Unmet Needs in Pediatric Functional Constipation
Bibliographic record
Abstract
Pediatric functional constipation (PFC) is one of the most common functional gastrointestinal complaints in pediatric patients, accounting for 3% of visits to a general pediatrician and up to 25% of visits to a pediatric gastroenterologist in the United States.1 Across epidemiologic studies, global prevalence of PFC has been reported as being between 0.3% and 29.6%, with similar rates for both genders.2-5 PFC has a significant impact on patient and family quality of life, and in the United States alone, the estimated economic burden of childhood constipation in 2011 was US$3.9 billion.6-8 Disease severity may vary from mild and short-lived to severe and chronic, with approximately 25% of patients continuing to have symptoms into adulthood.2 Despite currently available treatment options, quality of care in PFC is limited by lack of guidance for disease management, a poorly defined disease state, and insufficient data on drug therapies.9,10 PFC is defined in the Rome IV diagnostic criteria for childhood functional gastrointestinal disorders (FGIDs) as the patient (1) having 2 or more of the following symptoms at least once each week for 1 month prior to diagnosis: ≤2 defecations per week, at least 1 episode of fecal incontinence per week, history of retentive posturing or excessive volitional stool retention, history of painful or hard bowel movements, presence of a large fecal mass in the rectum, and history of large diameter stools that may obstruct defecation; and (2) having insufficient criteria for a diagnosis of irritable bowel syndrome.11,12 Although the Rome IV diagnostic criteria for childhood FGIDs provide a classification system, the criteria do not overlap well with physician diagnosis or daily symptoms reported in patient diaries.9 Similarly, issues also exist with treatment options used in PFC such as lack of data to support long-term use, lack of placebo-controlled trials, high levels of heterogeneity in eligibility criteria, lack of generally accepted endpoints for clinical data, and lack of established safety profiles in the pediatric population. Given the dearth of consistent guiding information, we conducted a systematic literature review to identify gaps and unmet medical and educational needs in PFC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.047 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".