Advertisement

Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 3105–3111 | Cite as

Usefulness of Bisacodyl Testing on Therapeutic Outcomes in Refractory Constipation

  • Edda Battaglia
  • Mario Grassini
  • Maria Pina Dore
  • Gabrio Bassotti
Original Article

Abstract

Background

Although chronically constipated patients usually respond to medical treatment, there is a subgroup with scarce/no response, generally labeled as refractory or intractable. However, whether this lack of response is real or due to ancillary causes (suboptimal dosage, lack of compliance etc.) is unknown.

Aims

To see whether a pharmacologic test (bisacodyl colonic intraluminal infusion during manometric assessment) may predict the therapeutic outcome.

Methods

Data of patients undergoing 24/h colonic manometry for severe intractable constipation in whom the bisacodyl test (10 ml of drug dissolved into saline and injected through the more proximal recording port) had been carried out were retrieved and analysed, and correlations with the therapeutic outcome made.

Results

Overall, charts from 38 patients (5 men) were available; of these, only 21% displayed naive high-amplitude propagated contractions (average, less than 2/24 h), mostly meal-induced, during the recordings. A bisacodyl response was present in 31.6% patients, with a mean number of events of 1.8 per patient. After bisacodyl testing, 47.3% patients underwent intensive medical treatment, 44.7% surgery (medical failures), and 8% transanal irrigation, a procedure employed to treat refractory patients. The presence of naive propulsive contractions significantly correlated with the response to bisacodyl infusion (p < 0.0001), and with a favourable outcome to intensive medical treatment (p < 0.0001).

Conclusions

The bisacodyl test may be clinically useful to better categorize constipated patients erroneously labelled as intractable and to exclude true colonic inertia, thus avoiding surgery in more than 30% of these subjects.

Keywords

Bisacodyl test Colonic manometry Refractory constipation Therapeutic outcomes 

Notes

Acknowledgments

Specific authors’ contribution: EB carried out the manometric procedures and analysed the tracings; MG carried out the manometric procedures; MPD reviewed the text for important intellectual contributions; GB planned the study, analysed the data, and wrote the first draft of the manuscript. All authors reviewed and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of Interest

None.

