morphine and Constipation

Meconium ileus at birth, distal intestinal obstruction syndrome (DIOS), and constipation are an interrelated group of intestinal obstruction syndromes with a variable severity of obstruction that occurs in cystic fibrosis patients. Long-term follow-up studies show that today meconium ileus is not a risk factor for impaired nutritional status, pulmonary function, or survival. DIOS and constipation are frequently seen in cystic fibrosis patients, especially later in life; genetic, dietary, and other associations have been explored. Diagnosis of DIOS is based on suggestive symptoms, with a right lower quadrant mass confirmed on abdominal radiography, whereas symptoms of constipation are milder and of longer standing. In DIOS, early aggressive laxative treatment with oral laxatives (polyethylene glycol) or intestinal lavage with balanced osmotic electrolyte solution and rehydration is required, which now makes the need for surgical interventions rare. Constipation can generally be well controlled with polyethylene glycol maintenance treatment.

Topics: Constipation; Cystic Fibrosis; Humans; Ileus; Intestinal Obstruction; Meconium; Risk Factors

In the majority of infants and children with constipation, no obvious cause can be identified. A rare cause of constipation is Hirschsprung disease (HD). HD is characterized by the absence of ganglion cells from the anorectum for a variable length up to the duodenum. The extent of the aganglionic segment varies, but in most patients the lesion does not extend beyond the rectum and sigmoid colon. This review focuses on the passage of meconium, the recognition of HD, and new insights in its pathophysiology and genetics. The authors also provide a summary of the diagnostic evaluation and treatment of HD in infancy and childhood.

Topics: Child; Child, Preschool; Constipation; Hirschsprung Disease; Humans; Infant; Meconium

Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies.. A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05).. Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension.. A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.

Topics: Adolescent; Age of Onset; Barium Sulfate; Biopsy; Child; Child, Preschool; Cohort Studies; Constipation; Diagnosis, Differential; Enema; Enterocolitis; Fecal Impaction; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Male; Meconium; Physical Examination; Rectum; Retrospective Studies; Unnecessary Procedures; Vomiting

Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesics. Peripherally acting μ opioid receptor antagonists (PAMORAs) can be applied in the treatment of OIC without compromising the analgesic effects. NAP, a 6β-N-4-pyridyl-substituted naltrexamine derivative, was previously identified as a potent and selective MOR antagonist mainly acting peripherally but with some CNS effects. Herein, we introduced a highly polar aromatic moiety, for example, a pyrazolyl or imidazolyl ring to decrease CNS MPO scores in order to reduce passive BBB permeability. Four compounds

Topics: Analgesics, Opioid; Constipation; Humans; Ligands; Naltrexone; Narcotic Antagonists; Opioid-Induced Constipation; Receptors, Opioid, mu

The endogenous opioid peptide endomorphin-1 (1) was modified by attachment of lactose to the N-terminus via a succinamic acid spacer to produce compound 2. The carbohydrate modification significantly improved the metabolic stability and membrane permeability of 2 while retaining μ-opioid receptor binding affinity and agonist activity. Analogue 2 produced dose-dependent antinociceptive activity following intravenous administration in a chronic constriction injury (CCI) rat model of neuropathic pain with an ED(50) of 8.3 (± 0.8) μmol/kg. The corresponding ED(50) for morphine was 2.6 (± 1.4) μmol/kg. Importantly, compound 2 produced dose-dependent pain relief after oral administration in CCI rats (ED(50) = 19.6 (± 1.2) μmol/kg), which was comparable with that of morphine (ED(50) = 20.7 (±3.6) μmol/kg). Antineuropathic effects of analogue 2 were significantly attenuated by pretreatment of animals with the opioid antagonist naloxone, confirming opioid receptor-mediated analgesia. In contrast to morphine, no significant constipation was produced by compound 2 after oral administration.

Topics: Absorption; Administration, Oral; Analgesics, Opioid; Animals; Chemistry Techniques, Synthetic; CHO Cells; Constipation; Cricetinae; Cricetulus; Glycosylation; Male; Naloxone; Narcotic Antagonists; Neuralgia; Oligopeptides; Rats; Rats, Sprague-Dawley; Receptors, Opioid

