Duodenal and proximal jejunal motility inhibition associated with bisacodyl-induced colonic high-amplitude propagating contractions

Abstract

Bisacodyl is a stimulant laxative often used in manometric studies of pediatric constipation to determine if it can initiate propulsive high amplitude propagating contractions. While the effects of bisacodyl infusion on colonic motility are well described, the effects of the drug on other regions of the gut after colonic infusion are not known. The aim of the present study was to characterize the effects of bisacodyl on both colonic and small bowel motility. Methods. Twenty seven children (9.3 + 1.2 years) undergoing simultaneous high resolution antroduodenal and colonic manometry were included. Small bowel and colonic motor patterns were assessed prior to and after colonic infusion of bisacodyl. Patients were divided into 2 groups; responders and non-responders based on the presence of high amplitude propagating contractions (HAPC) after bisacodyl infusion. Results. Nineteen patients were responders. 188 post-bisacodyl HAPCs were identified with a mean count of 10.4 ± 5.5 (range, 3 -22), at a frequency of 0.6 ± 0.2/min and mean amplitude of 119.8 ± 23.6 mmHg.No motor patterns were induced in the small bowel. However, in the 19 responders the onset of HAPCs was associated with a significant decrease in small bowel contractile activity. In the non-responders there was no detectable change in small bowel motility after bisacodyl infusion. Conclusion. Bisacodyl induced HAPCs are associated with a significant reduction in small bowel motility probably mediated by extrinsic sympathetic reflex pathways. This inhibition is potentially related to rectal distension, caused by the HAPC anal propulsion of colonic content.

High amplitude propagated contractions with Glycerin versus Bisacodyl: A within‐subject comparison in children undergoing colonic manometry

“…The data collected and analyzed after reviewing subjects’ CM tracings included presence of HAPCs during each phase (fasting, postprandial and after giving each stimulant). Furthermore, we looked at the onset of HAPC poststimulation (within 30 min of medication administration), 8 , 21 number of HAPCs poststimulation, length of propagation through the colon, and duration (maximum duration allowed was 1 h postadministration, after which the effect of the stimulant typically wears off). 8 In addition, the maximum amplitude of HAPC poststimulation was reported with each stimulant.…”

Simultaneous Colonic Pressure Waves in Children and Young Adults with Gastrointestinal Motility Disorders: Artefact or Colonic Physiology?

“…This is a second retrospective study utilizing some of these data. The first, looking at the interactions between colonic high-amplitude propagating contractions and small bowel motility, has already been published [ 6 ].…”

“…These motor patterns were defined as a series of monophasic pressure peaks occurring across 9 or more adjacent channels (minimum length 24 cm), where the waveforms in each channel overlapped with the adjacent channel, with a temporal offset. In addition, at least two pressure waves within the sequence had to have an amplitude ≥ 75 mmHg [ 6 , 11 ]. Once identified, it was then determined if they were associated with the following 2 motor patterns: Pressurizations ( Figure 1 C): as per our previous publication [ 6 ], we examined manometry traces for the presence of pressurizations that occurred at the end of HAPCs.…”

“…In pediatric patients presenting with severe and refractory gastrointestinal motility disorders, motility throughout the digestive tract can be assessed by performing manometry of the upper (stomach and proximal small bowel) and lower gut (colon) simultaneously. While conducting an analysis of these data for a recent publication [ 6 ], a high incidence of SPWs was noted in the colonic manometry recordings. It was also observed that many of these colonic SPWs appeared to span the entire gastric and small bowel recording, suggesting they represented an artefact related to the extrinsic forces applied to the colon (e.g., body movements or abdominal strain) rather than genuine colonic physiology.…”

Neurological disorders and small bowel dysmotility

“…There should be an awareness that certain laxatives (e.g. bisacodyl) may inhibit small bowel motility [51]. Naloxegol and methylnatrexone can be considered as additional treatments in patients who are opioid dependent [52].…”