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Misoprostol in the treatment of chronic refractory constipation: results of a long‐term open label trial
Author(s) -
ROARTY T. P.,
WEBER F.,
SOYKAN I.,
McCALLUM R. W.
Publication year - 1997
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1997.00237.x
Subject(s) - misoprostol , medicine , constipation , refractory (planetary science) , clinical trial , defecation , gastroenterology , chronic constipation , surgery , anesthesia , pregnancy , genetics , physics , abortion , astrobiology , biology
Background: Misoprostol is known to be effective in stimulating intestinal transit both in healthy individuals and in patients with chronic constipation when evaluated in short‐term trials. The aim of this study was to determine the utility of misoprostol in the long‐term management of patients with chronic refractory constipation. Methods: Eighteen patients were offered misoprostol (600–2400 μg/day) as adjunctive therapy in an open‐ended, non‐blinded trial. All patients were encouraged to continue the drug for a minimum of 4 weeks, after which time the effect on bowel movement patterns was evaluated and continued use of misoprostol was offered to those patients who demonstrated a clinical benefit. Results: Six patients withdrew prior to 4 weeks because of side‐effects. In the 12 patients who continued the treatment and were evaluated at 4 weeks, the mean interval between bowel movement frequency had decreased from a baseline of 11.25 to 4.8 days ( P =0.0004). Eight patients continued the long‐term treatment, with sustained response seen in six. In a subset of patients ( n =4) the effect of single‐dose misoprostol (400 μg) was evaluated compared to healthy controls ( n =5) on post‐prandial segmental colonic motility. Misoprostol augmented the colonic motility response to a meal throughout the colon, and this was significantly greater in the left versus right colonic segments ( P < 0.05). Conclusions: Misoprostol can be effective as part of the long‐term medical treatment of patients with chronic refractory constipation, but side‐effects are observed at higher doses and can be a limiting factor. Part of misoprostol's action may be mediated through the augmentation of colonic motility, particularly of the left colon.