title: Evaluating the safety and the effects on colonic compliance of neostigmine during motility testing in patients with chronic constipation.
abstract: Neostigmine, an acetyl cholinesterase inhibitor, stimulates colonic motor activity and may induce vagally mediated cardiovascular effects. Our aim was to evaluate effects of i.v. neostigmine on colonic compliance and its safety in patients with chronic constipation.
  
  
  
  We retrospectively reviewed medical records of a selected group of 144 outpatients with chronic constipation who were refractory to treatment. These patients had undergone intracolonic motility and compliance measurements with an infinitely compliant balloon linked to a barostat. Data abstracted included barostat balloon mean volumes with increases in pressure (4 mmHg steps from 0 to 44 mmHg) before and after i.v. neostigmine. Vital signs and oxygen saturation before and after neostigmine were recorded.
  
  
  
  Of the 144 patients, 133 were female, mean age was 41.0 ± 15.4 years (SD), and duration of constipation was 12.9 ± 13.8 years. Among patients who had undergone colonic transit measurement by scintigraphy, the overall colonic transit at 24 h (geometric center, GC24 [n = 115]) was 1.5 ± 0.7 (normal >1.3), and at 48 h (GC48 [n = 75]) it was 2.3 ± 0.9 (normal >1.9). Neostigmine decreased colonic compliance at lower distension pressures (e.g., 12 and 20 mmHg [both p < 0.001]), but not at 40 mmHg. There were expected minor changes in vital signs in response to neostigmine in 144 patients; however, one patient developed unresponsiveness, significant bradycardia, hypotension, and muscular rigidity that responded to 400 mcg i.v. atropine.
  
  
  
  Neostigmine significantly decreases colonic compliance in patients with refractory chronic constipation. Symptomatic bradycardia in response to neostigmine should be promptly reversed with atropine.
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: M A
authors: MA
authors: Mouchli
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: M
authors: M
authors: Camilleri
authors: Institute for Digestive Research, Soonchunhyang University, Seoul Hospital, Seoul, Korea.
authors: T
authors: T
authors: Lee
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: G
authors: G
authors: Parthasarathy
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: P
authors: P
authors: Vijayvargiya
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: M
authors: M
authors: Halland
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: A
authors: A
authors: Acosta
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
authors: A E
authors: AE
authors: Bharucha
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000139:chemically induced; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D003106:Colon / Q000187:drug effects* / Q000502:physiology; D003248:Constipation / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D009388:Neostigmine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine
keywords: chronic constipation; colonic compliance; motility testing; neostigmine