Characterization of the colonic response to bisacodyl in children with treatment-refractory constipation.
bisacodyl
children
constipation
manometry
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
10
11
2019
revised:
10
03
2020
accepted:
19
03
2020
pubmed:
14
4
2020
medline:
27
7
2021
entrez:
14
4
2020
Statut:
ppublish
Résumé
Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment-refractory constipation. If bisacodyl does not induce high-amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies. Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion. One hundred and sixty-five children were included (median age 10, range 1-17 years; n = 96 girls). One thousand eight hundred and ninety-three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre- vs post-bisacodyl (Z = -0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ Intraluminal bisacodyl induced HAPCs in 93% of children with treatment-refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined.
Sections du résumé
BACKGROUND
Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment-refractory constipation. If bisacodyl does not induce high-amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies.
METHODS
Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion.
RESULTS
One hundred and sixty-five children were included (median age 10, range 1-17 years; n = 96 girls). One thousand eight hundred and ninety-three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre- vs post-bisacodyl (Z = -0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ
CONCLUSIONS AND INFERENCES
Intraluminal bisacodyl induced HAPCs in 93% of children with treatment-refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined.
Substances chimiques
Laxatives
0
Bisacodyl
10X0709Y6I
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13851Subventions
Organisme : Royal Australasian College of Surgeons
ID : Peter King Research Scholarship
Pays : International
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Chitkara DK, Talley NJ, Weaver AL, et al. Incidence of presentation of common functional gastrointestinal disorders in children from birth to 5 years: a cohort study. Clin Gastroenterol Hepatol. 2007;5:186-191.
Koppen IJN, Wiklendt L, Yacob D, Di Lorenzo C, Benninga MA, Dinning PG. Motility of the left colon in children and adolescents with functional constipation: a retrospective comparison between solid-state and water-perfused colonic manometry. Neurogastroenterol Motil. 2018;30:e13401.
Bassotti G, Gaburri M, Imbimbo BP, et al. Colonic mass movements in idiopathic chronic constipation. Gut. 1988;29:1173-1179.
Rao SS, Sadeghi P, Beaty J, Kavlock R. Ambulatory 24-hour colonic manometry in slow-transit constipation. Am J Gastroenterol. 2004;99:2405-2416.
Wessel S, Koppen IJ, Wiklendt L, Costa M, Benninga MA, Dinning PG. Characterizing colonic motility in children with chronic intractable constipation: a look beyond high-amplitude propagating sequences. Neurogastroenterol Motil. 2016;28:743-757.
Krueger D, Demir IE, Ceyhan GO, Zeller F, Schemann M. bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM)-the active metabolite of the laxatives bisacodyl and sodium picosulfate-enhances contractility and secretion in human intestine in vitro. Neurogastroent Motil. 2018;30:e13311.
Schubert E, Strunz U, Mitznegg P, Domschke S, Domschke W, Demling L. The mode of action of bisacodyl on the smooth muscle of the small and the large intestine of the guinea pig. Arzneimittelforschung 1975; 25:1053-1056.
Mitznegg P, Schubert E, Domschke W, et al. Mode of action of bisacodyl (dulcolax) on isolated muscles of human colon. Klin Wochenschr. 1975;53:493-495.
Ewe K. Effect of bisacodyl on intestinal electrolyte and water net transport and transit. Perfusion studies in men. Digestion. 1987;37:247-253.
Farack UM, Nell G. Mechanism of action of diphenolic laxatives: the role of adenylate cyclase and mucosal permeability. Digestion. 1984;30:191-194.
Hardcastle JD, Mann CV. Study of large bowel peristalsis. Gut. 1968;9:512-520.
Bassotti G, Gaburri M. Manometric investigation of high-amplitude propagated contractile activity of the human colon. Am J Physiol. 1988;255:G660-664.
Bharucha A. High amplitude propagated contractions. Neurogastroenterol Motil. 2012;24:977-982.
