piperidines and Colonic-Diseases

Post-operative ileus (POI) and delayed return of gastrointestinal (GI) function are common complications after colorectal surgery. There is a lack of uniformity in enhanced recovery protocols (ERPs) with regards to interventions used to target these complications. This systematic review aims to categorize and summarize management recommendations available from published ERPs.. A systematic search of Ovid MEDLINE, Embase, Cochrane Library and PubMed databases was performed from January 1990 to May 2018. All studies publishing enhanced recovery or fast-track or multimodal pathway protocols for colorectal surgery in their full-text were included. Data on interventions aimed at reducing the duration of POI were extracted, as well as references quoted to support specific interventions.. Of 481 manuscripts screened, 37 published ERPs were identified from 37 studies (18 cohort, seven historical-control, five guidelines, four randomized controlled trials, one randomized controlled trial protocol, one case series and one narrative review). The most commonly recommended interventions were magnesium-based laxatives (18 of 37, 48.6%), chewing gum (13 of 37, 35.1%), Alvimopan (6 of 37, 16.2%), lactulose (4 of 37, 10.8%), neostigmine (2 of 37, 5.4%) and bisacodyl (2 of 37, 5.4%). Geographical trends were noted for the various interventions, but high-quality evidence was only referenced to support the use of Alvimopan.. ERP recommendations specific to interventions targeting POI and return of GI function are varied. While laxatives are the most commonly recommended intervention, there is only weak evidence reported to support this practice.

Topics: Bisacodyl; Chewing Gum; Colonic Diseases; Humans; Ileus; Lactulose; Neostigmine; Piperidines; Postoperative Complications; Recovery of Function; Rectal Diseases

Alvimopan, a peripherally acting Mu-opioid receptor antagonist, has been shown to enhance recovery of gastrointestinal (GI) function in open bowel resection. The aim of this study was to determine the effect of Alvimopan on patients undergoing laparoscopic right colectomies in preventing postoperative ileus (POI). A prospective, nonrandomized trial of laparoscopic right colectomies was carried out with and without perioperative Alvimopan. The length of stay (LOS), time to first flatus, bowel movement, and tolerance of solid foods were recorded. Additionally, any occurrences of POI defined as the need for insertion of a nasogastric tube (NGT) were also noted. Student t tests were used for statistical analysis. A total of 33 patients underwent laparoscopic right colectomies for both benign and malignant diseases from October 2008, to December 2009. Sixteen patients received Alvimopan, whereas 17 patients did not. The demographics of both patient groups were similar. Patients receiving Alvimopan had an accelerated return of bowel function in terms of first flatus (2.37 vs 3.34; P = 0.03), tolerance of solid food (2.75 vs 3.94; P = 0.03), and first stool (2.53 vs 3.80; P = 0.04). There was a trend toward shorter LOS in patients receiving Alvimopan (P = 0.07). Two patients with POI requiring NGT did not receive Alvimopan. Alvimopan was successful in enhancing return of GI function in laparoscopic right colectomies and avoiding POI. The decreased LOS trended but did not approach statistical significance. A large randomized prospective trial will be needed to determine the validity of this study.

Topics: Administration, Oral; Aged; Colectomy; Colonic Diseases; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Gastrointestinal Agents; Gastrointestinal Motility; Humans; Ileus; Laparoscopy; Male; Piperidines; Postoperative Complications; Prospective Studies; Receptors, Opioid, mu; Recovery of Function; Treatment Outcome

The objective of our study was to compare the safety and efficacy of remifentanil during colonoscopy with those of the standard combination of midazolam and pethidine.. One-hundred and sixteen consecutive patients scheduled for colonoscopy were randomly assigned to groups A or B. Patients in group A (n = 56) received intravenous (IV) midazolam and pethidine. Patients in group B (n = 60) received IV remifentanil.. Recovery was faster in group B (0 min) than in group A (56 +/- 11.3 min) (P < 0.001). There was a marked difference between groups B and A with regard to the time of hospital discharge-28.7 +/- 4.3 and 148.9 +/- 34 min, respectively (P < 0.001). Patients in group A rated the procedure as comfortable, as also did those in group B. A combination of midazolam and pethidine had a greater affect on patients' cardiorespiratory characteristics.. Remifentanil during colonoscopy provides sufficient pain relief with better hemodynamic stability, less respiratory depression, and significantly faster recovery and hospital discharge than moderate sedation with midazolam and pethidine.