References

  1. 1.
    Bassotti G, Villanacci V. A practical approach to diagnosis and management of functional constipation in adults. Intern Emerg Med. 2013;8:275–282.CrossRefGoogle Scholar
  2. 2.
    Gaburri M, Bassotti G, Bacci G, et al. Functional gut disorders and health care seeking behavior in an Italian non-patient population. Recenti Prog Med. 1989;80:241–244.PubMedGoogle Scholar
  3. 3.
    Neri L, Basilisco G, Corazziari E, et al. Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation. United European Gastroenterol J. 2014;2:138–147.CrossRefGoogle Scholar
  4. 4.
    Bassotti G. Being constipated: a bad omen for your cardiovascular system? Atherosclerosis. 2016;245:240–241.CrossRefGoogle Scholar
  5. 5.
    Bellini M, Usai-Satta P, Bove A, et al. Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E”. study. BMC Gastroenterol. 2017;17:11.CrossRefGoogle Scholar
  6. 6.
    Bassotti G. Understanding constipation treatment: Do we need to strain to obtain better results? Expert Opin Drug Metab Toxicol. 2013;9:387–389.CrossRefGoogle Scholar
  7. 7.
    Bharucha AE, Pemberton JH, Locke GR. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144:218–238.CrossRefGoogle Scholar
  8. 8.
    Wofford SA, Verne GN. Approach to patients with refractory constipation. Curr Gastroenterol Rep. 2000;2:389–394.CrossRefGoogle Scholar
  9. 9.
    Bassotti G, Blandizzi C. Understanding and treating refractory constipation. World J Gastrointest Pharmacol Ther. 2014;5:77–85.CrossRefGoogle Scholar
  10. 10.
    Bove A, Bellini M, Battaglia E, et al. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment). World J Gastroenterol. 2012;18:4994–5013.CrossRefGoogle Scholar
  11. 11.
    Lee YY. What’s new in the toolbox for constipation and fecal incontinence? Front Med (Lausanne). 2014;1:5.Google Scholar
  12. 12.
    Shin JE, Jung HK, Lee TH, et al. Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 Revised Edition. J Neurogastroenterol Motil. 2016;22:383–411.CrossRefGoogle Scholar
  13. 13.
    Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130:657–664.CrossRefGoogle Scholar
  14. 14.
    Chiarioni G, Bassotti G. Biofeedback therapy for constipation due to dyssynergic defecation: ready for prime time. Tech Coloproctol. 2015;19:331–332.CrossRefGoogle Scholar
  15. 15.
    Bassotti G, Chiarioni G, Vantini I, et al. Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation. Dig Dis Sci. 1994;39:1558–1564.CrossRefGoogle Scholar
  16. 16.
    Bassotti G, Chistolini F, Nzepa FS, Morelli A. Colonic propulsive impairment in intractable slow-transit constipation. Arch Surg. 2003;138:1302–1304.CrossRefGoogle Scholar
  17. 17.
    Dinning PG, Zarate N, Hunt LM, et al. Pancolonic spatiotemporal mapping reveals regional deficiencies in, and disorganization of colonic propagating pressure waves in severe constipation. Neurogastroenterol Motil. 2010;22:e340–e349.CrossRefGoogle Scholar
  18. 18.
    Redmond JM, Smith GW, Barofsky I, Ratych RE, Goldsborough DC, Schuster MM. Physiological tests to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol. 1995;90:748–753.PubMedGoogle Scholar
  19. 19.
    Bassotti G, Betti C, Pelli MA, Morelli A. Extensive investigation on colonic motility with pharmacological testing is useful for selecting surgical options in patients with inertia colica. Am J Gastroenterol. 1992;87:143–147.PubMedGoogle Scholar
  20. 20.
    Camilleri M, Bharucha AE, di Lorenzo C, et al. American Neurogastroenterology and Motility Society consensus statement on intraluminal measurement of gastrointestinal and colonic motility in clinical practice. Neurogastroenterol Motil. 2008;20:1269–1282.CrossRefGoogle Scholar
  21. 21.
    Dinning PG, Benninga MA, Southwell BR, Scott SM. Paediatric and adult colonic manometry: a tool to help unravel the pathophysiology of constipation. World J Gastroenterol. 2010;16:5162–5172.CrossRefGoogle Scholar
  22. 22.
    Nelson AD, Camilleri M, Chirapongsathorn S, et al. Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis. Gut. 2017;66:1611–1622.CrossRefGoogle Scholar
  23. 23.
    Preston DM, Lennard-Jones JE. Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation. Dig Dis Sci. 1985;30:289–294.CrossRefGoogle Scholar
  24. 24.
    Shouler P, Keighley MR. Changes in colorectal function in severe idiopathic chronic constipation. Gastroenterology. 1986;90:414–420.CrossRefGoogle Scholar
  25. 25.
    Varma JS, Bradnock J, Smith RG, Smith AN. Constipation in the elderly. A physiologic study. Dis Colon Rectum. 1988;31:111–115.CrossRefGoogle Scholar
  26. 26.
    De Schryver AM, Samsom M, Smout AI. Effects of a meal and bisacodyl on colonic motility in healthy volunteers and patients with slow-transit constipation. Dig Dis Sci. 2003;48:1206–1212.CrossRefGoogle Scholar
  27. 27.
