piperidines and Intestinal-Diseases

Opioid-induced bowel dysfunction (OIBD) is characterised by constipation, incomplete evacuation, bloating, and gastric reflux. It is one of the major adverse events of treatment for pain in cancer and in palliative care, resulting in increased morbidity and reduced quality of life.This is an update of two Cochrane reviews. One was published in 2011, Issue 1 on laxatives and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone. The other was published in 2008, Issue 4 on mu-opioid antagonists (MOA) for OIBD. In this updated review, we only included trials on MOA (including methylnaltrexone) for OIBD in people with cancer and people receiving palliative care.. To assess the effectiveness and safety of MOA for OIBD in people with cancer and people receiving palliative care.. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science to August 2017. We also searched clinical trial registries and regulatory websites. We contacted manufacturers of MOA to identify further data.. We included randomised controlled trials (RCTs) that assessed the effectiveness and safety of MOA for OIBD in people with cancer and people at a palliative stage irrespective of the type of terminal disease they experienced.. Two review authors assessed risk of bias and extracted data. The appropriateness of combining data from the trials depended upon sufficient homogeneity across the trials. Our primary outcomes were laxation, impact on pain relief, and adverse events. Impact on pain relief was a primary outcome because a possible adverse effect of MOAs is a reduction in pain relief from opioids. We assessed the evidence on these outcomes using GRADE.. We identified four new trials for this update, bringing the total number included in this review to eight. In total, 1022 men and women with cancer irrespective of stage or at a palliative care stage of any disease were randomised across the trials. The MOAs evaluated were oral naldemedine and naloxone (alone or in combination with oxycodone), and subcutaneous methylnaltrexone. The trials compared with MOA with a placebo or with the active intervention administered at different doses or in combination with other drugs. The trial of naldemedine and the two of naloxone in combination with oxycodone were in people with cancer irrespective of disease stage. The trial on naloxone alone was in people with advanced cancer. The four trials on methylnaltrexone were undertaken in palliative care where most participants had cancer. All trials were vulnerable to biases; four were at a high risk as they involved a sample of fewer than 50 participants per arm.In the trial of naldemedine compared to placebo in 225 participants, there were more spontaneous laxations over the two-week treatment for the intervention group (risk ratio (RR) 1.93, 95% confidence intervals (CI) 1.36 to 2.74; moderate-quality evidence). In comparison with higher doses, lower doses resulted in fewer spontaneous laxations (0.1 mg versus 0.2 mg: RR 0.73, 95% CI 0.55 to 0.95; 0.1 mg versus 0.4 mg: RR 0.69, 95% CI 0.53 to 0.89; moderate-quality evidence). There was moderate-quality evidence that naldemedine had no effect on opiate withdrawal. There were five serious adverse events. All were in people taking naldemedine (low-quality evidence). There was an increase in the occurrence of other (non-serious) adverse events in the naldemedine groups (RR 1.36, 95% CI 1.04 to 1.79, moderate-quality evidence). The most common adverse event was diarrhoea.The trials on naloxone taken either on its own, or in combination with oxycodone (an opioid) compared to oxycodone only did not evaluate laxation response over the first two weeks of administration. There was very low-quality evidence that naloxone alone, and moderate-quality evidence that oxycodone/naloxone, had no effect on analgesia. There was low-quality evidence that oxycodone/naloxone did not increase the risk of serious adverse events and moderate-quality evidence that it did not increase risk of adverse events.In combined analysis of two trials of 287 participants, we found methylnaltrexone compared to placebo induced more laxations within 24 hours (. In this update, the conclusions for naldemedine are new. There is moderate-quality evidence to suggest that, taken orally, naldemedine improves bowel function over two weeks in people with cancer and OIBD but increases the risk of adverse events. The conclusions on naloxone and methylnaltrexone have not changed. The trials on naloxone did not assess laxation at 24 hours or over two weeks. There is moderate-quality evidence that methylnaltrexone improves bowel function in people receiving palliative care in the short term and over two weeks, and low-quality evidence that it does not increase adverse events. There is a need for more trials including more evaluation of adverse events. None of the current trials evaluated effects in children.

