Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry

Borrelli, Osvaldo; Pescarin, Matilde; Saliakellis, Efstratios; Tambucci, Renato; Quitadamo, Paolo; Valitutti, Francesco; Rybak, Anna; Lindley, Keith; Thapar, Nikhil

doi:10.1111/nmo.12876

Cited by 17 publications

(13 citation statements)

References 53 publications

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“…The recording was started when the patients were fully awake, generally at least two hours after placement of the catheter. In accordance with our center's approved CM protocol (version 2016), there were four recording periods during the study: (a) fasting state, (b) postprandial state (after a meal containing 20 kcal/kg or at least 400 kcal consumed within 30 minutes), (c) post‐first bisacodyl stimulation (0.2 mg/kg; max dose of 10 mg), and (d) post‐second bisacodyl stimulation (0.4 mg/kg; max dose of 20 mg) . The duration of each recording period was at least 60 minutes.…”

Section: Methodsmentioning

confidence: 99%

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Sintusek

Rybak

Mutalib

et al. 2018

Neurogastroenterology Motil

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Background The colo‐anal reflex is a distinct reflex whereby the internal anal sphincter (IAS) relaxes in association with colonic high amplitude propagating contractions (HAPCs) in contrast to the recto‐anal inhibitory reflex (RAIR), which is characterized by IAS relaxation upon rectal distension. The RAIR is mediated by the myenteric plexus and therefore absent in Hirschsprung disease. We retrospectively assessed the presence and the characteristics of the colo‐anal reflex in children in whom large bowel continuity had been surgically disrupted to assess the role of the extrinsic nervous system in the reflex. Methods High‐resolution (HR) colonic manometry and HR‐anorectal manometry were used to evaluate both colonic and anal motor activity in ten children with treatment‐unresponsive slow transit constipation (STC), who had previously undergone left‐sided colostomy formation with consequent disruption of the bowel continuity, and in two children with Hirschsprung's disease (HSCR), who had previously undergone distal colon resection followed by Duhamel pull‐through. Eight children with STC, normal colonic motor activity, and preserved large bowel continuity served as a control group. The presence and characteristics of colo‐anal reflex were analyzed. Key Results In the study group, all patients showed the presence of both normal HAPCs and the presence of the colo‐anal reflex. In two cases of HSCR, RAIR was absent; however, both patients demonstrated a colo‐anal reflex. Conclusions In children with disrupted continuity of the colon and/or abnormal anal reflex, the colo‐anal reflex is still preserved suggesting that it is mediated by a different pathway from the RAIR, possibly an extrinsic neural pathway.

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Section: Methodsmentioning

confidence: 99%

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Sintusek

Rybak

Mutalib

et al. 2018

Neurogastroenterology Motil

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“…Corsetti et al, identified this motor pattern in constipated adults, albeit at significantly reduced numbers compared to healthy adults . In this study, we could not identify them, and they have not been described in other high‐resolution constipation pediatric studies . There have, however, been descriptions of simultaneous pressure waves in children.…”

Section: Discussionmentioning

confidence: 52%

“…In children, the procedure is used to diagnose and guide treatment . The recent introduction of high‐resolution manometry, has the potential to improve the diagnostic capabilities of the procedure even more and several research groups and tertiary centers in this field have begun to record colonic data with these catheters . However, to date there is no standardization of protocols, equipment or analytical techniques.…”

Section: Discussionmentioning

confidence: 99%

Motility of the left colon in children and adolescents with functional constpation; a retrospective comparison between solid‐state and water‐perfused colonic manometry

