Neostigmine for the treatment of acute colonic pseudo-obstruction

Title

Neostigmine for the treatment of acute colonic pseudo-obstruction

Creator

Ponec RJ; Saunders MD; Kimmey MB

Publisher

The New England Journal Of Medicine

Date

1999

Subject

Female; Humans; Male; Adult; Aged; Middle Aged; Acute Disease; Double-Blind Method; 80 and over; Recurrence; Abdominal Pain/chemically induced; Cholinesterase Inhibitors/adverse effects/therapeutic use; Colonic Pseudo-Obstruction/drug therapy; Neostigmine/adverse effects/therapeutic use

Description

BACKGROUND: Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment. METHODS: We studied 21 patients with acute colonic pseudo-obstruction. All had abdominal distention and radiographic evidence of colonic dilation, with a cecal diameter of at least 10 cm, and had had no response to at least 24 hours of conservative treatment. We randomly assigned 11 to receive 2.0 mg of neostigmine intravenously and 10 to receive intravenous saline. A physician who was unaware of the patients' treatment assignments recorded clinical response (defined as prompt evacuation of flatus or stool and a reduction in abdominal distention), abdominal circumference, and measurements of the colon on radiographs. Patients who had no response to the initial injection were eligible to receive open-label neostigmine three hours later. RESULTS: Ten of the 11 patients who received neostigmine had prompt colonic decompression, as compared with none of the 10 patients who received placebo (P<0.001). The median time to response was 4 minutes (range, 3 to 30). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Two patients who had an initial response to neostigmine required colonoscopic decompression for recurrence of colonic distention; one eventually underwent subtotal colectomy. Side effects of neostigmine included abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine. CONCLUSIONS: In patients with acute colonic pseudo-obstruction who have not had a response to conservative therapy, treatment with neostigmine rapidly decompresses the colon.
1999

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

137-141

Issue

3

Volume

341

Citation

Ponec RJ; Saunders MD; Kimmey MB, “Neostigmine for the treatment of acute colonic pseudo-obstruction,” Pediatric Palliative Care Library, accessed June 29, 2022, https://pedpalascnetlibrary.omeka.net/items/show/11973.

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