Various definitions for distal intestinal obstruction syndrome (DIOS), meconium ileus equivalent, and constipation in patients with cystic fibrosis (CF) are used. However, an unequivocal definition for DIOS, meconium ileus equivalent, and constipation is preferred. The aims of this study were, therefore, to seek consensus on the definitions for DIOS and constipation in patients with CF and to determine the incidence, characteristics, and treatment of DIOS in a cohort of paediatric patients with CF.. During the 2005 European Society for Paediatric Gastroenterology, Hepatology, and Nutrition meeting in Porto a group of paediatric gastroenterologists discussed the definition of DIOS and constipation in CF. Subsequently, all patients younger than or equal to 18 years with complete DIOS according to the definition agreed upon and diagnosed during the years 2001 to 2005 in 8 CF centres were studied.. Distal intestinal obstruction syndrome was defined as an acute complete or incomplete faecal obstruction in the ileocaecum, whereas constipation was defined as gradual faecal impaction of the total colon. Fifty-one episodes of DIOS in 39 patients were recorded, giving an overall incidence of 6.2 (95% confidence interval, 4.4-7.9) episodes per 1000 patient-years. Of the 39 patients with DIOS, 20% experienced a relapse, 92% were pancreatic insufficient, 44% had a history of meconium ileus at birth, and 82% had a severe genotype. Conservative treatment was effective in 49 of 51 DIOS episodes (96%).. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition CF Working Group definitions of DIOS and constipation in CF are specific and make a clear distinction between these 2 entities. The incidence of DIOS in the present study was considerably higher than reported previously.

Topics: Constipation; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Genotype; Humans; Ileal Diseases; Ileus; Incidence; Intestinal Obstruction; Meconium; Multicenter Studies as Topic

Topics: Constipation; Cystic Fibrosis; Genotype; Humans; Ileal Diseases; Intestinal Obstruction; Meconium; Multicenter Studies as Topic; Mutation

The aims of this study were to determine prevalence, risk factors and treatment of constipation in patients with Cystic Fibrosis (CF), as well as the diagnostic value of abdominal radiography.. A cohort of 214 pediatric CF patients was investigated. Furthermore, 106 abdominal radiographs of CF patients with or without constipation were independently assessed by three observers on two separate occasions using the Barr and Leech scores.. The prevalence of constipation was 47%. Low total fat absorption and meconium ileus were independent risk factors for constipation in CF, while fiber and fluid intake were not associated. In CF patients the inter and intraobserver variabilities of the Barr and Leech scores were poor to moderate.. Constipation is a significant medical issue in CF and was associated with low total fat absorption and a history of meconium ileus. Finally, abdominal radiography seems of little value in the regular follow-up of CF patients.

Topics: Adolescent; Child; Child, Preschool; Constipation; Cystic Fibrosis; Dietary Fats; Female; Humans; Ileus; Infant, Newborn; Intestinal Absorption; Malabsorption Syndromes; Male; Meconium; Observer Variation; Prevalence; Radiography, Abdominal; Risk Factors; Steatorrhea

To identify the normal defecation patterns and the factors affecting these patterns in the first two years of life, a questionnaire was given to the parents of 1,021 children who were followed in a well-child clinic. The time of first meconium passage, presence of colic symptoms, frequency, color, and consistency of stools were recorded.Mann Whitney U, Wilcoxon, chi-square, and correlation tests were used in the statistical analyses. The median number of defecations per day was six in the first month of life. This decreased to once in the second month and almost all cases remained so until the end of the 24th month. At the second month of age, 39.3% of infants passed stools less than once a day. This pattern of rare defecation was seen until the end of 6 months, when supplemental foods were started. Stool frequency was higher in exclusively breast-fed infants (p = 0.0001). Infants who had colic symptoms in the first 2 months had less frequent defecation during the first 2 years of life (p = 0.0001). In addition to confirming the previously observed defecation patterns of 0-2-year-old infants, this study provides the relationship between colic symptoms and stool frequency, and showed that the second month of life was unique in the sense that the frequency of stooling decreased to half of the previous month and 39.3% of these infants defecated less than once a day.

Topics: Breast Feeding; Chi-Square Distribution; Child Development; Child, Preschool; Constipation; Cross-Sectional Studies; Defecation; Diet; Dietary Fiber; Feces; Female; Gastrointestinal Motility; Humans; Infant; Infant Behavior; Infant Formula; Infant, Newborn; Male; Meconium; Parents; Statistics, Nonparametric; Surveys and Questionnaires; Toilet Training; Turkey

Topics: Biopsy; Child; Child, Preschool; Chronic Disease; Constipation; Female; Humans; Infant; Intestinal Diseases; Male; Meconium; Rectum

We hypothesise that constipated children would be more likely to come from a socially deprived background. We also hypothesise that a percentage of children with resistant constipation would have a congenital gut motility problem that might be recognised at birth, and that some of these would have slow transit constipation that could be recognised on nuclear transit study. One hundred and forty children with a constipation related diagnosis were seen in the last 4 years, and were reviewed as a retrospective audit. Twenty-six children who were felt likely to have a congenital cause for their constipation were offered nuclear colon transit study to search for slow transit constipation. One hundred and forty children from the constipation clinic were reviewed. There were 67 females (47.9%) and 73 males (52.1%), a sex ratio near equality. The mean age at presentation was 5.38 years. Forty-one percent were formally discharged, 36% were lost to follow up, and 23% are still being seen. There was a highly significant tendency for these children to have delayed passage of meconium, as compared normal newborns (P << 0.001). Twenty-six children were considered for possible transit study, and 14 were performed. Four of these were normal, seven showed hold up in the recto-sigmoid, and three showed more proximal slow transit. Two of these probably have non ISTC diagnoses. Social class seems similar to the general population on the criterion employed. Delayed passage of meconium in this group was significantly more frequent than in the general population, but only one of the group seems likely to have truly idiopathic slow transit constipation, and he did not have delayed passage of meconium. There is no evidence for an effect of social class in this population. Idiopathic slow transit constipation itself is rare.