Topics: Constipation; Defecation; Female; Gastrointestinal Agents; Humans; Intestinal Diseases; Male; Nalbuphine; Naloxone; Naltrexone; Narcotic Antagonists; Neoplasms; Opioid-Related Disorders; Oxycodone; Palliative Care; Piperidines; Quaternary Ammonium Compounds; Randomized Controlled Trials as Topic; Receptors, Opioid, mu

Opioid-induced bowel dysfunction (OBD) is characterized by constipation, incomplete evacuation, bloating, and increased gastric reflux. OBD occurs both acutely and chronically, in multiple disease states, resulting in increased morbidity and reduced quality of life.. To compare the efficacy and safety of traditional and peripherally active opioid antagonists versus conventional interventions for OBD.. We searched MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in January 2007. Additional reports were identified from the reference lists of retrieved papers.. Studies were included if they were randomized controlled trials that investigated the efficacy of mu-opioid antagonists for OBD.. Data were extracted by two independent review authors and included demographic variables, diagnoses, interventions, efficacy, and adverse events.. Twenty-three studies met inclusion criteria and provided data on 2871 opioid antagonist-treated patients. The opioid antagonists investigated were alvimopan (nine studies), methylnaltrexone (six), naloxone (seven), and nalbuphine (one). Meta-analysis demonstrated that methylnaltrexone and alvimopan were better than placebo in reversing opioid-induced increased gastrointestinal transit time and constipation, and that alvimopan appears to be safe and efficacious in treating postoperative ileus. The incidence of adverse events with opioid antagonists was similar to placebo and generally reported as mild-to-moderate.. Insufficient evidence exists for the safety or efficacy of naloxone or nalbuphine in the treatment of OBD. Long-term efficacy and safety of any of the opioid antagonists is unknown, as is the incidence or nature of rare adverse events. Alvimopan and methylnaltrexone both show promise in treating OBD, but further data will be required to fully assess their place in therapy.

Topics: Constipation; Defecation; Gastrointestinal Agents; Humans; Intestinal Diseases; Nalbuphine; Naloxone; Naltrexone; Narcotic Antagonists; Opioid-Related Disorders; Piperidines; Quaternary Ammonium Compounds; Receptors, Opioid, mu

Methylnaltrexone and alvimopan are two new and potentially useful agents in the management of opioid-induced bowel dysfunction and prevention of postoperative ileus. Both agents have promising prokinetic properties and appear to be capable of reversing the effects of opioids on delayed gastrointestinal transit. This article reviews currently available published literature to provide an overview of the clinical trials and to provide insight for the potential use of these agents for patients requiring opioid based analgesia. These compounds represent a new class of compounds that may impact the therapeutics for opioid induced bowel dysfunction as well as postoperative ileus.

Topics: Analgesics, Opioid; Gastrointestinal Transit; Humans; Ileus; Intestinal Diseases; Naltrexone; Narcotic Antagonists; Piperidines; Postoperative Complications; Quaternary Ammonium Compounds

Prokinetic drugs enhance the motility of the luminal organs of the gastrointestinal tract. Few drugs developed in this decade are likely to have a greater impact on the treatment of disorders of the gastrointestinal tract. Bethanechol and metaclopramide have proven the potential utility of this class of drugs, whereas newer agents promise to have both a greater margin of safety and tolerability and a broader scope of utility. The efficacy of these agents is reviewed for the treatment of impaired motility from gastroesophageal reflux to severe chronic constipation.

Topics: Biomechanical Phenomena; Cisapride; Domperidone; Forecasting; Gastroenterology; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Intestinal Diseases; Metoclopramide; Paralysis; Parasympathomimetics; Piperidines; Stomach Diseases

Topics: Adolescent; Adult; Benzophenones; Biliary Tract Diseases; Colic; Diclofenac; Dipyrone; Double-Blind Method; Drug Combinations; Female; Humans; Intestinal Diseases; Male; Middle Aged; Pain Measurement; Parasympatholytics; Piperidines; Prospective Studies; Ureteral Diseases

To study the efficacy and safety of a parenteral formulation of 'Manyana' (a combination of diclofenac + pitofenone + fenpiverinium) in ureteric, biliary and intestinal colic, an open labelled study was conducted at two centres. A total of 206 patients were enrolled and evaluated for decrease in pain with time on a visual analogue scale. A statistically significant difference was observed in pain within 30 minutes of drug administration and the pain relief lasted for as long as 24 hours post dosing. The study shows definite synergism between the antispasmodics pitofenone and fenpiverinium with the NSAID-diclofenac, reducing the prostaglandin levels and also the spasm related to colic.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Benzophenones; Biliary Tract Diseases; Colic; Diclofenac; Drug Combinations; Female; Humans; Injections, Intramuscular; Intestinal Diseases; Male; Middle Aged; Parasympatholytics; Piperidines; Ureteral Diseases

In this double blind, prospective study, the relative efficacy of Diclofenac + Pitofenone + Fenpiverinium (Manyana) and Analgin + Pitofenone + Fenpiverinium (Baralgan) in 200 patients of biliary, ureteric and intestinal colic was evaluated. Patients were given these coded drugs thrice daily for five days starting from day 0 to day 5. The results of the present clinical evaluation demonstrated that Manyana appeared to be superior to Baralgan in biliary and ureteric colic while it was therapeutically equivalent to Baralgan in reducing the pain intensity in intestinal colic. Both the medications were tolerated well and there were no side-effects reported.

