Fiber supplements don’t cut laxative use in children with severe EB
Kids who take fiber or iron tend to take laxatives as well, study shows
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Children with severe epidermolysis bullosa (EB) who take fiber or iron supplements are likely to take laxatives as well, a retrospective study in the U.K. found.
“Total fibre intake did not reduce the reliance on laxatives or improve stool consistency and frequency in children and adolescents with EB,” the researchers wrote.
The study, “Factors Impacting Laxative Use in Children and Adolescents With Epidermolysis Bullosa: Single Centre Retrospective Study,” was published in the Journal of Pediatrics and Child Health.
EB comprises a group of disorders in which the skin and mucous membranes are unusually fragile, causing blistering, wounds, and scarring. The disease can also affect the gastrointestinal tract, causing eating and swallowing issues that can lead to nutritional problems.
Children and adolescents with EB frequently experience constipation and difficulty passing stools due to recurrent blistering and scarring in the area surrounding the anus. Constipation can further worsen nutritional issues by reducing appetite, and patients may take laxatives to loosen stools and facilitate bowel movements.
Retrospective analysis
Researchers in the U.K. conducted a retrospective analysis of clinical data of 37 children and adolescents with EB, with the goal of identifying factors associated with stool frequency and the need for laxatives in children with severe forms of EB.
Children ranged in age from 9 months to 17.8, and were mainly girls (54%). Almost half (48%) had recessive dystrophic epidermolysis bullosa, and nearly a third (27%) had generalized severe EB simplex. The remaining patients had forms of junctional epidermolysis bullosa (JEB).
While about half of the children (49%) met their nutritional requirements from an oral diet, 21% required tube feeding to support oral intake, and 30% were fed exclusively via tube feeding.
Overall, children had a mean total fiber intake of 16 g/day, which corresponded to 78.4% of the recommended intake for their age. Fiber was mainly obtained from food (median of 11.1 g/day), followed by tube feeding (median of 5.5 g/day), and fiber supplements (median of 2 g/day).
About a quarter (27%) of the children reported pain on defecation. Two-thirds (73%) were taking laxatives. All children who were on laxatives were taking macrogol osmotic laxatives, which work by bringing water into the bowel to make stool softer and easier to pass.
The researchers found no meaningful association between daily fiber intake and stool consistency. They also found that children taking fiber supplements were more likely to be taking a macrogol osmotic laxative as well, suggesting that fiber supplementation did not reduce the need for additional laxatives.
The regular use of probiotics was not associated with a reduction in the use of laxatives. Because children with EB often receive broad-spectrum antibiotics to treat skin infections, “the potential benefits of probiotics in the management of constipation may be suppressed … due to regular antibiotic administration,” according to researchers.
Children taking iron supplements were more likely to be taking laxatives, which the researchers said may reflect the known gastrointestinal side effects of oral iron, which include constipation.
The scientists said the study points to a need for additional research, “ideally, a prospective controlled intervention that adequately accounts for all the factors that impact bowel function in children with EB.”
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