Scand J Gastroenterol. 1987 Sep;22(7):813-20.
Faecal osmolality and electrolyte concentrations in chronic diarrhoea: do they provide diagnostic clues?
Ladefoged K, Schaffalitzky de Muckadell OB, Jarnum S.
Medical Dept. P, Rigshospitalet, Copenhagen, Denmark.
Osmolality, pH, and electrolyte concentrations in faecal fluid were measured in 23 patients referred to our department because of diarrhoeal disorders. The aim of the study was to ascertain whether such measurements could provide valuable diagnostic information in patients with diarrhoea. The patients were studied on a fat-restricted diet (70 g fat/day) and during fasting. Osmolality, pH, and concentrations of electrolytes in faecal water showed wide variations but were within normal ranges in most of the patients. The patients were grouped into secretory and osmotic diarrhoea on the basis of: 1) current assumptions on the pathogenesis of diarrhoea in different disorders; 2) persistence versus resolution of diarrhoea during fasting (resolution = decrease of stool mass to less than 200 g/24 h); and 3) an osmotic gap (measured osmolality -2 X (Na + K]. The accordance between these three ways of grouping was very incomplete. It is concluded that measurements of faecal fluid osmolality and electrolyte concentrations are of little value as diagnostic procedures in chronic diarrhoea. Determination of the osmotic gap and/or of the decrease of stool mass during fasting may help to elucidate the pathogenesis of diarrhoea in different disorders but does not seem diagnostically useful. Three patients turned out to be laxative abusers, and laxative ingestion should always be considered in chronic unsettled diarrhoea.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3672039&dopt=Abstract constipation laxative
Eur J Pediatr. 1994 Aug;153(8):560-4.
The clinical value of solid marker transit studies in childhood constipation and soiling.
Papadopoulou A, Clayden GS, Booth IW.
Institute of Child Health, University of Birmingham, Edgbaston, UK.
Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptability of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2-13.5 years) at two referral centres. Median duration of symptoms was 60 months. Soiling was a prominent feature in 43 children (83%). Ten, 3 mm pieces of 6FG radio-opaque Silastic tubing were given orally at 9am on days 1, 2 and 3 and a plain abdominal film taken on day 5. Laxative treatment was not interrupted. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. The coefficient of variation of intra and inter-observer errors was 3.1% and 2.1% respectively. By day 5, 7% (group median) of markers were still in the right colon, 17% in the left colon and 42% in the rectosigmoid. Twenty-one patients (40%) had normal transit, 4 (8%) mild delay, 9 (17%) moderate and 18 (35%) severe transit delay. Marker distribution indicated slow pan-colonic transit in 29% and slow segmental transit in 10%. In 21%, clustering of markers in the rectosigmoid suggested outlet obstruction. A significant correlation was found between both transit delay and marker distribution and the severity of clinical symptoms of constipation and soiling. Repeat studies in six children following colonic evacuation revealed significant improvement (P < 0.05) in marker transit.(ABSTRACT TRUNCATED AT 250 WORDS)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7957401&dopt=Abstract constipation laxative
Schweiz Rundsch Med Prax. 1994 Oct 18;83(42):1190-4.
[Chronic constipation--what to do?]
[Article in German]
Medizinische Klinik II, Klinikum, J.-W.-Goethe-Universitat, Frankfurt.
Chronic constipation implicates heterogeneous disturbances of colonic transit and defecation which require both, careful medical evaluation and therapy. While the modes of action and side effects of laxatives are known for years, the understanding of dysfunctions underlying chronic constipation appears to be related to the understanding of subtle and new investigative techniques. This and the former extent of laxative prescriptions may explain why (based on an 'ex cathedra' decision by the governmental and insurance companies) the prescription of laxatives among primary care practitioners (in Germany) is not acknowledged as medical therapy. How to continue? First: two steps back, reestablishing understanding of constipation as a disease, including subtle diagnosis and differential diagnosis; then; two steps ahead, towards specific therapy, being aware that the available drugs are effective and require prescription by an experienced physician.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7973268&dopt=Abstract constipation laxative
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