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References: Laxative

Rev Gastroenterol Mex. 2002 Jul-Sep;67(3):161-5.
[Differences in the stress symptoms rating scale in Spanish between patients with irritable bowel syndrome (IBS) and healthy controls]

[Article in Spanish]

Huerta I, Bonder A, Lopez L, Ocampo MA, Schmulson M.

Departamento de Gastroenterologia, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, D.F.

Irritable bowel syndrome (IBS) can be explained by the interrelation of cognitive components such as illness behavior, emotional such as depression and anxiety, behavioral such as environmental stressors, and physiologic such as pain modulation alterations. The stress symptom rating (SSR) scale is being used in physiologic studies in IBS, but differences between IBS patients and healthy controls in the basal condition is unknown. AIMS: To determine the basal differences in the SSR-Spanish between IBS patients and controls, and between IBS patients according to bowel-habit predominance. METHODS: Forty consecutive IBS-Roma 1 patients [M: 28 (78%), F:8(22.2%), 42.6 +/- 2.7 years] and 36 healthy volunteers paired by gender and age [M: 28 (78%), F:8 (22.2%); 36.7 +/- 2.1 years] were included. IBS were classified as constipation, diarrhea, or alternating. All completed the SSR prior to the medical visit. Mean group values of the different SSR parameters were compared by ANOVA. A p < 0.05 was considered significant. RESULTS: Compared with controls, IBS patients reported higher anxiety (p = 0.005), attention (p = 0.04) fatigue (p = 0.04), and lower arousal (p = 0.003). There were no differences in stress and anger either in IBS patients according to bowel-habit predominance. CONCLUSIONS: Under basal conditions, there are differences in anxiety, weakness, attention, and arousal between IBS patients and controls that correspond to intrinsic characteristics of IBS independent of bowel-habit predominance. Higher anxiety is in agreement with psychological comorbidity, higher attention with hypervigilance, and fatigue and lower arousal

Br J Cancer. 2003 Apr 7;88(7):1017-24.
Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer.

Chau I, Allen M, Cunningham D, Tait D, Brown G, Hill M, Sumpter K, Rhodes A, Wotherspoon A, Norman AR, Hill A, Massey A, Prior Y.

Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, UK.

This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n=30, CT alone n=6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m(-2) day(-1) for 12 weeks) with mitomycin C (MMC) (7 mg m(-2) i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m(-2) day(-1) and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4-9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range=40-85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI=64-91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in

Int J Colorectal Dis. 2003 Sep;18(5):433-8. Epub 2003 Apr 04.
Effect of electrical stimulation in constipated patients with impaired rectal sensation.

Chang HS, Myung SJ, Yang SK, Jung HY, Kim TH, Yoon IJ, Kwon OR, Hong WS, Kim JH, Min YI.

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, 138-736 Seoul, Korea.

BACKGROUND AND AIMS: A subgroup of constipated patients complain of absent or diminished sense of wanting to defecate, suggesting that one of the causes of constipation is impaired rectal sensation. Electrical stimulation therapy (EST) has recently been used to treat patients with urinary and/or fecal incontinence. This study evaluated the efficacy of EST in constipated patients, especially those with impaired rectal sensation. PATIENTS AND METHODS: Of the 130 patients with functional constipation as defined by Rome II criteria, 22 patients who had impaired rectal sensation (rectal desire threshold volume > or =90 ml) on an anorectal manometry were selected. We treated 12 with EST and 10 with biofeedback therapy (BFT) according to a randomized order. RESULTS: Overall symptoms of patients significantly improved after each therapy in both groups. Interestingly, frequency of sense of wanting to defecate improved only after EST. On objective findings there was significant improvement in anal residual pressures on attempted defecation only after BFT solely. On the other hand, rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume improved significantly only in the EST group. CONCLUSION. Our findings show that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients, especially those with impaired rectal sensation. EST might be considered as an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12677456&dopt=Abstract constipation laxative [PubMed - in process]

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