Topics: Adolescent; Adult; Benzophenones; Biliary Tract Diseases; Colic; Diclofenac; Dipyrone; Double-Blind Method; Drug Combinations; Female; Humans; Intestinal Diseases; Male; Middle Aged; Pain Measurement; Parasympatholytics; Piperidines; Prospective Studies; Time Factors; Ureteral Diseases

Topics: Adolescent; Adult; Benzophenones; Biliary Tract Diseases; Colic; Diclofenac; Dipyrone; Double-Blind Method; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Humans; Intestinal Diseases; Male; Middle Aged; Parasympatholytics; Piperidines; Prospective Studies; Treatment Outcome; Ureteral Diseases

To assess the efficacy of a prokinetic agent in the long-term treatment of chronic intestinal dysmotility and the influence of extrinsic denervation.. We assessed symptoms, compliance and untoward effects in an open, 1-year trial of cisapride, 20 mg t.d.s., in 37 patients with neuropathic forms of chronic intestinal dysmotility. Patients' autonomic function had previously been characterized; effects of cisapride at 12 weeks in a placebo-controlled trial were previously reported.. Seventeen patients had idiopathic dysmotility, 11 had diabetes mellitus with autonomic dysfunction, five had had previous gastric surgery and four had neurological syndromes. Median medication compliance was 98.9% for the study period completed by each individual. Median duration of follow-up was 9.5 months; 20 patients completed 1 year of treatment, and 27 of 37 at least 6 months of treatment; seven dropped out because of lack of benefit. Mean total symptom score was significantly reduced at the last observation relative to the entry into the trial; this was particularly the case in those patients without abdominal vagal dysfunction. One patient withdrew because of aggravation of abdominal pain.. During an open, long-term trial, cisapride, 20 mg t.d.s., provided continued symptomatic relief to patients with chronic intestinal dysmotility, particularly those without vagal neuropathy.

Topics: Adult; Aged; Anti-Ulcer Agents; Autonomic Nervous System Diseases; Chronic Disease; Cisapride; Female; Follow-Up Studies; Gastrointestinal Motility; Humans; Intestinal Diseases; Male; Middle Aged; Patient Compliance; Piperidines; Regression Analysis

The effect of pre-treatment with cisapride on colonoscopy preparation with lavage solution was compared in 120 out-patients less than 60 years and 73 out-patients 60 years or older, who were scheduled for total colonoscopy. By random allocation, patients were assigned to receive cisapride 10 mg or placebo 30 minutes before ingesting the magnesium citrate lavage solution.. The cleansing results and patients' acceptance did not differ significantly in the two treatment groups in either age group. The time from the start of ingesting magnesium citrate until the rectal effluent became clear was significantly shorter in cisapride-treated patients of 60 years or more. Moreover, the residual fluid volume removed by suction during colonoscopy was significantly less in the patients above aged 60 years who received cisapride.. These findings indicate that the combination of cisapride and magnesium citrate is more effective than magnesium citrate alone in cleansing the colon for colonoscopy in elderly patients.

Topics: Adult; Aged; Aging; Antacids; Anti-Ulcer Agents; Chromatography, High Pressure Liquid; Cisapride; Citrates; Citric Acid; Colonoscopy; Female; Gastric Lavage; Humans; Intestinal Diseases; Male; Middle Aged; Piperidines; Premedication; Serotonin Antagonists; Suction

Seventy horses surgically treated for colic caused by disorders of the small intestine were included in a randomized blind trial to determine the effects of cisapride (0.1 mg/kg bw intramuscularly at 8-h intervals) on the post-operative restoration of gut motility. Cisapride appeared to reduce the incidence of post-operative ileus. It accelerated the restoration of bowel motility, reducing the period of post-operative intensive care. It is concluded that cisapride is an effective and useful drug in the post-operative treatment of horses after surgery of the small intestine.

