Dig Dis Sci. 1985 Apr;30(4):289-94.
Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation.
Preston DM, Lennard-Jones JE.
The resting motility of the pelvic colon was studied in 28 patients with constipation and compared with control subjects and patients with diarrhea. Colonic activity in patients who had been shown to have slow colonic transit was not significantly different from controls. In contrast, activity in patients who complained of constipation but who were found to have normal colonic transit time was increased (P less than 0.02). The response of the pelvic colon to the introduction of a surface-acting laxative was studied in 18 patients with slow-transit constipation. Eleven patients developed progressive peristaltic waves, while in 7 there was no response. It is possible that the relative inactivity of the colon in the latter group is due to a disorder of the myenteric plexus. If so, the bisacodyl stimulation test may distinguish patients with an abnormal myenteric plexus from those in whom it is normal.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3979235&dopt=Abstract constipation laxative
Biopharm Drug Dispos. 1985 Jul-Sep;6(3):325-34.
Comparative physiological disposition of some anthraquinone glycosides and aglycones.
Moreau JP, Moreau S, Skinner S.
The in vitro microbial degradation and the urinary excretion and biliary secretion in rats of two anthraquinone glycosides (sennosides A and B) and four aglycones (sennidins A and B, rhein, and danthron) were studied using a high performance liquid chromatographic system with gradient elution and amperometric detection. Microbial degradation of sennosides A and B occurred almost exclusively in the presence of mice caecum inoculae and was associated with the release of sennidins A and B. Rhein and danthron were indiscriminately metabolized by bacteria sampled from all regions of mice intestine, whereas sennidins lacked stability in biological media. The fraction of the dose administered orally to rats and recovered as aglycones or as glucuronides in bile and urine after 48 hours was five times greater for rhein (15 per cent) and danthron (13.4 per cent) than for sennosides A (1.8 per cent) and B (2.8 per cent) excreted or secreted as sennidins. These results support the concept that anthraquinone glycosides are less likely to enter the systemic circulation and, thus, are able to exert their laxative effect at lower doses than aglycones.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4041558&dopt=Abstract constipation laxative
Clin Gastroenterol. 1985 Jul;14(3):599-613.
Diarrhoea as a symptom.
Diarrhoea is a common symptom in all communities and in both general and hospital practice. Diarrhoeal diseases, particularly of infectious aetiology, are a huge health problem world-wide, causing much morbidity and mortality, especially amongst children. Although the symptom is almost universally understood, the definition of diarrhoea is difficult because of the wide variation in the bowel habits of normal individuals. Diarrhoea is, perhaps, best described as a change in bowel habit from normal with an increase in stool volume and/or fluidity with or without an increase in stool frequency. The disorders causing diarrhoea are many and various, but most episodes of diarrhoea are mild and self-limiting. However, all cases of chronic diarrhoea and all severe cases of acute diarrhoea require investigation after the initial clinical assessment. Investigation must be logical and structured and can be divided into three stages: the initial work-up (sigmoidoscopy, stool examination, screening blood tests), anatomical and functional assessment of the gastrointestinal tract, and further investigation of the difficult case (osmotic or secretory diarrhoea?, hormone levels, tests for laxative abuse, perfusion studies, laparotomy, etc.) Most cases are diagnosed after clinical assessment or the initial work-up. In the remainder, there are usually clues to the diagnosis or to the area of the gastrointestinal tract which needs to be investigated. Only a small number of cases require extensive investigation including the third stage of work-up. Analysis of the symptom of diarrhoea requires all the attributes of the good physician: wide clinical experience, careful history and examination, diagnostic and therapeutic acumen, a sound understanding of normal and abnormal physiology, skill and experience in selecting the appropriate investigations and interpreting their results, meticulous attention to detail and finally, a caring and sympatheti
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