Ravi K, Bharucha AE, Camilleri M, Rhoten D, Bakken T, Zinsmeister AR. Phenotypic variation of colonic motor functions in chronic constipation. Gastroenterology. 2010;138:89-97.
Bassotti G. If it is inert, why does it move? Neurogastroenterol Motil. 2004;16:395-396.
Koppen I, Di Lorenzo C, Saps M, et al. Childhood constipation: finally something is moving! Expert Rev Gastroenterol Hepatol. 2016;10:141-155.
Koppen I, Kuizenga-Wessel S, Lu PL, et al. Surgical decision-making in the management of children with intractable functional constipation: what are we doing and are we doing it right? J Pediatr Surg. 2016;51:1607-1612.
Rodriguez L, Heinz N, Nurko S. Utility of colon manometry in guiding therapy and predicting need for surgery in children with defecation disorders. J Pediatr Gastroenterol Nutr. 2019;70:232-237.
Pensabene L, Youssef NN, Griffiths JM, Di Lorenzo C. Colonic manometry in children with defecatory disorders. Role in diagnosis and management. Am J Gastroenterol. 2003;98:1052-1057.
Di Lorenzo C, Flores AF, Reddy SN, Hyman PE. Use of colonic manometry to differentiate causes of intractable constipation in children. J Pediatr. 1992;120:690-695.
Kerur B, Kantekure K, Bonilla S, Orkin B, Flores AF. Management of chronic intractable constipation in children. J Pediatr Gastroenterol Nutr. 2014;59:754-757.
Giorgio V, Borrelli O, Smith VV, et al. High-resolution colonic manometry accurately predicts colonic neuromuscular pathological phenotype in pediatric slow transit constipation. Neurogastroenterol Motil. 2013;25:70-77.e78-79.
Herve S, Savoye G, Behbahani A, Leroi AM, Denis P, Ducrotte P. Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation. Neurogastroenterol Motil. 2004;16:397-402.
Bassotti G, Chiarioni G, Germani U, Battaglia E, Vantini I, Morelli A. Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity. Digestion. 1999;60:69-73.
van den Berg MM, Hogan M, Caniano DA, et al. Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg. 2006;41:730-736.
Rodriguez L, Nurko S, Flores A. Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility. Neurogastroenterol Motil. 2013;25:140-e181.
Di Lorenzo C, Solzi GF, Flores AF, Schwankovsky L, Hyman PE. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol. 2000;95:1759-1764.
Villarreal J, Sood M, Zangen T, et al. Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions. J Pediatr Gastroenterol Nutr. 2001;33:588-591.
Rodriguez L, Sood M, Di Lorenzo C, Saps M. An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterol Motil. 2017;29:e12944.
Basson S, Charlesworth P, Healy C, Phelps S, Cleeve S. Botulinum toxin use in paediatric colorectal surgery. Pediatr Surg Int. 2014;30:833-838.
Siminas S, Losty PD. Current surgical management of pediatric idiopathic constipation: a systematic review of published studies. Ann Surg. 2015;262:925-933.
Christison-Lagay ER, Rodriguez L, Kurtz M, St Pierre K, Doody DP, Goldstein AM. Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. J Pediatr Surg. 2010;45:213-219; discussion 219.
Lee SL, DuBois JJ, Montes-Garces RG, Inglis K, Biediger W. Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: a preliminary report. J Pediatr Surg. 2002;37:76-79.
Levitt MA, Martin CA, Falcone RA Jr, Pena A. Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg 2009;44:1285-1291; discussion 1290-1281.
Bassotti G, Betti C, Fusaro C, Morelli A. Colonic high-amplitude propagated contractions (mass movements): repeated 24-h manometric studies in healthy volunteers. J Gastrointest Motil. 1992;4:187-191.
De Schryver A, Samsom M, Smout AJP. Effects of a meal and bisacodyl on colonic motility in healthy volunteers and patients with slow-transit constipation. Dig Dis Sci. 2003;48:1206-1212.
Koppen IJN, Thompson BP, Ambeba EJ, et al. Segmental colonic dilation is associated with premature termination of high-amplitude propagating contractions in children with intractable functional constipation. Neurogastroenterol Motil. 2017;29:e13110.
