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

Abstract

Background:The presence of high amplitude propagated contractions (HAPCs) measured by colonic manometry (CM) reflect an intact neuromuscular function of the colon. Bisacodyl and Glycerin are colonic stimulants that induce HAPCs and are used for the treatment of constipation. HAPCs characteristics with each drug have not been compared before. We aimed to compare the HAPC characteristics with Bisacodyl and Glycerin in children undergoing CM for constipation.Methods: This is a prospective single-center cross-over study of children aged 2-18 years undergoing CM. All patients received both Glycerin and Bisacodyl during CM.They were randomized to group A with Bisacodyl first (n = 22) and group B with Glycerin first (n = 23), with 1.5 hours in between each dose. Differences in patient and HAPC characteristics between groups were summarized using descriptive statistics and compared using Chi-square test or Wilcoxon rank sum test as appropriate.Key Results: A total of 45 patients were included. HAPCs post Bisacodyl had a longer duration of action (median of 40 vs 21.5 min, p < 0.0001), longer propagation (median of 70 vs 60 cm, p = 0.02), and more HAPCs (median of 10 vs 5, p < 0.0001) compared Glycerin. No differences were found in the HAPC amplitude and onset of action between both medications.

Testing in functional constipation—What's new and what works

“…The study includes a recording of a fasting period, followed by a meal challenge and post‐prandial recovery and medication challenge with intracolonic bisacodyl to induce HAPCs 65 in the majority of patients usually within 12 min of infusion 100 . Other medications like erythromycin, 101,102 octreotide 103 and glycerin 104 have been attempted but have not yielded the same results. The standard protocol last 6 h, but some have reported 24 h studies show no difference in HAPC frequency between children with refractory constipation and healthy adults 105 but others have reported prolonged studies providing more information than 4 h studies but in a smaller proportion of patients 106 …”

High amplitude propagated contractions with glycerin versus bisacodyl: Are we comparing apples to oranges?

“…As expected, bisacodyl was more effective than glycerin. 1 In their introduction, the authors rightly state that "Motility centers use bisacodyl rather than glycerin while performing colonic manometry"-and there is a strong reason behind this choice. Bisacodyl is a stimulant laxative and has a direct myogenic action in the colon involving L-type calcium channels.…”