BISACODYL AND HIGH-AMPLITUDE-PROPAGATING COLONIC CONTRACTIONS IN CHILDREN

Background: The purpose of these studies was to determine the suitabil ity of bisacodyl for stimulating high-amplitude-propagating contractio ns in pediatric studies of colonic manometry. Methods: Water-perfused manometry catheters were inserted into the right colon of children ref erred for evaluations related to defecation disorders. Colonic motilit y was measured in a 3-hour test session: an hour fasting, an hour afte r a meal, and 30 minutes after administration of a provocative agent. Results: Bisacodyl was superior to edrophonium as a stimulant for indu cing high-amplitude-propagating contractions. Bisacodyl-induced high-a mplitude-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 intr arectal bisacodyl was similar to that of intracecal bisacodyl, except for a delay of 10 minutes in onset. Bisacodyl induced high-amplitude-p ropagating contractions in all 28 children (22 with spontaneous high-a mplitude-propagating contractions) without evidence of neuromuscular d isease and in 2 of 9 children with a colonic neuromuscular disorder an d no spontaneous high-amplitude-propagating contractions. Conclusions: Bisacodyl-induced high-amplitude-propagating contractions were quanti tatively and qualitatively similar to naturally occurring high-amplitu de-propagating contractions. In selected cases, such as in children re ceiving total parenteral nutrition or restricted fluid intake, it may be possible to shorten diagnostic colonic manometry using bisacodyl ra ther than waiting for spontaneous high-amplitude-propagating contracti ons.