Related Experiment Video
Updated: Dec 24, 2025
Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation
Published on: July 5, 2024
Characterization of the colonic response to bisacodyl in children with treatment-refractory constipation
Paul T Heitmann1, Lukasz Wiklendt1, Nikhil Thapar2
1College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia.
Insights
Colonic manometry with bisacodyl infusion effectively assesses colonic neuromuscular function in children with constipation. A positive response, indicated by high-amplitude propagating contractions (HAPCs), occurred in 93% of patients, guiding potential surgical interventions.
Area of Science:
- Pediatric Gastroenterology
- Neurogastroenterology
- Colorectal Surgery
Background:
- Colonic manometry with bisacodyl infusion is a tool to evaluate colonic neuromuscular function in children with refractory constipation.
- Lack of high-amplitude propagating contractions (HAPCs) following bisacodyl may indicate surgical intervention is needed.
- Characterizing the colonic response to bisacodyl aids in interpreting manometry studies for pediatric constipation.
Purpose of the Study:
- To characterize the colonic response to intraluminal bisacodyl in children with treatment-refractory constipation.
- To establish the efficacy of bisacodyl in inducing high-amplitude propagating contractions (HAPCs).
- To inform clinical interpretation of colonic manometry in pediatric constipation.
Main Methods:
- Multi-center study involving five pediatric hospitals.
- Analysis of high-amplitude propagating contractions (HAPCs) characteristics and area under the curve (AUC).
- Comparison of responses based on hospital, catheter type, placement, and bisacodyl infusion site.
Main Results:
- 165 children included (median age 10 years).
- 1893 HAPCs identified in 154 children; mean amplitude 113.6 mm Hg, velocity 8.6 mm/s.
- Bisacodyl induced HAPCs in 93% of children; response characterized by ≥1 HAPC within 12 minutes. Defecation correlated with HAPCs (P < .01).
Conclusions:
- Intraluminal bisacodyl is effective in inducing HAPCs in 93% of children with refractory constipation.
- The majority of HAPCs terminate in the rectosigmoid.
- Further research is needed to determine optimal clinical management based on manometry findings.
Background:
Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment-refractory constipation. If bisacodyl does not induce high-amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies.
Methods:
Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion.
Results:
One hundred and sixty-five children were included (median age 10, range 1-17 years; n = 96 girls). One thousand eight hundred and ninety-three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre- vs post-bisacodyl (Z = -0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ2 (1)=7.04, P < .01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response.
Conclusions And Inferences:
Intraluminal bisacodyl induced HAPCs in 93% of children with treatment-refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined.
Related Concept Videos
01:21Drugs for Treatment of Constipation-Predominant IBS
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:17Drugs for Treatment of Diarrhea-Predominant IBS
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:22Drugs Affecting GI Tract Motility: Bulk-Forming and Stimulant Laxatives
Bulk-forming laxatives, such as psyllium, methylcellulose, and polycarbophil, absorb water in the intestine, increasing stool bulk and promoting bowel movement. This...
01:20Drugs Affecting GI Tract Motility: Adsorbents as Antidiarrheal Agents
Adsorbents...