Topics: Anesthetics, Intravenous; Colonic Diseases; Colonoscopy; Conscious Sedation; Female; Follow-Up Studies; Humans; Male; Midazolam; Middle Aged; Patient Satisfaction; Piperidines; Prospective Studies; Remifentanil; Treatment Outcome

A prospective, randomized, double-blind study was undertaken to evaluate Zamifenacin 30 mg (Pfizer Ltd), a novel, orally-administered, gut-specific muscarinic receptor antagonist, as an adjuvant to the double contrast barium enema examination (DCBE). Zamifenacin was compared with placebo in terms of side-effects and colonic tone. Analysis of colonic tone was carried out by two independent observers, using a subjective grading system and also by an objective method using computerized planimetry. Interobserver variability was also assessed. Zamifenacin is safe and well tolerated but at the prescribed dose is an ineffective antispasmodic for DCBE. Subjective assessment of colonic tone was shown to be of limited value whilst the objective analysis using computerized planimetry was reliable and highly reproducible.

Topics: Adolescent; Adult; Aged; Barium Sulfate; Colon; Colonic Diseases; Dioxoles; Double-Blind Method; Enema; Humans; Image Processing, Computer-Assisted; Middle Aged; Muscarinic Antagonists; Observer Variation; Piperidines; Prospective Studies; Radiography; Spasm

The effect of cisapride on postoperative colonic motility was studied in 40 patients undergoing cholecystectomy under randomized, double-blind conditions. The patients received 10 mg of cisapride or placebo by intravenous injection starting on the day of surgery and repeated every 12 h until the 3rd postoperative day. The return of propagative motility in the colon was visualized by means of radiopaque markers and serial abdominal radiographs. Cisapride induced a significantly earlier return of propulsive motility in the right colon, as indicated by the propagation of markers from the ascending colon to the transverse colon (p less than 0.05). Radiopaque markers reached the descending colon (p less than 0.05) and the rectosigmoid colon (p less than 0.05) significantly earlier in the cisapride group than in controls. The first passage of feces occurred significantly earlier in cisapride-treated patients than in controls (p less than 0.05). The first passage of gas after surgery did not differ significantly between the groups. Our results suggest that cisapride can be used to induce earlier return of propagative motility in the colon after major abdominal surgery.

Topics: Cholecystectomy; Cisapride; Colonic Diseases; Double-Blind Method; Female; Gastrointestinal Motility; Humans; Intestinal Pseudo-Obstruction; Male; Middle Aged; Piperidines; Postoperative Complications; Serotonin Antagonists

Postoperative ileus (POI) is a major cause of morbidity, increased length of stay (LOS) and hospital cost after colorectal surgery. Alvimopan is a µ-opioid antagonist used to accelerate upper and lower gastrointestinal function after bowel resection. We hypothesized that alvimopan would reduce LOS in patients undergoing colorectal resection with stoma, a situation that has not been evaluated.. A retrospective review (2010-2015) identified 58 patients who underwent colorectal resection for benign or malignant disease with stoma creation and received alvimopan. They were case-matched to 58 non-alvimopan patients based on age, BMI, baseline comorbidities, stoma type created and surgical approach. We compared overall LOS, incidence of POI and other postoperative complications.. There were equal numbers of laparoscopic (N = 18) and open resections (N = 40) in the alvimopan group and non-alvimopan group. There were also equal numbers of patients with an ileostomy (N = 37) or colostomy (N = 21) in each group. Overall, 41 patients underwent resection for malignant disease in the alvimopan group compared to 37 in the non-alvimopan group. There was a significant reduction in median LOS overall (alvimopan 5 (4-7) versus control 6 (4.75-9.25) days, P = 0.03). While the 6-day median LOS was similar for patients undergoing ileostomy creation (P = 0.25), alvimopan patients had a 3-day decreased median LOS that approached statistical significance (P = 0.06). The overall 30-day complication rate was higher in the control group (41.4 vs. 51.7%, P = 0.26), but the readmission rate within 30 days was higher in the alvimopan group (19 vs. 13.8%, P = 0.45). Neither of these differences reached statistically significance.. The use of alvimopan in patients undergoing colorectal resection with stoma is associated with a significantly shorter LOS, but the increased readmission rate warrants further study. Based on these data, alvimopan should be evaluated in a controlled setting for patients undergoing colorectal resection with colostomy creation.

