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Chronic constipation is a very common problem that negatively affects the quality of life of patients, especially the elderly population. It can also lead to significant health care expenditure. Careful assessment by obtaining a thorough history and physical examination with limited indicated diagnostic testing is important to identify potential underlying etiologies and to treat effectively.

Natriumpicosulfat-Tropfen erlauben eine sehr genaue Dosierung. Die randomisierte, plazebokontrollierte, doppelblinde cross-over Studie mit 20 gesunden Probanden wurde durchgeführt, um weitere Informationen sowohl über eine Dosis-Wirkungsbeziehung als auch über dosisabhängige pharmakokinetische Parameter und Verträglichkeit zu erhalten. Das Ziel war die Messung der Kolontransitzeit und der Zeit bis zum Wirkungseintritt und der Überprüfung, ob es eine Beziehung zwischen den kinetischen und dynamischen Parametern gibt. Die Probanden nahmen jeweils 5, 10 oder 15 mg Natriumpicosulfat-Tropfen oder Plazebo in einer oralen Einmaldosis. Die Kolontransitzeit, die Zeit bis zum Wirkungseintritt, die Urinausscheidung von BHPM (aktiver Metabolit von Natriumpicosulfat) und die Verträglichkeit wurden untersucht. Die mittlere Kolontransitzeit und die mittlere Zeit bis zum Wirkungseintritt waren nach Einnahme von 5, 10 und 15 mg Natriumpicosulfat-Tropfen im Vergleich zu Plazebo signifikant verkürzt. Es konnte jedoch keine eindeutige Dosis-Wirkungsbeziehung gefunden werden. Die Ausscheidung von BHPM sinkt mit Erhöhung der Natriumpicosulfatdosis und einer beschleunigten Kolontransitzeit. Die Verträglichkeit war gut. Die Nebenwirkungen (Magenkrämpfe, Blähungen) sind das Resultat der motilitätswirksamen Eigenschaften von Natriumpicosulfat. / Sodium picosulfate drops allow a very accurate dosage. The randomized, placebo-controlled, double blind cross-over study in 20 healthy volunteers was to provide further information about a dose-response ratio as well as dose-dependent pharmacokinetic parameters and tolerance. The aim was to measure transit time and time to onset of action and to check whether there was a correlation between kinetic and dynamic data. The volunteers received 5, 10 and 15 mg sodium picosulfate drops or placebo orally in a single dose. Colon transit time, time to onset of defecation, urinary excretion of BHPM (the active principle of sodium picosulfate) and tolerability were tested. Mean transit time and mean time to onset were significantly reduced by 5, 10 and 15 mg of sodium picosulfate, compared to placebo. No clear dose-response ratio could be found. The urinary excretion of BHPM dropped with increase of administered dose and accelerated transit velocity. The tolerance was good. The adverse events (stomach cramps, flatulence) are the result of motility stimulating effect of sodium picosulfate.

<p>Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (<i>P</i><0.05–0.001). Two individual patients had a delay in the right colon.</p><p>Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (<i>P</i><0.001). The number of patients with bloating, excessive straining and painful defecation decreased (<i>P</i><0.05). The laxative use decreased (<i>P</i><0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome.</p><p>Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (<i>P</i><0.05), and squeeze pressure tended to be lower (<i>P</i>=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95^th percentile of controls. The rectal compliance was increased in patients (<i>P</i><0.05–0.01).</p><p>Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (<i>P</i><0.05). However, the results varied considerably for individual patients.</p><p>In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.</p>

Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P&lt;0.05–0.001). Two individual patients had a delay in the right colon. Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P&lt;0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P&lt;0.05). The laxative use decreased (P&lt;0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome. Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P&lt;0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P&lt;0.05–0.01). Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P&lt;0.05). However, the results varied considerably for individual patients. In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.