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References: Laxative

Pain. 1994 Apr;57(1):109-16.
Treatment of cancer pain in Norway. A questionnaire study.

Warncke T, Breivik H, Vainio A.

Department of Anaesthesiology, National Hospital of Norway, Oslo.

A questionnaire study was performed in order to clarify knowledge and practice of cancer pain treatment in Norway: a 10% random sample of Norwegian physicians received a questionnaire. Of 800 correctly addressed questionnaires, 549 were returned and 306 were analyzed after exclusion of those doctors who never treated cancer patients. Their knowledge of the principles and methods of cancer pain treatment were evaluated with 8 multiple-choice and 13 open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 illustrative case histories. The results show that only 25% of Norwegian physicians treating cancer patients appear to have knowledge of the principles of the World Health Organization analgesic ladder strategy. However, the majority (86%) of the physicians were prepared to prescribe strong opioid analgesics, but in the illustrative cases where strong opioids were appropriate, 44% prescribed too small doses and often preferred neuroleptic drugs instead of increasing the analgesic to a sufficiently large dose. Patients needing step two on the analgesic ladder, in Norway often (49%) are treated with a standard combination of paracetamol and codeine. However, when a strong opioid is required, 50% of Norwegian physicians forget to continue the paracetamol or NSAID component. Two hundred seventy-four (97%) of the physicians said they experienced problems when treating cancer pain, ranging from inefficient pain relief (52%) to side effects of opioid analgesics (32%), most often sedation, in combination with nausea and constipation. Only 13% of the physicians had a correct understanding of opioid drug dependence. As many as 72% of Norwegian physicians thought their education in cancer pain treatment was insufficient.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8065787&dopt=Abstract constipation laxative colon cleansing

Am J Gastroenterol. 1994 Mar;89(3):387-91.
Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters.

Crowell MD, Cheskin LJ, Musial F.

Division of Digestive Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

OBJECTIVES: Disturbances in gastrointestinal function may result from disordered eating and may lead to increases in gastrointestinal (GI) symptoms. We compared GI symptoms in obese and non-obese binge eaters and non-binge eaters. METHODS: One hundred nineteen obese and 77 normal-weight females completed a questionnaire on bowel symptoms and binge eating behaviors for the previous 3 months. Based on binge behaviors and body mass index (> 30 kg/m2), individuals were grouped as obese binge eaters (n = 73), obese non-binge eaters (n = 43), non-obese binge eaters (n = 14), and normal-weight controls (n = 61). RESULTS: Obese binge eaters reported more upper GI symptoms than normal controls or obese non-binge eaters (p < 0.001). Compared with normal controls, nausea, vomiting, and bloating was 2-4 times more prevalent in both binge eating groups. Indigestion was more prevalent in both obese groups. Obese binge eaters reported more lower GI symptoms than normal-weight controls (p < 0.05). Binge eating in both weight groups was associated with more frequent abdominal pain and dyschezia. Obesity was associated with more frequent constipation, diarrhea, straining, and flatus, whether or not subjects reported binge eating. Chi-square showed a significant association between obesity, binge eating, and symptoms of irritable bowel syndrome, using the Manning criteria. CONCLUSIONS: Specific GI symptoms were associated with binge eating and obesity. Overall, symptoms were more prevalent and more severe in obese binge eaters. The high prevalence of GI symptoms in obese patients who indulge in binge eating should be considered in their evaluation and treatment.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8122651&dopt=Abstract constipation laxative colon cleansing

Gastroenterology. 1994 Apr;106(4):945-50.
Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities.

Aggarwal A, Cutts TF, Abell TL, Cardoso S, Familoni B, Bremer J, Karas J.

Clinical Research Center, University of Tennessee, Memphis.

BACKGROUND/AIMS: Irritable bowel syndrome may be influenced by the autonomic nervous system. Abnormalities in autonomic function, colon transit time, and psychological profiles in 21 patients were assessed. METHODS: Using modified Manning criteria for irritable bowel syndrome, patients were classified as constipation-predominant or diarrhea-predominant. Autonomic function was determined by one vagal cholinergic and two sympathetic adrenergic measures. Colon transit was assessed by radiopaque markers, and psychological profiles were determined by three inventories. RESULTS: Autonomic function tests showed that diarrhea-predominant subgroup values for one sympathetic adrenergic measure (postural adjustment ratio) were significantly different from controls (P < 0.01). Constipation-predominant subgroup values were significantly lower for the vagal cholinergic measure R-R interval (P < 0.05). Colon transit measures differed by subgroup in left, right, rectosigmoid, and total colon transit times. Both subgroups differed significantly from controls on psychological measures; the constipation subgroup showed more psychological distress. CONCLUSIONS: Irritable bowel syndrome specific-symptom subgroups had different patterns of autonomic functioning, colonic transit, and psychological measures. The constipation subgroup is associated with a cholinergic abnormality and the diarrhea-predominant subgroup with an adrenergic abnormality. These findings suggest specific associations between the autonomic nervous system, predominant physical symptoms, colon transit time, and psychological factors in patients with irritable bowel syndrome.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8143999&dopt=Abstract constipation laxative colon cleansing

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