Pilot study of pyridostigmine in constipated patients with autonomic neuropathy
Pilot study of pyridostigmine in constipated patients with autonomic neuropathy
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DOI：
10.1007/s10286-008-0476-x
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发表时间：
2008-08-01
影响因子：
5.8
通讯作者：
Zinsmeister, Alan R.
中科院分区：
文献类型：
--
作者：
Bharucha, Adil E.;Low, Phillip A.;Zinsmeister, Alan R.
背景胆碱酯酶抑制剂对慢性便秘的作用尚不清楚，胆碱酯酶抑制剂可增加健康人的结肠动力。我们的目的是评价胆碱酯酶抑制剂治疗植物神经功能障碍和慢性便秘的疗效，并评估急性反应是否可以预测长期疗效。方法在这项单盲研究中，10例自主神经病变和便秘患者接受安慰剂治疗(2周)，然后将吡斯的明剂量增加到最大耐受量(即180-540 mg/d)，持续6周。在第2周和第8周评估症状和胃肠通过情况。结果基线时，4例、6例和3例患者出现胃、小肠和结肠传输延迟。吡斯的明在大多数患者中耐受性良好，4例症状改善，3例患者在24小时加速结肠传输几何中心。静脉注射的效果。新斯的明对结肠传输和顺应性的影响预测(P<；0.05)吡斯的明对结肠传输的影响。结论吡斯的明改善了部分自主神经病变和便秘患者的结肠传输和症状。对新斯的明的运动反应可以预测口服吡斯的明的反应。
Background The effects of cholinesterase inhibitors, which increase colonic motility in health, on chronic constipation are unknown. Our aims were to evaluate the efficacy of cholinesterase inhibitors for dysautonomia and chronic constipation and to assess whether acute effects could predict the long term response.Methods In this single-blind study, 10 patients with autonomic neuropathy and constipation were treated with placebo (2 weeks), followed by an escalating dose of pyridostigmine to the maximum tolerated dose (i.e., 180-540 mg daily) for 6 weeks. Symptoms and gastrointestinal transit were assessed at 2 and 8 weeks. The acute effects of neostigmine on colonic transit and motility were also assessed.Results At baseline, 4, 6, and 3 patients had delayed gastric, small intestinal, and colonic transit respectively. Pyridostigmine was well tolerated in most patients, improved symptoms in 4 patients, and accelerated the geometric center for colonic transit at 24 h by >= 0.7 unit in 3 patients. The effects of i.v. neostigmine on colonic transit and compliance predicted (P < 0.05) the effects of pyridostigmine on colonic transit.Conclusions Pyridostigmine improves colonic transit and symptoms in some patients with autonomic neuropathy and constipation. The motor response to neostigmine predicted the response to oral pyridostigmine.