Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation

The aims of this study were to assess the prevalence of manometric colonic abnormalities and to evaluate the motor effect of intraluminal bisacodyl in a cohort of refractory constipated patients. Twenty-four hour colonic motility recordings were performed in 40 patients referred for a severe intractable chronic constipation. At the end of each recording session the motor effects of the endoluminal instillation of 10 mg bisacodyl were assessed. These patients were compared with 20 healthy subjects. The number of high-amplitude propagating contractions (HAPC) was significantly decreased in patients with slow transit constipation (12 +/- 11.6 vs 1 +/- 8.6, P < 0.001). Based on manometric patterns four groups of patients were isolated. Ten patients had no spontaneous HAPC, no food-induced colonic motor response and significantly lower colonic activity in transverse colon (374 +/- 1220 vs 3249 +/- 3458, P < 0.05). Five patients had significantly increased sigmoid segmental motility (20298 +/- 6364 vs 88780 +/- 3643, P < 0.001) and eight patients had significantly lower number of HAPC without other manometric abnormalities while 17 patients had normal colonic motility recordings. Endoluminal bisacodyl was able to induce HAPCs in all groups of patients. Patients with severe slow transit refractory constipation represented a heterogeneous group and endoluminal bisacodyl was able to promote a propagated motor activity in a majority of patients even in those suspected of having an inert colon.     

西沙必利、比沙可啶、多塞平联合治疗功能性便秘

目的 :比较西沙必利、比沙可啶、多塞平联合治疗与单用西沙必利对功能性便秘的疗效。方法 :6 0例临床诊断功能性便秘病人 ,随机分 2组 ,西沙必利组 (对照组 ) ,d 1～ 90单用西沙必利 10mg ,tid ;西沙必利、比沙可啶、多塞平组 (治疗组 )d 1～ 2 :西沙必利 10mg ,tid、比沙可啶 10mgqd ;d 3～ 30 :西沙必利 10mg ,tid ,多塞平 12 .5mg ,tid ;d 31～90 :西沙必利 10mgtid。结果 :对照组与治疗组治疗后 1wk ,1,2 ,3mo 2组便秘缓解率分别为 2 3%与 5 0 % ,33%与 6 0 % ,5 0 %与 80 % ,5 7%与 90% ,(P <0 .0 5 )。 2组病人治疗后均无不良反应。结论 :西沙必利、比沙可啶、多塞平联合治疗功能性便秘比单用西沙必利疗效好     

Phenolphthalein and bisacodyl: assessment of genotoxic and carcinogenic responses in heterozygous p53 (+/-) mice and syrian hamster embryo (SHE) assay.

Phenolphthalein (800 and 2400 mg/kg/day by gavage and 2400 mg/kg/day by diet) and bisacodyl (800-500, 4000-2000, and 8000 mg/kg/day by gavage) were administered to 15 male and 15 female and 20 male and 20 female p53(+/-) mice respectively for 26 weeks to investigate the potential carcinogenicity of each compound. Toxicokinetic analyses confirmed systemic exposure. p-Cresidine was administered by gavage (400 mg/kg/day) and served as the positive control agent in each study. Dietary phenolphthalein reduced survival in both sexes and early deaths were attributed to thymic lymphoma. No bisacodyl-related neoplasms were observed. Regardless of route of administration to p53(+/-) mice, phenolphthalein but not bisacodyl was unequivocally genotoxic, causing increased micronuclei in polychromatic erythrocytes. In the Syrian hamster embryo (SHE) cell transformation assay, phenolphthalein caused increases in morphologically transformed colonies, thereby corroborating NTP's earlier reports, showing phenolophthalein has potential carcinogenic activity. Bisacodyl was negative in the SHE assay. Results of these experiments confirm an earlier demonstration that dietary phenolphthalein causes thymic lymphoma in p53(+/-) mice and show that (1) phenolphthalein causes qualitatively identical results in this transgenic model regardless of route of oral administration, (2) phenolphthalein shows evidence of micronucleus induction in p53(+/-) mice for up to 26 weeks, (3) phenolphthalein induced transformations in the in vitro SHE assay, and (4) bisacodyl in p53(+/-) mice induces neither drug-related neoplasm, nor micronuclei in polychromatic erythrocytes, and did not induce transformations in the in vitro SHE assay.     

口服聚乙二醇溶液前或后吞服比沙可啶清洁肠道对CT结肠成像的影响研究

目的：比较口服2L聚乙二醇前或后1h吞服10mg比沙可啶对CT结肠成像结直肠清洁的差异。方法40例知情同意本研究的参与者分成A组、B组,每组20例。CT结肠成像检查前1d,A组3餐前口服40％W／V硫酸钡20mL,晚餐后口服溶解于250mL水之60％泛影葡胺20mL,口服2L聚乙二醇电解质液前1h吞服10mg比沙可啶肠溶片。B组口服2L聚乙二醇电解质液后1h吞服10mg比沙可啶肠溶片,其余同A组。统计分析两组结直肠粪块、肠液的清洁效果及存留肠液的CT值。结果A组结直肠粪块清洁效果评分（1．96±0．11）分低于B组（2．01±0．12）分,结直肠粪块清洁效果好的肠段（87／120,72．50％）高于B组（83／120,69．17％）,差异均无统计学意义（P＞0．05）。A组结直肠肠液清洁效果评分（1．50±0．06）分低于B组（1．53±0．06）分,结直肠肠液清洁效果好的肠段（113／120,94．17％）高于B组（111／120,92．50％）,差异均无统计学意义（P＞0．05）。A组结直肠存留肠液的CT值（729±29）HU高于B组（653±25）HU,差异有统计学意义（P＜0．05）。结论口服2L聚乙二醇前或后1h吞服10mg比沙可啶不影响结直肠粪块、肠液的清洁效果,但是前者对结直肠肠液的清洁效果更佳,有利于CT结肠成像检出结直肠息肉。     

