Of tubes and men: studying manometrically the effects of laxatives on colonic motility

Understanding constipation treatment: do we need to strain to obtain better results?

Chronic constipation is a commonly encountered symptom in everyday clinical practice, and numerous drugs are available for its medical treatment. However, there are several misconceptions that still often limit an effective approach, as well as the fact that it is older but effective treatments are sometimes neglected in favor of more recent, but not necessarily more effective, treatments. The actual knowledge on the efficacy and safety of currently available laxative treatment for chronic constipation, as shown by the review on which this editorial comments, clearly demonstrates that constipation may be effectively treated in most cases. Those caring for constipated patients, however, must be confident with use (and misuse) of medical treatment, to avoid lack of efficacy and onset of side effects leading to drug withdrawal. As for many other pathological issues, understanding the pathophysiological grounds of the condition to face greatly simplifies and accurately individuates the problem, to target the problem and help in reaching the therapeutic goal.

Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation

The aims of this study were to assess the prevalence of manometric colonic abnormalities and to evaluate the motor effect of intraluminal bisacodyl in a cohort of refractory constipated patients. Twenty-four hour colonic motility recordings were performed in 40 patients referred for a severe intractable chronic constipation. At the end of each recording session the motor effects of the endoluminal instillation of 10 mg bisacodyl were assessed. These patients were compared with 20 healthy subjects. The number of high-amplitude propagating contractions (HAPC) was significantly decreased in patients with slow transit constipation (12 +/- 11.6 vs 1 +/- 8.6, P < 0.001). Based on manometric patterns four groups of patients were isolated. Ten patients had no spontaneous HAPC, no food-induced colonic motor response and significantly lower colonic activity in transverse colon (374 +/- 1220 vs 3249 +/- 3458, P < 0.05). Five patients had significantly increased sigmoid segmental motility (20298 +/- 6364 vs 88780 +/- 3643, P < 0.001) and eight patients had significantly lower number of HAPC without other manometric abnormalities while 17 patients had normal colonic motility recordings. Endoluminal bisacodyl was able to induce HAPCs in all groups of patients. Patients with severe slow transit refractory constipation represented a heterogeneous group and endoluminal bisacodyl was able to promote a propagated motor activity in a majority of patients even in those suspected of having an inert colon.

Effect of areca on contraction of colonic muscle strips in rats

AIM: To investigate the effects of areca on the contractile activity of isolated colonic muscle strips in rats and mechanism involved.

METHODS: Each strip (LMPC, longitudinal muscle of proximal colon; CMPC, circular muscle of proximal colon; LMDC, longitudinal muscle of distal colon; CMDC, circular muscle of distal colon.) was suspended in a tissue chamber containing 5 mL Krebs solution (37 °C), bubbled continuously with 950 mL•L⁻¹ O₂ and 50 mL•L⁻¹ CO₂. The mean contractile amplitude (A), the resting tension (T), and the contractile frequency (F) were simultaneously recorded on recorders.

RESULTS: Areca dose dependently increased the mean contractile amplitude, the resting tension of proximal and distal colonic smooth muscle strips in rats (P < 0.05). It also partly increased the contractile frequency of colonic smooth muscle strips in rats (P < 0.05). The effects were partly inhibited by atropine (the resting tension of LMPC decreased from 0.44 ± 0.12 to 0.17 ± 0.03; the resting tension of LMDC decreased from 0.71 ± 0.14 to 0.03 ± 0.01; the mean contractile amplitude of LMPC increased from -45.8 ± 7.2 to -30.5 ± 2.9; the motility index of CMDC decreased from 86.6 ± 17.3 to 32.8 ± 9.3; P < 0.05 vs areca), but the effects were not inhibited by hexamethonium (P > 0.05).

CONCLUSION: Areca stimulated the motility of isolated colonic smooth muscle strips in rats. The stimulation of areca might be relevant with M receptor partly.