Early resolution of Ogilvie's syndrome with intravenous neostigmine

Abstract

These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

Cholinergic interactions between donepezil and prucalopride in human colon: potential to treat severe intestinal dysmotility

“…These include post-operative ileus, intestinal pseudo-obstruction (Coulie and Camilleri, 1999), 'acute colonic pseudoobstruction' (Saunders, 2007) and 'megacolon ' (Bharucha and Phillips, 1999), collectively leading to significant individual morbidity and incident mortality (Coulie and Camilleri, 1999). Cholinesterase inhibitors such as neostigmine or pyridostigmine are sometimes used to enhance intestinal propulsion in patients with severe hypomotility (Law et al, 2001), especially those with acute colonic pseudo-obstruction in which dilatation of the colon can lead to perforation and death (Turégano-Fuentes et al, 1997;Ponec et al, 1999;Amaro and Rogers, 2000;Trevisani et al, 2000;Loftus et al, 2002;Mehta et al, 2006;Saunders, 2007;McNamara and Mihalakis, 2008;O'Dea et al, 2010;Elsner et al, 2012;Bharucha et al, 2013). The latter can occur in patients of any age after major surgery or trauma, severe illness or during intensive care (Saunders and Kimmey, 2005;Saunders, 2007;Giorgio and Knowles, 2009).…”

“…However, it most commonly occurs in susceptible elderly patients with extensive co-morbidities (Hyatt, 1987), in whom neostigmine and pyridostigmine may be absolutely contraindicated or hazardous due to cardio-bronchial side effects or renal insufficiency (Saunders, 2007). Further, neostigmine is an unattractive treatment option in any patient due to side effects of abdominal pain, excess salivation, nausea and/or vomiting, bradycardia (necessitating cardiac monitoring; Saunders, 2007;McNamara and Mihalakis, 2008), hypotension and bronchospasm (Turégano-Fuentes et al, 1997;Amaro and Rogers, 2000). For these reasons, the use of cholinesterase inhibitors beyond acute colonic pseudo-obstruction has been limited to anecdotal reports of patients with cancer and opioid-induced chronic constipation (Rubiales et al, 2006;Papa and Turconi, 2010), chronic constipation associated with spinal injury (Singal et al, 2006;Ebert, 2012) and patients with autonomic neuropathies (Bharucha et al, 2008).…”

Síndrome de Ogilvie o pseudobstrucción aguda del colon: una causa rara de abdomen agudo, de elevada mortalidad y asociada a patologías frecuentes en un Servicio de Medicina Interna

“…La neostigmina, estimula el sistema nervioso autónomo parasimpático restableciendo el peristaltismo. Se utiliza en bolo intravenoso único a la dosis de 2-2,5 mg. Otros fármacos como los agonistas de los receptores de la 5-hidroxitriptamina están aún en estudio (7,9,10). En nuestro caso tras realizarse el estudio radiológico que descarta causa obstructiva, tratamiento de la insuficiencia y sobreinfección respiratoria, así como las medidas de ayuno, sonda rectal, enemas de limpieza y reposición hídrica y de electrolíticos, el paciente mejoró de forma lenta y progresiva hasta recibir el alta hospitalaria.…”

Update on acute colonic pseudo-obstruction

“…None of those agents provided predictable clinical responses, either in the literature or in clinical experience. Specific medical therapy that might result in dramatic improvement was suggested by anecdotal reports of the use of the acetylcholinesterase inhibitor neostigmine [10][11][12][13][14]. The theoretical advantage of this treatment is enhanced parasympathetic activity in the colon with improved peristalsis [15].…”