Topics: Biopsy; Child, Preschool; Constipation; Female; Follow-Up Studies; Gastrointestinal Transit; Humans; Infant, Newborn; Male; Meconium; Rectum; Retrospective Studies; Severity of Illness Index; Time Factors

The aim of this study was to develop new nonoperative strategies for the management of meconium ileus in an attempt to improve on the current unacceptable failure rate.. Mice were constipated with subcutaneous morphine injection. Each then received an enema solution (perflubron, surfactant, Tween-80, Gastrografin, Golytely, DNase, N-Acetylcysteine, Viokase, or normal saline). After the enema solution was administered, stool output was quantitated. Histologic examination of the intestines was performed on a second group of mice that also received enemas. Finally, viscosity measurements were taken of human meconium at baseline and after variable incubation periods with each test solution.. For relieving constipation in vivo, Gastrografin enema was most efficacious. All agents were equally benign to the intestinal mucosa. In vitro, only 4% N-Acetylcysteine and perflubron were less effective at decreasing meconium viscosity than normal saline at T = 0 hours, with N-Acetylcysteine producing greater reduction in viscosity than normal saline at T = 6 hours.. Our results show that surfactant and Gastrografin are the most effective for the in vivo relief of constipation. This is accomplished without mucosal damage. These agents also significantly reduce viscosity in vitro, and we speculate that they may be beneficial in relieving constipation caused by meconium ileus in cystic fibrosis patients.

Topics: Animals; Constipation; Diatrizoate Meglumine; Enema; Humans; In Vitro Techniques; Infant, Newborn; Intestinal Obstruction; Intestines; Male; Meconium; Mice; Viscosity

Topics: Animals; Animals, Newborn; Constipation; Horse Diseases; Horses; Male; Meconium

We identified 21 children (14 boys and seven girls) with long-segment Hirschsprung's disease defined as aganglionosis extending proximal to the ileocecal valve. Long-segment Hirschsprung's disease is difficult to diagnose and treat; symptoms may be mild, and diagnosis delayed. Abdominal distention and constipation or delayed passage of meconium are the most common symptoms. Radiologic studies are unreliable in establishing the diagnosis. The morbidity rate is high because of the high transition zone and short gut. The long-term outcome of patients after the standard Duhamel procedure is satisfactory, except with extremely high transition zones. Pull-through procedures should not be performed in the small infant, but should be delayed until patients are old enough to be continent.

Topics: Abdomen; Constipation; Female; Follow-Up Studies; Hirschsprung Disease; Humans; Ileal Diseases; Ileocecal Valve; Ileostomy; Infant; Infant, Newborn; Male; Meconium; Survival Rate; Vomiting

Meconium constipation is observed in a number of foals during every foaling period. The literature on the clinical picture, methods of treatment and complications, is reviewed in the present paper. In addition, the cases of seventy-five foals are reviewed, in which meconium constipation was suspected and which were submitted to the Internal Disease Department of Large Animals during the period from 1972 to 1982. The clinical picture was found to be due to another disorder in nine cases. Treatment with castor oil and alcohol resulted in discharge of the meconium in fifty-eight cases. Complications occurred in twenty-five foals, fifteen of which died from the effects.

Topics: Animals; Cathartics; Constipation; Horse Diseases; Horses; Meconium

Topics: Appendicitis; Barium Sulfate; Constipation; Diverticulum; Duodenal Diseases; Duodenal Obstruction; Duodenum; Enema; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestine, Small; Meconium; Megacolon; Preoperative Care; Radiography; Syndrome

Topics: Abdomen; Adolescent; Anemia; Child; Child, Preschool; Constipation; Diagnosis, Differential; Female; Guaiac; Humans; Infant, Newborn; Male; Meconium; Megacolon; Melena; Neuromuscular Diseases; Pain; Pediatrics; Posture; Rectal Diseases; Rectum; Sigmoidoscopy; Urethral Diseases; Vaginal Diseases

Topics: Calcinosis; Constipation; Female; Fetal Diseases; Gastrointestinal Motility; Humans; Infant; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Radiography, Abdominal; Time Factors; Tissue Adhesions; Vomiting

Topics: Adolescent; Age Factors; Barium Sulfate; Biopsy; Birth Weight; Child; Child, Preschool; Constipation; Enema; Female; Humans; Infant; Infant, Newborn; Male; Meconium; Megacolon

Topics: Acetylcholinesterase; Biopsy; Constipation; Diagnosis, Differential; Diarrhea; Histocytochemistry; Humans; Infant; Infant, Newborn; Meconium; Megacolon; Radiography; Rectum