24 hours)
  2. History of excessive stool retention
  3. History of painful or hard bowel movements
  4. History of large-diameter stools
  5. Presence of a large fecal mass in the rectum
  6. At least 1 episode/week of incontinence after the acquisition of toileting skills
  7. History of large-diameter stools that may obstruct the toilet in toilet-trained children

• Insufficient symptom management despite at least three months of medical management (including education, non-pharmacological advice and laxatives) by a physician. Insufficient symptom management is defined as the presence of at least one of the Rome IV criteria for FC despite medical management by a physician.

• are treated with PEG with a minimum dose of 0.2 g/kg/day for a minimum of 1 month prior to inclusion in the study

• Written informed consent obtained from parents or guardians and all children ≥12 years.

Exclusion criteria

• A potential subject who meets any of the following criteria will be excluded from participation in this study:
• children with FC not treated with PEG with a minimum dose of 0.2g/kg/day during at least one month at the time of potential inclusion.
• Irritable bowel syndrome.
• Organic causes of constipation; e.g. celiac disease, pediatric intestinal pseudo-obstruction, hypothyroidism, spina bifida, anorectal malformations, or Hirschsprung disease.
• Significant chronic health conditions requiring specialty care (e.g. cardiac, pulmonary, hepatic, hematopoietic, renal, endocrine, or metabolic diseases, sickle cell disease, cerebral palsy) that could potentially impact the child's ability to participate or confound the results of the study.
• Unintentional weight loss greater than or equal to 5% of their body weight within the last 3 months.
• Gastrointestinal blood loss.
• Recurrent or unexplained fevers.
• Pregnancy.
• Smoking.
• History of abdominal surgery involving the luminal gastrointestinal tract, except appendectomy or hernia repairs.
• Concomitant use of drugs that are known to affect gastrointestinal motility.
• Established diagnoses of autism spectrum disorders.
• Major psychiatric disorders (bipolar disorder, schizophrenia, major depression) or a history of abuse.
• Severe needle-related anxiety.
• Rash or active local infection over an acupuncture point.
• Immunocompromised children (specifically inadequately regulated diabetes mellitus, active staphylococcal-related skin conditions)
• Clotting disorders or a recent history of thrombocytopenia.
• Children who previously received acupuncture for constipation.
• Children who currently participate in another clinical trial.

Trial design

Primary purpose: Other

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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18 participants in 1 patient group

Single-arm study. The intervention consists of acupuncture treatments

Other group

Description:

This is an open-label, non-randomized single-arm study. The intervention consists of acupuncture (see description under intervention). Throughout the study duration, participants will maintain their therapeutic recommendations related to treating constipation (PEG at the dosage prior to entering the study, minimum of 0.2 g/kg/day, education and non-pharmacological advice as previously described by the medical team in charge). Initiation of new treatments for FC or increasing the dosage of PEG is not allowed during the intervention period. Decreasing the dosage of PEG is allowed if instructed by the treating physician and will be documented. After the last acupuncture session, if the patient requires an increase in the dosage of PEG, this is allowed during the follow-up period and will be documented. As per current treatment guidelines, participants are allowed to use escape medication (bisacodyl or enemas) after 72 hours without defecation or when their symptoms become intolerable.

Treatment:

Other: Acupuncture treatment