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Bisacodyl and high-amplitude-propagating colonic contractions in children
S A Hamid1, C Di Lorenzo, S N Reddy
1Department of Pediatric Gastroenterology, Miller Memorial Children's Hospital of Long Beach, California, USA.
Insights
Bisacodyl effectively stimulates high-amplitude-propagating contractions in pediatric colonic manometry, offering a reliable alternative to natural contractions for diagnostic purposes.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Studies
- Pharmacological Stimulation
Background:
- Colonic manometry is crucial for diagnosing defecation disorders in children.
- Stimulating high-amplitude-propagating contractions (HAPCs) aids in accurate diagnosis.
- The efficacy of pharmacological agents for HAPC induction in pediatrics requires further investigation.
Purpose of the Study:
- To evaluate bisacodyl's suitability for inducing HAPCs in pediatric colonic manometry.
- To compare bisacodyl's efficacy against edrophonium as a stimulant.
- To assess the characteristics of bisacodyl-induced HAPCs.
Main Methods:
- Water-perfused manometry catheters were used in children undergoing defecation disorder evaluations.
- Colonic motility was recorded over a 3-hour period: fasting, post-meal, and post-provocative agent.
- Bisacodyl and edrophonium were administered as provocative agents.
Main Results:
- Bisacodyl proved superior to edrophonium in stimulating HAPCs.
- Bisacodyl-induced HAPCs exhibited similar characteristics (amplitude, duration, velocity) to spontaneous HAPCs.
- Both intrarectal and intracecal bisacodyl induced HAPCs, with intrarectal administration showing a slight delay in onset.
- Bisacodyl successfully induced HAPCs in all children without neuromuscular disease and in some with colonic neuromuscular disorders.
Conclusions:
- Bisacodyl is a suitable agent for inducing HAPCs in pediatric colonic manometry.
- Bisacodyl-induced HAPCs are quantitatively and qualitatively comparable to naturally occurring HAPCs.
- Bisacodyl can potentially shorten diagnostic colonic manometry procedures, especially in specific pediatric populations.
Background:
The purpose of these studies was to determine the suitability of bisacodyl for stimulating high-amplitude-propagating contractions in pediatric studies of colonic manometry.
Methods:
Water-perfused manometry catheters were inserted into the right colon of children referred for evaluations related to defecation disorders. Colonic motility was measured in a 3-hour test session: an hour fasting, an hour after a meal, and 30 minutes after administration of a provocative agent.
Results:
Bisacodyl was superior to edrophonium as a stimulant for inducing high-amplitude-propagating contractions. Bisacodyl-induced high-amplitude-propagating contractions were similar in amplitude, duration, propagation velocity, and sites of origin and extinction to naturally occurring high-amplitude-propagating contractions. The effect of intrarectal bisacodyl was similar to that of intracecal bisacodyl, except for a delay of 10 minutes in onset. Bisacodyl induced high-amplitude-propagating contractions in all 28 children (22 with spontaneous high-amplitude-propagating contractions) without evidence of neuromuscular disease and in 2 of 9 children with a colonic neuromuscular disorder and no spontaneous high-amplitude-propagating contractions.
Conclusions:
Bisacodyl-induced high-amplitude-propagating contractions were quantitatively and qualitatively similar to naturally occurring high-amplitude-propagating contractions. In selected cases, such as in children receiving total parenteral nutrition or restricted fluid intake, it may be possible to shorten diagnostic colonic manometry using bisacodyl rather than waiting for spontaneous high-amplitude-propagating contractions.