title: Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry.
abstract: BACKGROUND
  Colonic manometry is the standard diagnostic modality for evaluating colonic motility in children. Intraluminal bisacodyl is routinely used to trigger high-amplitude propagating contractions (HAPCs), a feature of normal colonic motility. Usually, only a single dose (0.2 mg/kg) is suggested. We retrospectively explored whether the use of an additional higher (0.4 mg/kg) dose of bisacodyl increases the yield of colonic manometry.
  
  
  METHODS
  In 103 children (median age: 8.8 years, range 3.2-15.7 years) with a diagnosis of slow transit constipation, colonic motility was recorded for 1 h before and 1 h after each of two incremental doses of bisacodyl (low, L, dose: 0.2 mg/kg, max 10 mg; high, H, dose: 0.4 mg/kg, max 20 mg) and the characteristics of HAPCs analyzed.
  
  
  RESULTS
  High-amplitude propagating contractions were seen in 85 children. H dose significantly increased the proportion of patients with fully propagated HAPCs (H dose: 57/103 [55%], L dose: 27/103 [26%], p < 0.001), paralleling the significant decrease in the proportion with partially propagated HAPCs (H dose: 29/103 [28%], L dose: 47/103 [46%], p < 0.01). Mean HAPC number significantly increased throughout the colon at H compared to L dose (7.2 ± 5.05 vs 5.6 ± 5.1, p < 0.05). Finally, the proportion of patients with normal pressure wave morphology of HAPCs significantly increased with higher dose (H dose: 55/85 [65%], L dose: 27/85 [32%], p < 0.001).
  
  
  CONCLUSIONS
  An additional higher dose of bisacodyl during colonic manometry improves colonic neuromuscular function suggesting its use might improve interpretation and decision making in children with slow transit constipation.
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK. osvaldo.borrelli@gosh.nhs.uk.
authors.forename: O
authors.initials: O
authors.lastname: Borrelli
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Pescarin
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Saliakellis
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Tambucci
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Quitadamo
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Valitutti
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.|Department of Gastroenterology, Hepatology, Nutrition Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Rybak
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lindley
authors.affiliation: Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.|Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Thapar
mesh_terms: D000293:Adolescent; D001726:Bisacodyl / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000187:drug effects* / Q000503:physiopathology; D003248:Constipation / Q000175:diagnosis* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage; D008297:Male; D008365:Manometry / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies
chemical_list: D054368:Laxatives; D001726:Bisacodyl
keywords: bisacodyl; children; chronic constipation; colonic manometry; diagnosis; motility test; refractory