Use of polyethylene glycol solution in functional and organic constipation in children

A brief review is made of the use of high dose polyethylene glycol solution in the treatment of functional constipation and encopresis in children. Experience with low dose polyethylene glycol for the treatment of neurogenic constipation in children with severe brain damage is also reported. Treatment with polyethylene glycol caused a significant increase in bowel frequency and a decrease in gastrointestinal transit time. Side-effects, consisting of nausea, vomiting and irritability, have limited the use of this treatment in a few children.     

Use of low dose polyethylene glycol solutions in the treatment of functional constipation

A brief review is made of trials which used low doses of polyethylene glycol (13-30 g/day) solutions (125-500 ml/day) in the treatment of chronic functional constipation. Most of these were short-term studies, and confirmed that polyethylene glycol solution increased bowel frequency, improved defaecation and decreased stool consistency. Three studies reported that polyethylene glycol electrolyte solution accelerated transit through the large bowel. One long-term study observed remission of constipation-related symptoms in more than 70% of the polyethylene glycol electrolyte solution treated patients, and the efficacy of the treatment was maintained over a 6-month period, despite progressive reduction of daily dosage.     

肠神经系统与慢传输型便秘

慢传输型便秘(STC)病因未明,多因素与其发病相关.肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义.此文就此予以阐述,为STC临床治疗提供依据.     

New polyethylene glycol electrolyte solution for the treatment of constipation and faecal impaction

Results from a controlled clinical trial indicate that low doses of polyethylene glycol solutions are more effective and have fewer side-effects than lactulose. Large doses of polyethylene glycol are effective in the treatment of faecal impaction. Resolution of faecal impaction was obtained in all patients, and in 25/30 patients with three administrations in a three-day period.     

Results of colectomy for severe slow transit constipation

PURPOSE: This study assesses the outcome of a standardized operation performed by two surgeons for severe idiopathic slow transit constipation that was resistant to laxative treatment. METHODS: Fifty-nine consecutive patients, 4 men and 55 women, with a mean age of 42.3 years, underwent colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. Fifty-two patients were available for follow-up, with median time to follow-up being 42 (range, 3–81) months. RESULTS: Median bowel frequency was 4 per 24 hours. Sixty-nine percent had four or less bowel movements daily. Ten percent used antidiarrheal medication regularly. One patient had a stoma for recurrent severe constipation. Mean continence score was 1.8 (on a scale of 0–20); six patients were incontinent, and four of these six had normal preoperative anal manometry. Fourteen patients (27 percent) had difficulty with rectal evacuation. Preoperative defecating proctography was a poor predictor of postoperative evacuation difficulties. Twenty-seven patients (52 percent) had persisting abdominal pain, but there was a significant improvement in the degree of pain (P <0.00001). Forty-seven patients (90 percent) were satisfied with the outcome of the operation (and would elect to have it done again). Dissatisfied patients had recurrent constipation or diarrhea and incontinence. CONCLUSION: Colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients undergoing surgery for severe constipation with proven slow colonic transit.Supported by the Division of Surgery and the Colorectal Research Fund.Read at the meeting of the Royal Australasian College of Surgeons, Perth, Australia, May 1995.     

慢传输型便秘发病机制的研究进展

慢传输型便秘(STC)病因未明,多种因素如肠神经系统、肠神经递质、胃肠激素、Cajal间质细胞等与其发病相关。此文就此予以阐述,为STC临床治疗提供依据。     

Peptide YY release after colectomy in slow transit constipation

Background: The gut hormone peptide YY is abundant in the colonic mucosa. Circulating PYY inhibits gastrointestinal motility and decreases food intake. The aim was to determine whether colectomy decreases PYY release in patients with slow transit constipation. Methods: Plasma PYY concentrations were measured in 10 patients with slow transit constipation before and 3–24 months after total abdominal colectomy with ileorectal anastomosis, and in 8 healthy controls. A liquid meal was infused intraduodenally to stimulate PYY release. Results: Postprandial PYY significantly (P?Conclusion. Despite removal of a major source of PYY‐secreting cells, colectomy with ileorectal anastomosis does not induce major impairment of PYY release in slow transit constipation.     

