Journal Mobile Options
Table of Contents
Vol. 60, No. 1, 1999
Issue release date: January–February 1999

Endoluminal Instillation of Bisacodyl inPatients with Severe (Slow Transit Type)Constipation Is Useful to Test Residual ColonicPropulsive Activity

Bassotti G. · Chiarioni G. · Germani U. · Battaglia E. · Vantini I. · Morelli A.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Chronic constipation is a frequent symptom among the general population, and a minority of cases do not respond to any therapeutic measures, except surgery. The purpose of this study was to test the residual colonic motor propulsive activity with a pharmacologic stimulus in a series of patients referred for severe constipation. Patients: Twenty-five chronically constipated patients, slow transit type, age range 16–71 years, unresponsive to conventional medical treatment and referred for functional evaluation, entered the study. Methods: Colonic manometry by means of an endoscopically positioned probe was carried out in all patients. Following a basal recording period, a placebo solution followed by 10 mg bisacodyl solution was infused into the colon through the more proximal recording port. Results: After bisacodyl infusion, about 90% of patients showed a motor response characterized by the appearance (within on average 13 ± 3 min) of one or more high-amplitude propagated contractions, the manometric equivalent of mass movements, and about 75% of these were followed (mean 18.5 ± 4 min) by defecation. Conclusions: Physiological and pharmacological testing of colonic motor activity may be important in severely constipated patients, especially in those labeled as ‘intractable’, in whom more in depth investigation planning may encourage further therapeutic efforts.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Thompson WG, Heaton KW: Functional bowel disorders in apparently healthy people. Gastroenterology 1980;79:283–288.
  2. Sandler RS, Drossman DA: Bowel habits in young adults not seeking health care. Dig Dis Sci 1987;32:841–845.

    External Resources

  3. Gaburri M, Bassotti G, Bacci G, Cinti A, Bosso R, Ceccarelli P, Paolocci N, Pelli MA, Morelli A: Functional gut disorders and health care seeking behavior in an italian non-patient population. Rec Prog Med 1989;80:241–244.

    External Resources

  4. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ: Functional constipation and outlet delay: A population-based study. Gastroenterology 1993;105:781–790.
  5. Camilleri M, Thompson WG, Fleshman JW; Pemberton JH: Clinical management of intractable constipation. Ann Intern Med 1994;121:520–528.
  6. Kamm M, Hawley P, Lennard-Jones J: Outcome of colectomy for severe idiopathic constipation. Gut 1988;29:969–973.
  7. Leon S, Khrishnamurti S, Schuffler M: Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients. Dig Dis Sci 1987;32:1249–1254.

    External Resources

  8. Gasslander T, Larsson J, Wetterfors J: Experience of surgical treatment for chronic idiopathic constipation. Acta Chir Scand 1987;153:553–555.

    External Resources

  9. Redmond JM, Smith GW, Barofsky I, Ratych RE, Goldsborough DC, Schuster MM: Physiological tests to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol 1995;90:748–753.
  10. Wexner S, Daniel N, Jagelman D: Colectomy for constipation: Physiologic investigation is the key to success. Dis Colon Rectum 1991;34:851–856.
  11. Pemberton J, Rath D, Ilstrup D: Evaluation and surgical treatment of severe chronic constipation. Ann Surg 1991;214:403–413.
  12. Bassotti G, Betti C, Erbella GS, Cavalletti ML, Pelli MA, Morelli A: Prolonged manometric investigation of the colon in research on chronic constipation. Ital J Gastroenterol 1991;23(suppl 1):13–15.
  13. Bassotti G, Chiarioni G, Vantini I, Betti C, Fusaro C, Pelli MA, Morelli A: Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation. Dig Dis Sci 1994;39:1558–1564.
  14. Bassotti G, Betti C, Pelli MA, Morelli A: Extensive investigation on colonic motility with pharmacological testing is useful for selecting surgical options in patients with inertia colica. Am J Gastroenterol 1992;87:143–147.
  15. Phillips SF, Pemberton JH: Megacolon: Congenital and acquired; in Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease, ed Philadelphia, Saunders, 1993, pp 888–897.
  16. Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, Morelli A: Colonic mass movements in idiopathic chronic constipation. Gut 1988;29:1173–1179.
  17. Narducci F, Bassotti G, Gaburri M, Morelli A: Twenty-four hour manometric recording of colonic motor activity in healthy man. Gut 1987;28:17–25.
  18. Bassotti G, Gaburri M: Manometric investigation of high-amplitude propagated contractile activity of the human colon. Am J Physiol 1988;255:G660–G664.

