Characterization of the colonic response to bisacodyl in children with treatment‐refractory constipation

Abstract

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 (χ2(1)=7.04, P < .01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response. 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.

High amplitude propagated contractions with Glycerin versus Bisacodyl: A within‐subject comparison in children undergoing colonic manometry

“…We used water perfused catheters for the ability to clip them with an Endo clip to the colonic mucosa to stay in place after placement. Previous multicenter studies did not show major differences between solid state vs water perfused catheters in the assessment of HAPC 8 . None of the patients had complications during or after the study.…”

“…6 HAPC is defined as high amplitude contractions of 65 mmHg or more, propagating at least 30 cm distally for at least 10 s, although slightly varying definitions have been described in literature. 5,[7][8][9] A colonic manometry study is performed using published guidelines (ANMS and NASPGHAN guidelines). 5 Measurements during fasting, after a meal, and after colonic stimulation by stimulants to induce HAPC are done to evaluate colonic motility.…”

“…One of the most easily recognized metrics on the CM is the high amplitude propagated contraction (HAPC) 6 . HAPC is defined as high amplitude contractions of 65 mmHg or more, propagating at least 30 cm distally for at least 10 s, although slightly varying definitions have been described in literature 5,7–9 . A colonic manometry study is performed using published guidelines (ANMS and NASPGHAN guidelines) 5 .…”

“…Both Bisacodyl and Glycerin have been widely used successfully in bowel regimens in patients with constipation as a method of disimpaction as well as to prevent fecal incontinence in patients with neurogenic bowel 6,11,12 . Motility centers use Bisacodyl rather than Glycerin while performing CM as per guidelines 5,8 . Bisacodyl stimulates sensory nerve endings to increase colonic peristalsis as well as inhibiting intestinal water absorption 13–16 .…”

An Update of Pharmacological Management in Children with Functional Constipation

“…Bisacodyl can elicit high-amplitude propagating contractions and therefore helps to distinguish between patients with normal or impaired colonic propulsion [46,47]. A recent study including 165 children with treatment-refractory constipation found that in 93% of children intraluminal administration of bisacodyl induced highamplitude propagating contractions, confirming the stimulating effect of bisacodyl on the colonic peristalsis in children [48]. However, good-quality evidence for the efficacy and safety of bisacodyl in children with FC is lacking [27].…”