Evaluation of the Effect of Oral Pyridostigmine on the Ileus after Abdominal Surgery: A Blinded Randomized Clinical Trial

Abstract

Postoperative ileus is one of the most important and common complications after abdominal surgery. This single-blind randomized clinical trial study was conducted with the aim of evaluating the effect of oral pyridostigmine (60 mg) on the duration and frequency of response to the treatment of ileus after abdominal surgery on 40 patients in two 20-subject groups of oral pyridostigmine (interventional) and starch (control) in 2015. All 40 people completed the study process and entered the final analysis. In the oral Pyridostigmin group (60 mg) the mean response time for the disposal of gas and stool were 5.4 ± 4.7 h and 4.9 ± 3.4 h, respectively. Most of the participants 10 (50%) (Disposal of stool) responded to treatment 4 h after the administration of oral pyridostigmine. In the starch group, the mean response time for the disposal of gas and stool were 32.4 ± 9.9 h and 36.2 ± 10.3 h, respectively. The mean treatment response time in two groups showed a significant difference between both groups (p = 0.001). Regarding the frequency of response to treatment (disposal of gas or stool) in the 24-h period after the initiation of treatment in the oral pyridostigmine group, 95% (n = 19) of the subjects responded to the treatment in the first 24 h. However, in the starch group, only 50% (n = 10) responded to treatment in the first 24 h, the results showed a significant difference between the two groups (p = 0.001). The results indicate that oral pyridostigmine can be used as a simple and effective treatment for gastrointestinal ileus.

Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report

“…Thus, pyridostigmine is shown to reduce constipation in patients with Parkinson's disease and autoimmune neuropathy 14 , as well as in other patients with refractory chronic constipation 15 . Furthermore, one study has shown that oral pyridostigmine is an effective and safe treatment for postoperative ileus 16 .…”

The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review

“…However, given the low sample size, this study was underpowered. 40 This study had a greater proportion of caesarean section patients, and limitations of sample bias. In addition, colorectal operations that have the highest incidence of POI were not included, and the routine use of nasogastric tubes likely confounded the results (as this is not standard practice in the types of surgery included in the study).…”

“…In the first 24 h, more patients given pyridostigmine passed stool compared to the placebo group (95% versus 50%, p = 0.001). However, given the low sample size, this study was underpowered 40 . This study had a greater proportion of caesarean section patients, and limitations of sample bias.…”

PyRICo‐Pilot: pyridostigmine to reduce the duration of postoperative ileus after colorectal surgery – a phase II study

“…Median age was 58 (50-82) years and seven (47%) were men. Most participants had an ASA grade ≥2 (53%), and the median BMI was 27 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) kg/m 2 . Benign conditions such as reversal of stoma and diverticulosis were the most common indication for surgery (n = 8, 53%), and 53% of procedures were minimally invasive (Table 1).…”

“…Although there have been some concerns regarding the use of neostigmine in the postoperative setting due to potential cardiac and respiratory side effects and a requirement for intensive monitoring, oral pyridostigmine is much safer in this regard and may be a good therapeutic option. In a randomized controlled trial (RCT) conducted by Maleknejad et al in patients undergoing abdominal surgery [25], the safety and efficacy data appeared promising, with a 1‐day reduction in time to first passage of stool and flatus and no obvious adverse effects. However, in that study all patients underwent noncolorectal abdominal surgery, with a lower baseline risk of ileus and a lower risk of cardiorespiratory complications.…”