Pyridostigmine in chronic intestinal pseudo‐obstruction – a systematic review

Wilkie, Bruce; Noori, Jawed; Johnston, Michael; Woods, Rodney; Keck, James; Behrenbruch, Corina

doi:10.1111/ans.18478

Cited by 4 publications

(1 citation statement)

References 28 publications

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“…Cholinesterase inhibitors stimulate upper and lower gastrointestinal motility, with parenteral neostigmine commonly used in the treatment of acute intestinal pseudo-obstructions and oral pyridostigmine having shown a benefit in the management of chronic and recurrent intestinal pseudo-obstruction [55][56][57]. Pyridostigmine reduces colonic transit times and improves the symptoms in patients with chronic constipation and those with secondary causes of slow transit constipation [58][59][60][61][62].…”

Section: Prokineticsmentioning

confidence: 99%

Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management

Vlismas,

Wu,

2024

Medicina

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Slow transit constipation (STC) has an estimated prevalence of 2–4% of the general population, and although it is the least prevalent of the chronic constipation phenotypes, it more commonly causes refractory symptoms and is associated with significant psychosocial stress, poor quality of life, and high healthcare costs. This review provides an overview of the pathophysiology, diagnosis, and management options in STC. STC occurs due to colonic dysmotility and is thought to be a neuromuscular disorder of the colon. Several pathophysiologic features have been observed in STC, including reduced contractions on manometry, delayed emptying on transit studies, reduced numbers of interstitial cells of Cajal on histology, and reduced amounts of excitatory neurotransmitters within myenteric plexuses. The underlying aetiology is uncertain, but autoimmune and hormonal mechanisms have been hypothesised. Diagnosing STC may be challenging, and there is substantial overlap with the other clinical constipation phenotypes. Prior to making a diagnosis of STC, other primary constipation phenotypes and secondary causes of constipation need to be ruled out. An assessment of colonic transit time is required for the diagnosis and can be performed by a number of different methods. There are several different management options for constipation, including lifestyle, dietary, pharmacologic, interventional, and surgical. The effectiveness of the available therapies in STC differs from that of the other constipation phenotypes, and prokinetics often make up the mainstay for those who fail standard laxatives. There are few available management options for patients with medically refractory STC, but patients may respond well to surgical intervention. STC is a common condition associated with a significant burden of disease. It can present a clinical challenge, but a structured approach to the diagnosis and management can be of great value to the clinician. There are many therapeutic options available, with some having more benefits than others.

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Section: Prokineticsmentioning

confidence: 99%

Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management

Vlismas,

Wu,

2024

Medicina

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Neuroimmune communication of the cholinergic system in gut inflammation and autoimmunity

Halder,

Yadav,

Lal

2024

Autoimmunity Reviews

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Effective Management of Chronic Intestinal Pseudo-Obstruction in MELAS Using Acotiamide: A Case Report

Kawano,

Taniguchi,

Narita

et al. 2024

Case Rep Neurol

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Background: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is reported to be a secondary cause of chronic intestinal pseudo-obstruction (CIPO). Although few case reports have described CIPO in MELAS, effective treatment for CIPO has not been established. Here, we present a case report of amelioration of CIPO symptoms using acotiamide in a patient with MELAS. Case Presentation: A 51-year-old Japanese female with a mitochondrial disorder with m.3243A>G mutation and a history of anorexia for two years presented to our hospital with a left temporal headache and acute paraphasia. A stroke-like episode of MELAS was suspected, and combined therapy with arginine, edaravone, and levetiracetam was initiated. Although her symptoms improved, she presented with nausea and vomiting and abdominal distension six days following admission. Abdominal contrast-enhanced computed tomography revealed dilatation from the stomach to the intestine, particularly marked the stomach, with neither obstruction nor impaired blood flow in the intestine. CIPO exacerbation with MELAS was suspected, and the patient’s symptoms gradually improved with acotiamide. Conclusion: Patients with MELAS could possibly experience stroke-like episodes during CIPO. Since acetylcholine possibly plays an important role in the pathophysiology of CIPO and acotiamide possesses prokinetic activity by inhibiting acetylcholinesterase, acotiamide could possibly improve CIPO symptoms.

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Pyridostigmine in chronic intestinal pseudo‐obstruction – a systematic review

Cited by 4 publications

References 28 publications

Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management

Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management

Neuroimmune communication of the cholinergic system in gut inflammation and autoimmunity

Effective Management of Chronic Intestinal Pseudo-Obstruction in MELAS Using Acotiamide: A Case Report

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