Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity

Background: Chronic constipation is a frequent symptom among the general po pulation, and a minority of cases do not respond to any therapeutic measure s, except surgery. The purpose of this study was to test the residual colon ic motor propulsive activity with a pharmacologic stimulus in a series of p atients referred for severe constipation. Patients: Twenty-five chronically constipated patients, slow transit type, age range 16-71 years, unresponsi ve to conventional medical treatment and referred for functional evaluation , entered the study. Methods: Colonic manometry by means of an endoscopical ly positioned probe was carried out in all patients. Following a basal reco rding period, a placebo solution followed by 10 mg bisacodyl solution was i nfused into the colon through the more proximal recording port. Results: Af ter bisacodyl infusion, about 90% of patients showed a motor response chara cterized by the appearance (within on average 13 +/- 3 min) of one or more high-amplitude propagated contractions, the manometric equivalent of mass m ovements, and about 75% of these were followed (mean 18.5 +/- 4 min) by def ecation. Conclusions: Physiological and pharmacological testing of colonic motor activity may be important in severely constipated patients, especiall y in those labeled as 'intractable', in whom more in depth investigation pl anning may encourage further therapeutic efforts.