Topics: Adult; Aged; Colectomy; Colonic Diseases; Female; Gastrointestinal Agents; Humans; Ileus; Length of Stay; Male; Middle Aged; Ostomy; Piperidines; Postoperative Complications; Rectal Diseases; Rectum; Retrospective Studies; Treatment Outcome

Alvimopan was approved by the Food and Drug Administration in May 2008 and has been shown to accelerate gastrointestinal recovery after colectomy. Our independent study evaluated alvimopan as it is used in actual hospital practice in the state of Michigan. We hypothesized that alvimopan significantly decreases incidence of prolonged ileus and reduces length of stay (LOS) in patients who have undergone colectomy.. We identified 4749 patients from the Michigan Surgical Quality Collaborative (N = 28 hospitals) database between August 2007 and December 2010 who underwent elective colectomy operations. A total of 528 patients received alvimopan both pre- and postoperatively. We first selected a control group of patients from hospitals that had never administered alvimopan (n = 1833) and used propensity matching to manage differences in patient demographics and clinical characteristics. To control for hospital and surgeon characteristics, we then performed a sensitivity analysis, using a separate group of historical control patients treated before May 2008 in hospitals that would later administer alvimopan (n = 270). The Fisher exact test was used to compare complication rates, and the Student t test was used to compare LOS.. Patients who received alvimopan had significantly lower incidence of prolonged ileus (2.3% vs 7.9%; P < 0.001) and a significantly shorter LOS (4.84 ± 4.54 vs 6.40 ± 4.45 days; P < 0.001) than control patients in hospitals that had never administered alvimopan. No differences were noted in these outcomes using sensitivity analysis.. This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.

Topics: Colectomy; Colonic Diseases; Dose-Response Relationship, Drug; Female; Gastrointestinal Agents; Humans; Ileus; Incidence; Laparoscopy; Length of Stay; Male; Michigan; Middle Aged; Piperidines; Postoperative Period; Recovery of Function; Treatment Outcome

A 54-year-old woman with acute onset of hematochezia and lower abdominal pain proved to have ischemic colitis associated with the use of naratriptan. The diagnosis was established by colonoscopy with biopsy. There were no other obvious risk factors for intestinal ischemia. The condition resolved within 4 days. Because the use of triptans for the treatment of migraine is increasing, health care providers should be aware of their potential for inducing ischemic colitis.

Topics: Abdominal Pain; Colon; Colonic Diseases; Female; Headache; Humans; Indoles; Ischemia; Middle Aged; Piperidines; Serotonin Receptor Agonists; Tryptamines

Distension of the rat intestine causes a depressor response which is predictive of nociception. This study investigated the effects of previous infection with Nippostrongylus (N.) brasiliensis on the sensitivity to intestinal distension and the role of tachykinin NK2 receptors. The tachykinin NK2 receptor antagonist, SR48968 (S)-N-methyl-N[4-(4-acetylamino-4-phenylpiperidino)-2-(3,4-dichloropheny l)butyl]benzamide) inhibited the nociceptive response (ED50 = 0.7 mg/kg) in control rats. In post-N. brasiliensis-infected rats sensitivity to intestinal distension was increased which was accompanied by an increase in the apparent potency value of SR48968 (ED50 = 0.1 mg/kg). The hypersensitivity was limited to areas of hypermastocytosis. It is concluded that the post-inflammatory changes that occur in post-infected rats increase visceral sensitivity and the apparent potency of tachykinin NK2 receptor antagonists.

Topics: Animals; Benzamides; Colon; Colonic Diseases; Dilatation, Pathologic; Intestinal Diseases, Parasitic; Jejunal Diseases; Jejunum; Male; Mast Cells; Nippostrongylus; Pain Measurement; Peroxidase; Piperidines; Rats; Rats, Wistar; Receptors, Neurokinin-2; Strongylida Infections

Cisapride has been used in the treatment of chronic intestinal pseudo-obstruction with some success; however, the use of cisapride in the treatment of acute pseudo-obstruction has not been adequately studied. We describe a case of acute intestinal pseudo-obstruction successfully treated with cisapride. To our knowledge, this is the second such case reported in the English language literature. Our patient's acute intestinal pseudo-obstruction was probably precipitated by pneumonia and sepsis, and the prompt resolution of his intestinal pseudo-obstruction after initiation of cisapride therapy (despite progressive deterioration of his overall clinical status) implicates cisapride as the cause of the improved intestinal function. Therefore, we suggest that a trial of cisapride be considered for patients with acute intestinal pseudo-obstruction when other therapeutic maneuvers have failed.

