Murray, C.D.R.; Emmanuel, A.V.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA15
Academic Journal
Background: Behavioural therapy biofeedback (BF), is an established treatment for patients with functional constipation, allowing avoidance of laxatives in successfully treated patients. Improvement with BF is known to be associated with enhanced autonomic input to the hindgut, as measured by laser Doppler flowmetry (LDF) of rectal mucosal blood flow. It is unknown whether laxatives affect autonomic tone and whole gut transit (WGT). Methods: Forty-nine consecutive consenting female patients were randomised to receive either BF (n = 27, mean age 46 years, range 23-75) or bisacodyl, 5 to 10 mg as required (n = 22, 41 years 22-81). Outcome with treatment was subjectively reported. Physiological studies were made blind to knowledge of treatment group and outcome. Physiological data comprised WGT and LDF measurement, and was assessed before, and at the end of treatment. WGT was performed using radio-opaque markers, slow transit defined as excess retention of one or more of the three marker sets used. On the same day as WGT studies, LDF of rectal mucosa was performed. Results: Subjectively, 19/27 (70%) BF and 6/22 (27%) laxative patients reported improvement, p < 0.01. Nineteen BF patients had slow transit initially, and this normalised in 9 (47%), while 11 laxative treated patients had slow transit, normalised in 1 (9%), p < 0.05. The number of retained markers significantly reduced with BF (31±3 to 22±3, p = 0.002) associated with increased LDF (157±7 to 192±7, p < 0.001). There was no change in either transit (27±5 to 24±5, p = 0.3) or LDF (167±8 to 168±7, p = 0.8). There was a significant negative correlation between WGT and LDF in the BF treated patients (r=-0.51, p < 0.01) but no such correlation in the laxative group (r=-0.17, p > 0.1). Discussion: Biofeedback is effective in improving symptoms, whole gut transit, and autonomic tone. Bisacodyl improved symptoms in a minority of patients and did not alter...


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