    External Resources

  19. Bassotti G, Gaburri M, Imbimbo BP, Morelli A, Whitehead WE: Distension-stimulated propagated contractions in human colon. Dig Dis Sci 1994;39:1955–1960.
  20. Bassotti G: Physiology of colonic motility; in Barbara L, Corinaldesi R, Gizzi G, Stanghellini V (eds): Chronic Constipation. London, Saunders, 1996, pp 38–50.
  21. Bassotti G, Betti C, Fusaro C, Morelli A: Colonic high-amplitude propagated contractions (mass movements): Repeated 24-h manometric studies in healthy volunteers. J Gastrointest Motil 1992;4:187–191.
  22. Hardcastle JD, Mann CV: Study of large bowel peristalsis. Gut 1968;9:512–520.

    External Resources

  23. Kamm MA, Van der Sijp JRM, Lennard-Jones JE: Colorectal and anal motility during defaecation. Lancet 1992;339:820.
  24. Preston DM, Lennard-Jones JE: Pelvic motility and response to intraluminal bisacodyl in slow-transient constipation. Dig Dis Sci 1985;30:289–294.

    External Resources

  25. Reynolds JC, Ouyang A, Lee CA, Baker L, Sunshine AG, Cohen S: Chronic severe constipation. Prospective motility studies in 25 consecutive patients. Gastroenterology 1987;92:414–420.
  26. Bassotti G, Chiarioni G, Imbimbo BP, Betti C, Bonfante F, Vantini I, Morelli A, Whitehead WE: Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow-transit type) constipation. Dig Dis Sci 1993;38:1040–1045.
  27. Gattuso JM, Kamm MA: Adverse effects of drugs used in the management of constipation and diarrhoea. Drug Safety 1994;10:47–65.

    External Resources

  28. Ewe K, Ueberschaer B, Press AG, Kurreck C, Klump M: Effect of lactose, lactulose and bisacodyl on gastrointestinal transit studied by metal detector. Alim Pharmacol Ther 1995;9:69–73.
  29. Ewe K: The physiological basis of laxatives action. Pharmacology 1980;20:2–20.

    External Resources

  30. de Witte P, Lemli L: The metabolism of anthranoid laxatives. Hepato-gastroenterology 1990;37:601–605.
  31. Rachmilewitz D, Karmeli F, Okon E: Effects of bisacodyl on cAMP and prostaglandin E2 contents, (Na + K) ATPase, adenyl cyclase, and phospodiesterase activity of rat intestine. Dig Dis Sci 1980;25:602–608.

    External Resources

  32. Staumont G, Fioramonti J, Frexinos J, Bueno L: Changes in colonic motility induced by sennosides in dogs: Evidence of a prostaglandin mediation. Gut 1988;29:1180–1187.

    External Resources

  33. Karmeli F, Stalnikowicz R, Rachmilewitz D: Effect of colchicine and bisacodyl on rat intestinal transit and nitric oxide synthase activity. Scand J Gastroenterol 1997;32:791–796.
  34. Kamm MA, van der Sijp JRM, Lennard-Jones JE: Observations on the characteristics of stimulated defaecation in severe idiopathic constipation. Int J Colorect Dis 1992;7:197–201.
  35. Diamant NE. Physiology of the esophagus: in Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease, Philadelphia, Saunders, 1993, pp 319–340.
  36. Conklin JL, Christensen J: Motor functions of the pharynx and esophagus; in Johnson LR (ed): Physiology of the Gastrointestinal Tract, ed 3. New York, Raven Press, 1994, pp 903–928.
  37. Sarna SK: Physiology and pathophysiology of colonic motor activity. I. Dig Dis Sci 1991;36:827–862.
  38. Bassotti G, Germani U, Morelli A: Flatus-related colorectal and anal motor events. Dig Dis Sci 1996;41:335–338.
  39. Kamm MA, Lennard-Jones JE, Thompson DG, Sobnack R, Garvie NW, Granowska M: Dynamic scanning defines a colonic defect in severe idiopathic constipation. Gut 1988;29:1085–1092.
  40. Ghosh S, Papachrysostomou M, Batool M, Eastwood MA: Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol 1996;31:1083–1091.
  41. Frexinos J: Inertie colique primitive: mythe ou realité? Gastroentérol Clin Biol 1987;11:302–306.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50