After 5 years from diagnosis, functional constipation persisted in 52% of the children [16]. Van Ginkel et al. [17] reported data on 418 constipated children (median age: 8 years) who were followed up 5 years (range: 1–8 years) after intensive initial medical and behavioral treatment. The cumulative percentage of children who were treated successfully during follow-up was 60% at 1 year, increasing to 80% at 8 years. Successful treatment was more frequent in children without encopresis

and in children with the onset of bowel problems when older than 4 years of age. In a IDO inhibitor non-blinded, randomized study by Loening-Baucke and Pashankar [15], 79 children (mean age: 8.1 ± 3.0 years) with chronic constipation and fecal incontinence were assigned randomly to receive polyethylene glycol (n = 39) or milk of magnesia (n = 40). After 12 months, the percentages of children who experienced improvement were similar in both groups (62% vs. 43%, respectively, p < 0.086). Furthermore, 33% of the polyethylene glycol-treated click here children and 23% of the milk of magnesia-treated children had recovered (p = 0.283). Finally, van den Berg et al. [16] attempted to describe the clinical course of severe functional constipation

in early childhood. Forty-seven children (median age: 3.5 months) who had constipation during their first year of life were observed. Treatment success was defined as a period of at least 4 weeks with ≥3 painless bowel movements per week. Six months after the initial evaluation, 69% of the children had recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A shorter enough duration

of symptoms (<3 mo) before referral correlated significantly with a better outcome. In Poland, one long-term, follow-up study [17] revealed that 60% of all children (2–16 years) initially recruited for treatment with Lactobacillus GG as an adjunct to lactulose or lactulose alone were treated successfully at 24 months. However, 25% (20/79) of the children continued to use laxatives during the last 6 months of the study. Collectively, the available data are consistent with regard to the rate of recovery and exacerbations of constipation. However, evidence is insufficient to identify risk factors associated with poor, long-term, clinical outcomes. A follow-up of children with functional constipation diagnosed according to the Rome III criteria showed that a substantial number of children continue to have bowel problems. Identification of the predictive factors of an unsatisfactory course of constipation seems to be the basis for the development of accurate preventive strategies. These data confirm that functional constipation is not a mild, self-limiting entity. AH and AC contributed to the study design and conducted the study. AH analyzed the data. AH wrote the first draft of the manuscript. All authors approved of the final version. AH is the guarantor. The work was funded by the Medical University of Warsaw. None declared.