Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo‐obstruction: A prospective study

Mehta, Rajiv; John, Anil; Nair, Prem; Vv, Raj; Cp, Mustafa; Suvarna, Deepak; BALAKRISHNAN, BALAKRISHNAN

doi:10.1111/j.1440-1746.2005.03994.x

Cited by 62 publications

(42 citation statements)

References 16 publications

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“…19,[26][27][28][29][30][31][32] Collectively, rapid decompression of colonic distention was observed in 87% of patients with a recurrence rate of approximately 10% (Table 6). In the prospective series reported by Mehta et al, 32 a response to neostigmine was more likely in the post-operative setting (11 of 15 (73%) versus 1 of 4 (25%), P ¼ 0.07), and less likely in those with electrolyte imbalance or receiving antimotility agents (3 of 15 (20%) versus 4 of 4, P ¼ 0.003).…”

Section: Neostigminementioning

confidence: 99%

Acute colonic pseudo-obstruction

Saunders

2007

Best Practice & Research Clinical Gastroenterology

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Section: Neostigminementioning

confidence: 99%

Acute colonic pseudo-obstruction

Saunders

2007

Best Practice & Research Clinical Gastroenterology

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“…Recurrence of ACPO has been reported in 17-38% of cases after initial success with neostigmine [33,37]. The oral administration of polyethylene glycol (PEG) has been proposed in the literature to prevent recurrent ACPO [38].…”

Section: Pharmacologic Treatment Neostigminementioning

confidence: 99%

Ogilvie's syndrome–acute colonic pseudo-obstruction

Pereira

Djeudji

Leduc

et al. 2015

Journal of Visceral Surgery

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Ogilvie's syndrome describes an acute colonic pseudo-obstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. It often occurs in debilitated patients. Its pathophysiology is still poorly understood. Since computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, the possibility of organic colonic obstruction must be excluded. If there are no criteria of gravity, initial treatment should be conservative or pharmacologic using neostigmine; decompression of colonic gas is also a favored treatment in the decision tree, especially when cecal dilatation reaches dimensions that are considered at high risk for perforation. Recurrence is prevented by the use of a multiperforated Faucher rectal tube and oral or colonic administration of polyethylene glycol (PEG) laxative. Alternative therapeutic methods include: epidural anesthesia, needle decompression guided either radiologically or colonoscopically, or percutaneous cecostomy. Surgery should be considered only as a final option if medical treatments fail or if colonic perforation is suspected; surgery may consist of cecostomy or manually-guided transanal pan-colorectal tube decompression at open laparotomy. Surgery is associated with high rates of morbidity and mortality.

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Broad

Kung

Boundouki

et al. 2013

British J Pharmacology

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BACKGROUND AND PURPOSECholinesterase inhibitors such as neostigmine are used for acute colonic pseudo-obstruction, but cardio-bronchial side-effects limit use. To minimize side-effects, lower doses could be combined with a 5-HT4 receptor agonist, which also facilitates intestinal cholinergic activity. However, safety concerns, especially in the elderly, require drugs with good selectivity of action. These include the AChE inhibitor donepezil (used for Alzheimer's disease, with reduced cardio-bronchial liability) and prucalopride, the first selective, clinically available 5-HT4 receptor agonist. This study examined their individual and potential synergistic activities in human colon. EXPERIMENTAL APPROACHNeuronally mediated muscle contractions and relaxations of human colon were evoked by electrical field stimulation (EFS) and defined phenotypically as cholinergic, nitrergic or tachykinergic using pharmacological tools; the effects of drugs were determined as changes in 'area under the curve'. KEY RESULTSPrucalopride increased cholinergically mediated contractions (EC50 855 nM; 33% maximum increase), consistent with its ability to stimulate intestinal motility; donepezil (477%) and neostigmine (2326%) had greater efficacy. Concentrations of donepezil (30-100 nM) found in venous plasma after therapeutic doses had minimal ability to enhance cholinergic activity. However, donepezil (30 nM) together with prucalopride (3, 10 μM) markedly increased EFS-evoked contractions compared with prucalopride alone (P = 0.04). For example, the increases observed with donepezil and prucalopride 10 μM together or alone were, respectively, 105 ± 35%, 4 ± 6% and 35 ± 21% (n = 3-7, each concentration). CONCLUSIONS AND IMPLICATIONSPotential synergy between prucalopride and donepezil activity calls for exploration of this combination as a safer, more effective treatment of colonic pseudo-obstruction. AbbreviationsAUC, area under the curve; Cmax, peak concentration of drug measured in blood after a single dose; EFS, electrical field stimulation; Emax, maximum response to agonist; GI, gastrointestinal; L-NAME, Nω-nitro-L-arginine methyl ester; NK, neurokinin; TTX, tetrodotoxin BJP IntroductionRestoration of normal intestinal motility is a key objective in treatment of a range of acute and chronic digestive motility disorders. In the most common -chronic constipation, laxatives remain the mainstay of pharmacological intervention, although new drugs have recently been introduced. These include prucalopride, a selective 5-HT4 receptor agonist, which facilitates enteric cholinergic and nitrergic activities to promote intestinal motility (Cellek et al., 2006), and lubiprostone and linaclotide, which, respectively, activate chloride type-2 channels and guanylate cyclase type-C receptors to promote defecation primarily by increasing fluid secretion into the lumen (Lembo et al., 2011;Chey et al., 2012). Such breakthroughs have renewed interest in how best to treat other conditions associated with hypomotility and also with acute or chronic small...

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Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo‐obstruction: A prospective study

Abstract: Electrolyte imbalance and usage of anti-motility agents are factors associated with a poor response, while postoperative patients showing good response to neostigmine therapy.

Cited by 62 publications

References 16 publications

Acute colonic pseudo-obstruction

Acute colonic pseudo-obstruction

Ogilvie's syndrome–acute colonic pseudo-obstruction

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

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