[Advances in the Treatment of Refractory Pediatric Constipation].

Refractory functional constipation is a persistent challenge inpediatrics. Beyond polyethylene glycol and traditional laxatives, newpharmacological and non-pharmacological therapies are emerging. Amongthe innovative medications, prosecretory agents like linaclotide(already approved for children over 6 years old), lubiprostone andplecanatide, wich increase intestinal secretion, stand out. Other drugs,such as prucalopride (5HT-4 agonist) and pyridostigmine, aim to improvemotility. Rectal and interventional therapies include transanalirrigation, -which has shown good results-; antegrade enemas andbotulinum toxin A injections, which are useful for specificdysfunctions. Biofeedback remains an effective tool. Neuromodulation isemerging as a promising option. Implanted sacral nerve stimulation andnon-invasive techniques such as percutaneous/transcutaneous tibial nervestimulation and transcutaneous sacral neuromodulation demonstrateimprovements in symptoms and quality of life. There are therapies thathave been little explored but show promise for the future, such asvibrating capsules, magnetic neurostimulation, and mind-body approacheslike hypnosis. Specific pediatric research and an individualizedtreatment approach are crucial to optimize adherence and outcomes inthese complex patients.