References: Laxative
Am J Med. 1984 Nov 19;77(5B):51-6.
Problems associated with medical treatment of peptic ulcer disease.
Zimmerman TW.
In the United States, the drugs most commonly used to treat peptic ulcer disease are antacids and the H2-receptor antagonists cimetidine and ranitidine. Other available agents include anticholinergics and the coating agent sucralfate. Investigational drugs such as colloidal bismuth, carbenoxolone, prostaglandins, the tricyclic compound pirenzepine, and substituted benzimidazoles are not available for use in the United States. Most of the commercially available and investigational compounds have similar efficacy; therefore the optimal drug may be the one associated with the fewest adverse effects and the most convenient dosing regimen. Cimetidine causes a small number of adverse effects, including neuropsychiatric disorders, gynecomastia, impotence, loss of libido, elevation of serum creatinine and serum transaminases concentrations, and drug interactions. Some of these reactions have been of clinical significance. Presently, there are rare reports of gynecomastia, bradycardia, inhibition of acetylcholinesterase, headache, lethargy, diarrhea, and rash in patients receiving ranitidine. Antacids can produce either diarrhea or constipation and have been associated with low serum phosphorus concentrations, and metabolic alkalosis. Anticholinergics, especially in elderly or debilitated patients, can cause central nervous system disorders, intestinal atony, or urinary retention. Sucralfate may cause constipation, diarrhea, nausea, and headache. The investigational agents have their own side effect profiles. The adverse effects of anticholinergics make them unattractive therapeutic choices, and antacids and sucralfate have inconvenient dosing requirements compared with some equally efficacious alternatives. In addition, clinical experience with sucralfate in the United States is limited. The safety record of cimetidine is admirable. As clinical experience with ranitidine increases, cur
Z Kinderchir. 1984 Jun;39(3):191-201.
[Animal experimental studies of the smooth muscle pedicle flap (tunnel graft) in the goat]
[Article in German]
Holschneider AM, Amano S, Lohrs U, Donhauser G, Biese K, Kampf B.
Anorectal smooth muscles pedicle flaps (funnel grafts) according to the dragging method described by Holschneider in 1980, 1981 and Hofmann-von Kap-herr and Koltai 1981 were performed on 20 Syrian goats and German pedigree goats. Postoperatively, three animals died because of pulmonary infection with worms; 17 animals could be examined. Six of these 17 animals died during the postoperative follow-up period from the sequels of the operation. In five animals the cause of death was prestretching of the transplant by 150 and 200%; three of these developed severe enterocolitis, whereas two had stenosis and ileus, resulting in death in each case. In addition, five further animals showed signs of enterocolitis; eight goats had constipation which in every case could be ascribed to prestretching of the transplant by 150% and more. These animals had to be treated by infusion and bouginage, leading to recession of the signs after four to six days. Electromanometrically an increased anorectal resting pressure profile was found postoperatively in all cases, i.e. even if the transplant was prestretched to tension values of only over 100%. Relaxations of the internal anal sphincter could be achieved in all animals; however, in goats with a transplant stretch of 150% and more they were observed only after the resting pressure profile had receded, a few months after the operation. Histologically, there was increasing fibrosis and disintegration of the transplant in all animals with more than 150% prestretch. With 200% prestretch, the plexus myentericus disintegrated also, so that no relaxation could be achieved. Basing on these clinical, manometrical and histological results, smooth muscle transposition (funnel graft) can be recommended to improve continence in infants by employing the dragging
Dig Dis Sci. 1983 Nov;28(11):1025-33.
Constipation with colonic inertia. A manifestation of systemic disease?
Watier A, Devroede G, Duranceau A, Abdel-Rahman M, Duguay C, Forand MD, Tetreault L, Arhan P, Lamarche J, Elhilali M.
Transit of radiopaque markers was delayed in the ascending colon of 51 females and 3 males treated for severe idiopathic constipation. Onset of symptoms was between age 10 and 20 in more than half of the patients. Eighteen percent had previously undergone unnecessary laparotomy for large bowel pseudoobstruction. Stool frequency ranged from 1 stool every three days to 1 every 2 months. Twenty-six percent suffered from fecal incontinence. In addition, 30% had orthostatic hypotension and 15% galactorrhea of idiopathic origin. Patients had a higher than normal anal pressure (P less than 0.001). They all had a rectoanal inhibitory reflex, but it was abnormal in 76%. In the upper esophageal sphincter, resting pressure was higher (P less than 0.02), and coordination poorer (P less than 0.05) than in normal control subjects. Incidence of spontaneous tertiary contractions in the body of the esophagus was greater than normal (P less than 0.03). In the lower esophageal sphincter, resting pressure was lower (P = 0.001) and gastroesophageal gradient weaker (P = 0.05). Closing pressure of the sphincter was lower (P less than 0.001) and coordination less adequate (P less than 0.02). After subcutaneous injection of 0.035 mg/kg bethanechol, urinary bladder intraluminal pressure increased by over 15 cm H2O in 31% of patients but never did in controls, and average maximal pressure was greater (P less than 0.025). Time taken to reach peak pressure was shorter (P less than 0.01). This study provides evidence that patients who suffer from constipation with colonic inertia also have abnormal function in other hollow viscera.(ABSTRACT TRUNCATED AT 250 WORDS)
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6628151&dopt=Abstract constipation laxative colon cleansing
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