Review article: the pharmacological treatment of acute colonic pseudo-obstruction

Acute colonic pseudo-obstruction (Ogilvie's syndrome) can be defined as a c linical condition with symptoms, signs and radiological appearance of acute large bowel obstruction unrelated to any mechanical cause. Recent reports of the efficacy of cholinesterase inhibitors in relieving acute colonic pse udo-obstruction have fuelled interest in the pharmacological treatment of t his condition. The aim of the present review is to outline current perspect ives in the pharmacological treatment of patients with acute colonic pseudo -obstruction. The best documented pharmacological treatment of Ogilvie's syndrome is intr avenous neostigmine (2-2.5 mg), which leads to quick decompression in a sig nificant proportion of patients after a single infusion. However, the searc h for new colokinetic agents for the treatment of lower gut motor disorders has made available a number of drugs that may also be therapeutic options for Ogilvie's syndrome. Among these agents, the potential of 5-hydroxytrypt amine-4 receptor agonists and motilin receptor agonists is discussed.