Koppen

Wiklendt

Yacob

et al. 2018

Neurogastroenterology Motil

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Background: Using water-perfused (WP) high-resolution manometry, we recently demonstrated that children with functional constipation (FC) lacked the postprandial increase in distal colonic cyclic motor patterns that was observed in healthy adults.Our aim was to determine if similar results could be detected using a solid-state (SS) manometry catheter. Methods:We performed a retrospective analysis of 19 children with FC (median age 11.1 years, 58% male) who underwent colonic manometry with a SS catheter (36 sensors, 3 cm apart). Data were compared with previously published data using a WP catheter (36 sensors, 1.5 cm apart) recorded from 18 children with FC (median age 15 years; 28% male). Key Results:The cyclic motor patterns recorded by the SS catheter did not differ from those previously recorded by the WP catheter. There was no detected increase in this activity in response to the meal in either group. Long-single motor patterns were recorded in most patients (n = 16, 84%) with the SS catheter. The number of these events did not differ from the WP recordings. In the SS data, HAPCs were observed in 4 children prior to the meal, in 5 after the meal. This did not differ significantly from the WP data. Conclusions & Inferences:These data recorded by SS manometry did not differ from WP manometry data. Regardless of the catheter used, both studies revealed an abnormal colonic response to a meal, indicating a pathology which is not related to the catheter used to record these data. K E Y W O R D S children, colonic manometry, constipation, motilityThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…3,4 In a recent study, a higher dose of bisacodyl during colonic manometry increased the number of propagated HAPCs. 24 This implies that an activation of mucosal nerve endings may contribute more to the mechanism of action of bisacodyl, compared to a direct effect on the colon smooth muscle, because the intrinsic neural reflex within the colonic myenteric plexus has been suggested as a potential underlying mechanism of HAPC. 25 However, the tonic contraction of the longitudinal muscle by a direct effect of bisacodyl on the smooth muscle could reduce colon elongation, which improves the spatiotemporal-coordinated pattern of HAPCs.…”

Section: Discussionmentioning

confidence: 99%

Increased Tone of the Human Colon Muscle by Bisacodyl In Vitro

Kim

et al. 2018

J Neurogastroenterol Motil

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Background/AimsAlthough bisacodyl is a widely administered laxative, its underlying mechanism of action remains generally unknown. This study focuses on investigating the effects of bisacodyl on the human colon muscle contraction, and elucidating its mechanism of action.MethodsSigmoid colon muscle strips (20 longitudinal and 18 circular muscles) were obtained from 20 subjects who underwent colectomy for colon cancer. Isometric force measurements were calculated in response to electrical field stimulation (EFS, 0.3 milliseconds in trains of 10 Hz for 20 seconds, 150 V). Peak and nadir (tone) during and after EFS, were measured in a controlled state, and after sequential addition of bisacodyl (1 μM), atropine (1 μM), N-nitro-L-arginine (L-NNA, 100 μM), MRS2500 (1 μM), and tetrodotoxin (TTX, 1 μM) to the organ bath.ResultsTransient phasic contractions were observed during EFS, and after cessation of EFS. In the longitudinal muscles, nadir during EFS, and tone after EFS, significantly increased after addition of bisacodyl, and persisted after sequential addition of atropine, L-NNA, MRS2500, and TTX, indicating a direct action of bisacodyl on the smooth muscle. In the second experiment, pretreatment of TTX abolished EFS-induced phasic contractions. Although no phasic contraction was produced after perfusion of bisacodyl, tone was increased, thereby supporting evidence of a direct mechanism of action of bisacodyl on the colon smooth muscle.ConclusionsBisacodyl increases the tone of longitudinal muscle in the human sigmoid colon through a direct action on the smooth muscle. Further study is warranted to investigate the neural mechanism of action of bisacodyl.

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Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry

Abstract: An additional higher dose of bisacodyl during colonic manometry improves colonic neuromuscular function suggesting its use might improve interpretation and decision making in children with slow transit constipation.

Cited by 17 publications

References 53 publications

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Motility of the left colon in children and adolescents with functional constpation; a retrospective comparison between solid‐state and water‐perfused colonic manometry

Increased Tone of the Human Colon Muscle by Bisacodyl In Vitro

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