聚乙二醇4000联合比沙可啶对帕金森病患者便秘症状及相关生活质量的影响

目的探讨聚乙二醇4000联合比沙可啶对帕金森病患者便秘症状及相关生活质量的影响。方法将98例明确诊断为帕金森病便秘的患者随机分为试验组49例和对照组49例,其中对照组予以聚乙二醇4000口服,治疗组在对照组方案基础上联合比沙可啶肠溶片口服,疗程均为2周,观察比较两组患者的大便频率、形状等便秘相关症状及其相关生活质量的变化。结果完成本研究试验者共87例,其中对照组44例,治疗后排便频率和粪便性状均有明显改善(P<0.05),治疗组43例患者在排便频率、粪便性状及费力程度等相关症状方面均较治疗前显著改善(P<0.05),组间比较:治疗组优于对照组(P<0.05);两组患者治疗后生活质量评分均有降低(P<0.05),且组间比较治疗组明显优于对照组,差异有统计学意义(P<0.05)。结论聚乙二醇4000联合比沙可啶对有效改善帕金森病患者便秘相关症状、提高其生活质量具有重要作用。     

An assessment of bisacodyl-based bowel preparation for colonoscopy in children

Background The most commonly used methods for bowel preparation are polyethylene glycol-electrolyte lavage solution (PEG-ELS) and sodium phosphate. Both are problematic in children. The use of bisacodyl together with fleet enema has been suggested as an alternative; however, its use without dietary restriction is inferior to other preparations. We aimed to study the effect of bisacodyl together with fleet enema and a half day of clear fluid diet. Methods Ninety-eight children (aged 30 months to 12 years) were studied prospectively according to the following protocol: on the day prior to the colonoscopy, the patient received a 5-mg bisacodyl tablet at noon and started a clear fluid diet. An additional bisacodyl tablet was taken in the evening by patients more than 5 years old. Two pediatric fleet enemas were performed, on the evening before and on the morning of the procedure. The patients were compared with 26 historical control patients that had been prepared with PEG-ELS solution. Results The compliance of the bisacodyl group was excellent (100%), compared with 88% of the control group. Ninety-five percent of the bisacodyl group had good to excellent bowel preparation, compared with 88% of the PEG-ELS group. Conclusions This method is safe and appropriate for use in children younger than 12 years.     

Dietary potassium and laxatives as regulators of colonic potassium secretion in end-stage renal disease.

BACKGROUND: In end-stage renal disease (ESRD), colonic potassium (K+) secretion increases as renal K+ excretion declines. The nature of this adaptive process is poorly understood, but post-prandial increases in plasma K+ concentration may be a determining factor. In addition, even though colonic K+ secretion increases in ESRD, interdialytic hyperkalaemia is a serious problem in haemodialysis patients, which might be reduced by stimulating colonic K+ secretion still further using laxatives. METHODS: Plasma K+ concentrations were measured in the fasting state, and for 180 min after the oral administration of 30 mmol of K+ to nine control subjects and 16 normokalaemic patients with ESRD (eight "predialysis" patients and eight patients undergoing continuous ambulatory peritoneal dialysis (CAPD)). Plasma K+ concentrations were also monitored for 180 min in fasting controls and ESRD patients who were not given the oral K+ load. To study the effect of laxatives on interdialytic hyperkalaemia, plasma K+ concentrations were measured in eight control subjects and 13 haemodialysis patients before and during 2 weeks treatment with bisacodyl (a cAMP-mediated laxative) and in five haemodialysis patients before and during 2 weeks treatment with lactulose (an osmotic laxative). RESULTS: Oral K+ loading caused plasma K+ concentration to rise within the normal range (3.5-5.1 mmol/l) in control subjects, while significantly higher concentrations were achieved in the "predialysis" patients and sustained hyperkalaemia developed in the CAPD patients. Bisacodyl treatment had no effect on plasma K+ concentrations in control subjects, but significantly decreased the mean interdialytic plasma K+ concentration (from 5.9+/-0.2 to 5.5+/-0.2 mmol/l, P<0.0005) in haemodialysis patients, whereas plasma K+ concentration did not change during lactulose treatment. CONCLUSIONS: Higher plasma K+ concentrations after food may help to maintain K+ homeostasis in ESRD by enhancing colonic K+ secretion. Bisacodyl may be useful for reducing interdialytic hyperkalaemia in patients undergoing haemodialysis.