    Bassotti G, Chiarioni G, Germani U, Battaglia E, Vantini I, Morelli A. Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity. Digestion. 1999;60:69–73.CrossRefGoogle Scholar
  28. 28.
    Bassotti G. If it is inert, Why does it move? Neurogastroenterol Motil. 2004;16:395–396.CrossRefGoogle Scholar
  29. 29.
    Hervé S, Savoye G, Behbahani A, Leroi AM, Denis P, Ducrotté P. Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation. Neurogastroenterol Motil. 2004;16:397–402.CrossRefGoogle Scholar
  30. 30.
    Bharucha AE. High amplitude propagated contractions. Neurogastroenterol Motil. 2012;24:977–982.CrossRefGoogle Scholar
  31. 31.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–1491.CrossRefGoogle Scholar
  32. 32.
    Bassotti G, Gaburri M. Manometric investigation of high-amplitude propagated contractile activity of the human colon. Am J Physiol. 1988;255:G660–G664.PubMedGoogle Scholar
  33. 33.
    Kendall M. A new measure of rank correlation. Biometrika. 1938;30:81–89.CrossRefGoogle Scholar
  34. 34.
    Bassotti G, Gambaccini D, Bellini M. Prucalopride succinate for the treatment of constipation: an update. Expert Rev Gastroenterol Hepatol. 2016;10:291–300.CrossRefGoogle Scholar
  35. 35.
    Christensen P, Krogh K, Perrouin-Verbe B, et al. Global audit on bowel perforations related to transanal irrigation. Tech Coloproctol. 2016;20:109–115.CrossRefGoogle Scholar
  36. 36.
    Kamm MA, Van der Sijip JRM, Lennard-Jones JE. Colorctal and anal motility during defecation. Lancet. 1992;339:820.CrossRefGoogle Scholar
  37. 37.
    Kamm MA, van der Sijp JR, Lennard-Jones JE. Observations on the characteristics of stimulated defaecation in severe idiopathic constipation. Int J Colorectal Dis. 1992;7:197–201.CrossRefGoogle Scholar
  38. 38.
    Manabe N, Cremonini F, Camilleri M, Sandborn WJ, Burton DD. Effects of bisacodyl on ascending colon emptying and overall colonic transit in healthy volunteers. Aliment Pharmacol Ther. 2009;30:930–936.CrossRefGoogle Scholar
  39. 39.
    Giorgio V, Borrelli O, Smith VV, et al. High-resolution colonic manometry accurately predicts colonic neuromuscular pathological phenotype in pediatric slow transit constipation. Neurogastroenterol Motil. 2013;25:70–78.CrossRefGoogle Scholar
  40. 40.
    Borrelli O, Pescarin M, Saliakellis E, et al. Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry. Neurogastroenterol Motil. 2016;28:1747–1755.CrossRefGoogle Scholar
  41. 41.
    van den Berg MM, Hogan M, Caniano DA, Di Lorenzo C, Benninga MA, Mousa HM. Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg. 2006;41:730–736.CrossRefGoogle Scholar
  42. 42.
    Bassotti G, Roberto GD, Sediari L, Morelli A. Toward a definition of colonic inertia. World J Gastroenterol. 2004;10:2465–2467.CrossRefGoogle Scholar
  43. 43.
    Dinning PG, Wiklendt L, Gibbins I, et al. Low-resolution colonic manometry leads to a gross misinterpretation of the frequency and polarity of propagating sequences: initial results from fiber-optic high resolution manometry studies. Neurogastroenterol Motil. 2013;25:e640–e649.PubMedGoogle Scholar
  44. 44.
    Singh S, Heady S, Coss-Adame E, Rao SS. Clinical utility of colonic manometry in slow transit constipation. Neurogastroenterol Motil. 2013;25:487–495.CrossRefGoogle Scholar
  45. 45.
    Dudekula A, Huftless S, Bielefeldt K. Colectomy for constipation: time trends and impact based on the US Nationwide Inpatient Sample, 1998–2011. Aliment Pharmacol Ther. 2015;42:1281–1293.CrossRefGoogle Scholar
  46. 46.
    Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25:599–608.CrossRefGoogle Scholar
  47. 47.
    Corsetti M, Pagliaro G, Demedts I, et al. Pan-colonic pressurizations associated with relaxation of the anal sphincter in health and disease: a new colonic motor pattern identified using high-resolution manometry. Am J Gastroenterol. 2017;112:479–489.CrossRefGoogle Scholar
  48. 48.
    Dinning PG, Sia TC, Kumar R, et al. High-resolution colonic motility recordings in vivo compared with ex vivo recordings after colectomy, in patients with slow transit constipation. Neurogastroenterol Motil. 2016;28:1824–1835.CrossRefGoogle Scholar
  49. 49.
    Chen JH, Yu Y, Yang Z, et al. Intraluminal pressure patterns in the human colon assessed by high-resolution manometry. Sci Rep. 2017;7:41436.CrossRefGoogle Scholar
  50. 50.
    Keller J, Bassotti G, Clarke J, et al. Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018 (in press).Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastroenterology and Endoscopy UnitCardinal Massaja HospitalAstiItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity of SassariSassariItaly
  3. 3.Gastroenterology and Hepatology Section, Department of MedicineUniversity of Perugia School of MedicinePerugiaItaly
  4. 4.Clinica di GastroenterologiaOspedale Santa Maria della MisericordiaSan SistoItaly

Personalised recommendations