Peptide YY release after colectomy in slow transit constipation

BACKGROUND: The gut hormone peptide YY is abundant in the colonic mucosa. Circulating PYY inhibits gastrointestinal motility and decreases food intake. The aim was to determine whether colectomy decreases PYY release in patients with slow transit constipation. METHODS: Plasma PYY concentrations were measured in 10 patients with slow transit constipation before and 3-24 months after total abdominal colectomy with ileorectal anastomosis, and in 8 healthy controls. A liquid meal was infused intraduodenally to stimulate PYY release. RESULTS: Postprandial PYY significantly (P < 0.05) increased from a basal value of 15.6 +/- 1.8 pM to a peak of 71.2 +/- 11.6 pM after colectomy. Basal and postprandial plasma PYY concentrations were not significantly different from the results before surgery. Fasting, but not postprandial, plasma peptide YY after colectomy was significantly higher than that in healthy volunteers, 10.9 +/- 0.9 pM. CONCLUSION: Despite removal of a major source of PYY-secreting cells, colectomy with ileorectal anastomosis does not induce major impairment of PYY release in slow transit constipation.     

Hand-assisted laparoscopic total colectomy for slow transit constipation

Purpose Current medical treatments for slow transit constipation (STC) are often ineffective, and total colectomy with ileorectal anastomosis has been the procedure of choice for selected patients with refractory STC. Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to assess the safety and utility of hand-assisted laparoscopic total colectomy for STC. Method From January 2002 to December 2005, 44 women presented with complaints of intractable constipation and failed to respond to medical treatment. Slow transit constipation was diagnosed after a series of examinations, including a colonic transit test, anal manometry, balloon expulsion test, and barium enema. All eligible patients underwent a hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Main outcome measures included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result The mean operative time was 197 min (range, 125–295 min). The mean estimated blood loss was 113 ml (range, 100–300 ml). The mean day of first time to flatus was 2 days, and the mean hospital stay was 7.6 days. There was no conversion to an open procedure and no surgical mortality. In the following period, two patients developed intestinal obstruction, which underwent exploratory laparotomy. However, some 39 patients (88.6%) expressed excellent or good in satisfaction. Conclusion Hand-assisted laparoscopic total colectomy could be a safe and efficient technique in the treatment of STC.     

慢传输性便秘结肠阿片受体的病理生理改变

目的 为了更加深入地了解慢传输性便秘的发病机理和病理生理改变。方法 应用放射配体结合分析检测了患结肠mu、Kappa阿片受体含量变化。结果 与正常对照组比较,STC患结肠壁肌层ma、Kappa阿片受体含量增加。结论 STC患内源性阿片肽活性增加,肠道运动受抑制,提示阿片受体拮抗剂可能是治疗STC的一个新途径。     

慢传输型便秘外科治疗的主要术式及疗效

近年来,便秘的发病率呈缓慢上升趋势。然而,国际上对于慢传输型便秘的发病原因及发病机理尚未完全认清。虽然经过一段时间的内科保守治疗能够暂时缓解便秘症状,但不能从根本上解决慢传输型便秘的问题。手术可能是最终而有效的治疗慢传输型便秘的方法。现阶段,治疗慢传输型便秘的主要术式有：全结肠切除回直肠吻合术、结肠次全切除盲肠直肠吻合术、结肠旷置术和末端回肠造口术等。本文主要介绍这几种术式及其疗效。     

胶质细胞源性神经生长因子与慢传输性便秘

慢传输型便秘(STC)至今病因未明。肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义。胶质细胞源性神经营养因子(GDNF)不仅可促进多种神经元的存活与分化,而且对多种原因造成的神经损伤具有明显的保护作用。此文主要从肠神经系统的功能变化和胶质细胞源性神经营养因子的营养作用这两方面来阐述与功能性便秘之间的相关性。     