King S, Catto-Smith AG, Stanton MP, et al. 24-hour colonic manometry in pediatric slow transit constipation shows significant reductions in antegrade propagation. Am J Gastroenterol. 2008;103:2083-2091.
Kamm M, van der Sijp JR, Lennard-Jones JE. Observations on the characteristics of stimulated defaecation in severe idiopathic constipation. Int J Colorectal Dis. 1992;7:197-201.
Borrelli O, Pescarin M, Saliakellis E, et al. Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry. Neurogastroenterol Motil. 2016;28:1747-1755.
van den Berg MM, Hogan M, Mousa HM, Di Lorenzo C. Colonic manometry catheter placement with primary fluoroscopic guidance. Dig Dis Sci. 2007;52:2282-2286.
Dinning P, Wiklendt L, Gibbins I, et al. Low-resolution colonic manometry leads to a gross mis-interpretation of the frequency and polarity of propagating sequences: initial results from fibreoptic high-resolution manometry studies. Neurogastroenterol Motil. 2013;25:e640-9.
Dinning P, Wiklendt L, Maslen L, et al. Quantification of in vivo colonic motor patterns in healthy humans before and after a meal revealed by high-resolution fiber-optic manometry. Neurogastroenterol Motil. 2014;26:1443-1457.
Corsetti M, Costa M, Bassotti G, et al. First translational consensus on terminology and definitions of colonic motility in animals and humans studied by manometric and other techniques. Nat Rev Gastroenterol Hepatol. 2019;16:559-579.
Corsetti MPG, Demedts I, Deloose E, et al. Pan-colonic pressurisations associated with relaxation of the anal sphincter in health and disease: a new colonic motor pattern identified using high-resolution manometry. Am J Gastroenterol. 2017;112:479-489.
Ikarashi N, Baba K, Ushiki T, et al. The laxative effect of bisacodyl is attributable to decreased aquaporin-3 expression in the colon induced by increased PGE2 secretion from macrophages. Am J Physiol Gastrointest Liver Physiol. 2011;301:G887-895.
Jauch R, Hankwitz R, Beschke K, Pelzer H. Bis-(p-hydroxyphenyl)-pyridyl-2-methane: the common laxative principle of Bisacodyl and sodium picosulfate. Arzneimittelforschung. 1975;25:1796-1800.
Friedrich C, Richter E, Trommeshauser D, et al. Absence of excretion of the active moiety of bisacodyl and sodium picosulfate into human breast milk: an open-label, parallel-group, multiple-dose study in healthy lactating women. Drug Metab Pharmacokinet. 2011;26:458-464.
Tipnis N, El-Chammas KI, Rudolph CD, Werlin SL, Sood MR. Do oro-anal transit markers predict which children would benefit from colonic manometry studies? J Pediatr Gastroenterol Nutr. 2012;54:258-262.
Moreno-Osset E, Bazzocchi G, Lo S, et al. Association between postprandial changes in colonic intraluminal pressure and transit. Gastroenterology. 1989;96:1265-1273.
Hamid SA, Di Lorenzo C, Reddy SN, Flores AF, Hyman PE. Bisacodyl and high-amplitude-propagating colonic contractions in children. J Pediatr Gastroenterol Nutr. 1998;27:398-402.
Martin M, Steele SR, Noel JM, Weichmann D, Azarow KS. Total colonic manometry as a guide for surgical management of functional colonic obstruction: preliminary results. J Pediatr Surg. 2001;36:1757-1763.
Battaglia E, Grassini M, Dore MP, Bassotti G. Usefulness of bisacodyl testing on therapeutic outcomes in refractory constipation. Dig Dis Sci. 2018;63:3105-3111.
Gasior A, Reck C, Vilanova-Sanchez A, et al. Surgical management of functional constipation: An intermediate report of a new approach using a laparoscopic sigmoid resection combined with malone appendicostomy. J Pediatr Surg. 2018;53:1160-1162.