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References: Laxative

Med Hypotheses. 1994 Oct;43(4):234-8.
Lactulose--a potential drug for the treatment of inflammatory bowel disease.

Liao W, Cui XS, Jin XY, Floren CH.

Clinical Research Laboratory, Beijing Charity Hospital, China Rehabilitation Research Centre.

Lactulose is a drug mainly used as a laxative and for the treatment of porto-systemic encephalopathy. Following oral administration, intact lactulose reaches the colon, where it is split by bacteria, leading to a reduction in faecal pH and creating intestinal conditions beneficial to Lactobacillus acidophilus and inhibitory to coliform bacteria, bacteroides, Salmonella and Shigella. It was shown that lactulose therapy clears faecal salmonella and shigella species and reduces the prevalence of urinary-tract infection and respiratory tract infections. Oral administration of lactulose abolishes and prevents systemic endotoxemia of gut origin. Therefore lactulose may be used for treatment of inflammatory bowel disease as bacteria and bacterial endotoxin have an important role in the pathogenesis of this disease.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7838007&dopt=Abstract constipation laxative

Med J Aust. 1995 Feb 6;162(3):155-7.
Lower gastrointestinal tract. 1. Constipation.

Balson R, Gibson PR.

Royal Melbourne Hospital, Melbourne, Vic.

An accurate diagnosis is of primary importance in lower gastrointestinal problems in the elderly. Reversible causes should be treated specifically whenever possible, but symptomatic treatment can be a useful adjunct or a mainstay if no cause can be found. For constipation symptomatic treatment should proceed stepwise, commencing with increase in dietary fibre content. Only if this approach fails should laxatives (osmotic) be used. Stimulant laxatives and paraffin are best used intermittently, if at all, because of their side effects.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7854230&dopt=Abstract constipation laxative

Am J Gastroenterol. 1995 Mar;90(3):372-6.
Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?

Marshall JB, Singh R, Diaz-Arias AA.

Department of Internal Medicine, University of Missouri School of Medicine, Columbia.

OBJECTIVE: We sought to determine the frequency of clinically important histological abnormalities in patients with chronic, unexplained diarrhea who had macroscopically normal colonic endoscopies. METHODS: Of 855 consecutive patients undergoing colonoscopy (595 cases) or flexible proctosigmoidoscopy (260 cases) by one endoscopist, biopsies were taken in 111 cases of unexplained diarrhea of at least 4-6 weeks duration in which the colorectal mucosa appeared grossly normal. All biopsies were blindly reviewed by one pathologist. RESULTS: In this group of patients with macroscopically normal colons, we identified no cases of Crohn's disease or ulcerative colitis or any definite cases of collagenous colitis (CC) or lymphocytic colitis (LC). There was one case classified as "possible CC" and 13 cases classified as "some features of LC". There were five cases of melanosis coli, one case of cytomegalovirus colitis (in an immunosuppressed patient), and one case of radiation injury. Ninety-one cases were classified as no pathological diagnosis or minimal histological change. Patients with abnormal histology were contacted to see if they had persistence or resolution of diarrhea. For the cases of "possible CC" and "some features of LC," diarrhea had resolved spontaneously in the majority. Interesting to note, only one of the five melanosis coli patients admitted to laxative use, raising the question of surreptitious abuse. CONCLUSIONS: We conclude that the yield of biopsies in diarrhea patients with macroscopically normal colons at endoscopy is low. It may be reasonable to obtain biopsies in patients with relatively severe or debilitating symptoms, with diarrhea that sounds "organic" (e.g., nocturnal stools, freq

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