泰魄颗粒对慢传输型便秘治疗机制的研究

[目的]研究泰魄颗粒治疗慢传输型便秘的机制。[方法]①分别测定20例正常人和25例便秘患者长期服用刺激性泻下药餐前及餐后5、10、15、30min横-降导联肠电图。②用大黄浸液制造慢传输型便秘模型,观察泰魄颗粒对模型大鼠血浆血管活性肠肽(VIP)、P物质(SP)的影响。[结果]长期服用刺激性泻药患者肠电图波幅、频率较正常人下降,餐后肠电图不升反降,治疗后波幅和频率均升高(P0.05,0.01)。便秘模型大鼠SP和VIP水平,与正常对照组比较显著降低(P0.01)。经泰魄颗粒治疗10d后血浆SP水平与模型对照组比较差异有统计学意义(P0.01),VIP水平在低剂量组与模型对照组比较差异无统计学意义,高剂量组有统计学意义(P0.05)。[结论]泰魄颗粒能有效改善长期服用刺激性泻剂便秘患者的肠电图异常现象,增加肠道推进性运动;改善慢传输模型大鼠血浆SP、VIP水平,从而促进肠道运动和水分的分泌。泰魄颗粒对泻剂导致的慢传输型便秘具有治疗作用。     

Normal aspects of colorectal motility and abnormalities in slow transit constipation

Human colonic motility is a relatively difficult topic to investigate. However, the refinement of manometric techniques in recent years enabled us to study both the proximal and distal segments of the viscus. The present paper reviews our knowledge about normal aspects of colorectal motility in man and the abnormalities found in slow transit constipation (STC), one of the most frequent and difficult to treat subtypes of constipation. An internetbased search strategy of the Medline and Science Citation Index was performed using the keywords colon, colonic, colorectal, constipation, slow transit, motility, rectal, rectum in various combinations with the Boolean operators AND, OR and NOT. Only articles related to human studies were used, and manual cross-referencing was also performed. Most of colonic motor activity is represented by single nonpropagated contractions, rarely organized in bursts; this activity is maximal during the day, especially after waking and following meals. In addition, a specialized propagated activity with propulsive features is detectable, represented by high-and low-amplitude propagated contractions. In the severe form of constipation represented by the slow transit type, the above motor activity is completely deranged. In fact, both basal segmental activity (especially in response to meals) and propagated activity (especially that of high amplitude) are usually decreased, and this may represent a physiologic marker of this disorder. Human colonic motor activity is quite a complex issue, still only partly understood and investigated, due to anatomic and physiological difficulties. In recent years, however, some more data have been obtained, even in proximal segments. These data have helped in elucidating, although only in part, some pathophysiological mechanisms of chronic constipation, and especially of the STC subtype.     

Fatal aspiration of polyethylene glycol solution

Endoscopy of the colon requires adequate cleansing of the entire bowel. Several laxative regimens have been propagated, but bowel preparation with polyethylene glycol (PEG) solution is popular because of the easy application and good cleansing results. Although very safe in daily use, complications of this bowel-cleansing procedure have been reported and aspiration of the PEG solution is a possible and serious hazard. A case report is presented of a patient who aspirated the PEG solution and ultimately died because of respiratory failure.     

Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation

Background—Polyethylene glycol(PEG) 3350 is a non-absorbable, non-metabolised osmotic agent used inlavage solutions for gut cleansing.
Aims—To compare the efficacy of PEGand lactulose in chronic constipation.
Methods—A total of 115 patientswith chronic constipation entered a multicentre, randomised,comparative trial. They initially received two sachets containingeither PEG (13 g/sachet) or lactulose (10 g/sachet) and were given anoption to change the dose to one or three sachets/day, depending on response.
Results—Ninety nine patientscompleted the trial. After four weeks, patients in the PEG group (n=50)had a higher number of stools and a lower median daily score forstraining at stool than patients in the lactulose group (n=49). Overall improvement was greater in the PEG group. Clinical tolerance was similar in the two groups, but flatus was less frequently reported inthe PEG group. The mean number of liquid stools was higher in the PEGgroup but the difference was significant only for the first two weeks.There were no serious adverse events and no significant change inlaboratory tests in either group. At the end of the study, the numberof sachets used by the patients was 1.6 (0.7)/day in the PEG group and2.1 (0.7)/day in the lactulose group. Sixty one patients completed afurther two months open study of one to three sachets PEG daily; therewas no loss of efficacy and no serious toxicity.
Conclusion—Low dose PEG 3350 wasmore effective than lactulose and better tolerated.

Keywords:constipation; polyethylene glycol; lactulose; cathartics; randomised trial