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References: Laxative

Z Gastroenterol. 1997 May;35(5):313-8.
Melanosis coli--a harmless pigmentation or a precancerous condition?

Nusko G, Schneider B, Ernst H, Wittekind C, Hahn EG.

Dept. of Medicine I, University of Erlangen.

Melanosis coli has long been considered as a harmless pigmentation of the colorectum associated with the use of laxatives containing anthraquinone. Recent experimental and clinical studies, however, have provided some evidence of a possible association between melanosis coli/laxative use and colorectal cancer. METHODS: In 2.229 consecutive patients we retrospectively analyzed the association of melanosis coli and laxative use with colorectal neoplasia. All the patients had undergone total colonoscopy, and the colorectal neoplasias had been examined histopathologically in accordance with the WHO classification. Information concerning laxative use, bowel habits and family history of colorectal cancer was obtained from the medical records. The statistical analysis was done using the Mantel-Haenszel-test for linear association. RESULTS: The presence of colorectal cancer was not associated with melanosis coli or laxative use. However, colorectal adenomas were found significantly more frequently in patients with melanosis coli than in those without melanosis (p = 0.0002). But adenomas associated with melanosis coli were significantly smaller than those not associated with melanosis (p < 0.0001), and were located predominantly in the proximal colon (p = 0.0002). In the patients with melanosis coli the relative risk was significantly higher for tubular (1.80; 95% CI: 1.26-2.56) and tubulovillous adenomas (2.03; 95% CI: 1.09-3.76), but not for villous adenomas. No significant differences were found in the grade of dysplasia of adenomas in patients with, and those without, melanosis coli. CONCLUSION: There appears to be no association between colorectal cancer and melanosis coli or laxative use. Colorectal adenomas are more frequently found in patients with melanosis coli. Colorectal adenomas d

Spinal Cord. 1997 Jun;35(6):394-401.
Constipation-related symptoms and bowel program concerning individuals with spinal cord injury.

Harari D, Sarkarati M, Gurwitz JH, McGlinchey-Berroth G, Minaker KL.

Division on Aging, Harvard Medical School, Boston, MA, USA.

PURPOSE: To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of difficulty with evacuation. PATIENTS AND METHODS: This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n = 197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n = 161, 82%) regarding bowel-related symptoms and treatment over the previous 1 month period. The study definition of difficulty with evacuation was spending more than 1 h per episode of bowel evacuation. RESULTS: Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with difficulty with evacuation (n = 66) were compared with those who spent less than 1 h on evacuation (n = 95). Factors associated with difficulty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. CONCLUSION: Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable

Carcinogenesis. 1997 Jun;18(6):1259-63.
Enhancement of cell proliferation and prostaglandin biosynthesis by 1,8-dihydroxyanthraquinone in the rat large intestine.

Nishikawa A, Kase Y, Hayakawa T, Yanagisawa T, Kanno J, Hayashi Y.

Biological Safety Research Center, National Institute of Health Sciences, Setagaya-ku, Tokyo, Japan.

The effects of 1,8-dihydroxyanthraquinone (DHAQ), a stimulant laxative named danthron, on cell kinetics and prostaglandin (PG) biosynthesis in the gastrointestinal tract were investigated in male 8-week-old F344 rats divided into three groups, each consisting of 10 animals. The animals in groups one, two and three were respectively given diets supplemented with 0%, 0.1% and 0.2% DHAQ for 24 days. PGE2 levels in the colorectal mucosa were significantly (P < 0.05 and 0.001) elevated after DHAQ treatment and showed some evidence of a dependence of DHAQ dose, consistent with the plasma PGE2 levels. BrdU-labeling indices in the large intestinal epithelium were also significantly (P < 0.01) increased, although the other portions of the gut such as the stomach and small intestine were not significantly affected. Excretion of the main urinary metabolite of PGE (PGE-MUM) was significantly (P < 0.001 or 0.01) increased whereas the urinary PGE2 concentration and total PGE2 excretion were not changed. Thus the results of the present study clearly indicate enhancement of cell proliferation by DHAQ in the large intestine epithelia, correlated with increased PGE2 levels in the large intestinal mucosa as well as the plasma, and possible support for the conclusion that quantitative analysis of urinary PGE-MUM, but not PGE2 itself, offer a useful approach for biomonitoring exposure to such stimulant laxatives.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9214611&dopt=Abstract constipation laxative

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