Topics: Acute Disease; Cisapride; Colonic Diseases; Fatal Outcome; Humans; Intestinal Pseudo-Obstruction; Male; Middle Aged; Parasympathomimetics; Piperidines; Radiography

Topics: Alginates; Aluminum Hydroxide; Amylases; Antacids; Anti-Ulcer Agents; Bromelains; Cisapride; Colon; Colonic Diseases; Constriction, Pathologic; Cystic Fibrosis; Drug Combinations; Humans; Infant; Intestinal Mucosa; Intestinal Obstruction; Lipase; Male; Piperidines; Silicic Acid; Sodium Bicarbonate; Trypsin

Halofuginone was evaluated for its activity against experimentally induced infection due to Cryptosporidium parvum in rats rendered immunosuppressed with dexamethasone. The drug's activity was dose-related and both prophylaxis and therapy reduced the rate and severity of infection in the small intestine and caecum. Prophylactic treatment reduced infection of the common bile duct, but therapeutic administration did not and neither form of treatment reduced the infection rate in the colon. Intestinal infection recurred at a level comparable to that of untreated controls when treatment was discontinued. Treatment with halofuginone may reduce the severity of acute cryptosporidiosis, but is less efficacious for chronic cryptosporidiosis involving the colon and extraintestinal tissues, a manifestation increasingly seen in the immunocompromised host.

Topics: Animals; Colonic Diseases; Common Bile Duct; Cryptosporidiosis; Cryptosporidium parvum; Dexamethasone; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Feces; Female; Immunosuppression Therapy; Intestine, Large; Intestine, Small; Parasite Egg Count; Piperidines; Quinazolines; Quinazolinones; Rats; Rats, Sprague-Dawley; Treatment Outcome

Topics: Animals; Cisapride; Colonic Diseases; Fecal Impaction; Gastrointestinal Motility; Horse Diseases; Horses; Intestinal Obstruction; Male; Parasympathomimetics; Piperidines

A case is reported of a 68-year-old woman admitted in the ICU for acute exacerbation of a chronic obstructive respiratory disease. The trachea was intubated and the lungs ventilated mechanically. She received sedation including midazolam and phenoperidine 1 mg.h-1. On the 6th day, she experienced a massive colonic dilation (caecal diameter of 10 cm at X-ray examination). A colonoscopy was performed which showed the absence of obstruction, confirmed the diagnosis of pseudo-obstruction of the colon and allowed a decompression which was inefficient. A new colonoscopic decompression was performed on the 8th day, without prolonged effect. At that time, the patient was given cisapride in her gastric tube (80 mg). This treatment restarted the bowel movements within 48 hours and the caecal diameter decreased immediately to 7 cm. Cisapride was maintained for 10 days and mechanical ventilation for 30 days. No further dilation occurred during this time and the patient was discharged from the ICU. Few cases of Ogilvie's syndrome successfully treated with cisapride have been reported in the literature. The efficacy of this agent for the treatment of Ogilvie's syndrome remains to be assessed in a controlled study.

Topics: Aged; Cisapride; Colonic Diseases; Colonoscopy; Female; Gastrointestinal Motility; Humans; Intestinal Pseudo-Obstruction; Piperidines; Respiration, Artificial

Topics: Cisapride; Colonic Diseases; Combined Modality Therapy; Hirschsprung Disease; Humans; Ileostomy; Infant; Intestinal Pseudo-Obstruction; Parenteral Nutrition, Total; Piperidines

A 73-yr-old white woman admitted with lobar pneumonia and congestive heart failure developed progressive colonic pseudoobstruction (Ogilvie's syndrome) 2 days after admission which was unrelieved by diatrizoate meglumine (Gastrografin, Squibb Canada, Montreal) enema and rectal tube. Cisapride, a new gastrointestinal prokinetic agent, was administered intravenously with full resolution of the syndrome. To the authors' knowledge, this is the first reported case of successful treatment of acute colonic pseudoobstruction with cisapride.

Topics: Acute Disease; Aged; Cisapride; Colonic Diseases; Colonic Pseudo-Obstruction; Drug Evaluation; Drugs, Investigational; Female; Humans; Infusions, Intravenous; Intestinal Pseudo-Obstruction; Piperidines; Serotonin Antagonists; Time Factors

Topics: Biomedical Research; Colchicine; Colectomy; Colitis; Colitis, Ulcerative; Colonic Diseases; Colonic Diseases, Functional; Crohn Disease; Diabetic Neuropathies; Diarrhea; Diphenoxylate; Diverticulitis; Diverticulitis, Colonic; Drug Therapy; Dysentery; Dysentery, Amebic; Enteritis; Gastroenteritis; Humans; Piperidines; Postgastrectomy Syndromes; Postoperative Complications; Toxicology; Virus Diseases

Topics: Benzilates; Colic; Colitis; Colitis, Ulcerative; Colonic Diseases; Humans; Hydrocarbons, Brominated; Parasympatholytics; Piperidines

Topics: Benzilates; Cholinergic Antagonists; Colon; Colonic Diseases; Disease; Muscle Relaxants, Central; Piperidines