Topics: Animals; Cisapride; Colic; Double-Blind Method; Female; Gastrointestinal Motility; Horse Diseases; Horses; Intestinal Diseases; Intestine, Small; Male; Piperidines; Serotonin Antagonists

Alvimopan accelerates GI recovery after colorectal resection. Data on real-world cost-effectiveness have been mixed.. This study aimed to evaluate if adding alvimopan to an enhanced recovery pathway reduces length of stay.. Patients undergoing colorectal resection or ostomy reversal for the year before and after the introduction of alvimopan were evaluated.. This study was conducted at a single academic medical center.. Patients undergoing elective colorectal resection (488) or ostomy reversal (148) were included.. The primary outcomes measured were length of stay and prolonged length of stay defined as >75th percentile for each procedure.. Two hundred eighty-six patients (45%) received alvimopan. Alvimopan and no-alvimopan groups had similar demographics, comorbidities, operative indication, and case mix. In the alvimopan group, more of the colorectal resections were laparoscopic (87% vs 79%, p = 0.015). Length of stay was reduced with alvimopan (6.2 vs 4.9 days, p = 0.003), and this effect persisted when controlling for procedure type, approach, and ASA class (decreased length of stay by 1.0 day, p = 0.014). The alvimopan group had lower risk of prolonged length of stay (14.7% vs 23.1%, p = 0.007) and ileus (10.8% vs 16.2%, p = 0.05). On multivariable analysis, no alvimopan use (OR, 1.8; 95% CI, 1.2-2.7), ASA ≥3 (OR, 2.0; 95% CI, 1.3-3.1), and history of cardiac surgery (OR, 2.8; 95% CI, 1.2-6.5) were significant predictors of prolonged length of stay. Alvimopan use was associated with a lower risk of infectious complications other than surgical site infection (2.8% vs 6.7%, p = 0.025), and did not increase risk of any adverse outcomes. The addition of alvimopan to the protocol resulted in cost savings of $708.39 per patient.. Data collected from a single center limit external validity.. The introduction of alvimopan to a postoperative protocol following elective colorectal resection or ostomy reversal significantly reduces length of stay and is associated with cost savings even within an enhanced recovery protocol. See Video Abstract at http://links.lww.com/DCR/A911.

Topics: Aged; Clinical Protocols; Colectomy; Cost Savings; Female; Gastrointestinal Agents; Health Care Costs; Humans; Intestinal Diseases; Laparoscopy; Length of Stay; Male; Middle Aged; Ostomy; Piperidines; Recovery of Function

Polyphenols are natural compounds capable of interfering with the inflammatory pathways of several in vitro model systems. In this study, we developed a stable and effective strategy to administer polyphenols to treat in vivo models of acute intestinal inflammation. The in vitro suppressive properties of several polyphenols were first tested and compared for dendritic cells (DCs) production of inflammatory cytokines. A combination of the polyphenols, quercetin and piperine, were then encapsulated into reconstituted oil bodies (OBs) in order to increase their stability. Our results showed that administration of low dose reconstituted polyphenol OBs inhibited LPS-mediated inflammatory cytokine secretion, including IL-6, IL-23, and IL-12, while increasing IL-10 and IL-1Rα production. Mice treated with the polyphenol-containing reconstituted OBs (ROBs) were partially protected from dextran sodium sulfate (DSS)-induced colitis and associated weight loss, while mortality and inflammatory scores revealed an overall anti-inflammatory effect that was likely mediated by impaired DC immune responses. Our study indicates that the administration of reconstituted quercetin and piperine-containing OBs may represent an effective and potent anti-inflammatory strategy to treat acute intestinal inflammation.

Topics: Acute Disease; Alkaloids; Animals; Benzodioxoles; Capsules; Colitis; Dendritic Cells; Dextran Sulfate; Dose-Response Relationship, Drug; Drug Stability; Inflammation; Interleukin-6; Intestinal Diseases; Lipopolysaccharides; Liposomes; Mice; Peptidoglycan; Piperidines; Polyphenols; Polyunsaturated Alkamides; Quercetin; Tumor Necrosis Factor-alpha

SB-207266 is a new 5-HT4 receptor antagonist which in a pilot study reduced the symptoms of irritable bowel syndrome. To help validate this and further studies, we examined the ability of SB-207266 to antagonize at the human 5-HT4 receptor (human isolated intestine) and to affect the mechanisms of peristalsis (guinea-pig isolated ileum) and defaecation (conscious, fed mice). In the human intestine, the potency of 5-HT4 receptor antagonism (pKB 9.98) was similar to that previously demonstrated using a guinea-pig model of the receptor, validating the use of SB-207266 in clinical trials. In each of the animal models, SB-207266 did not affect normal patterns of intestinal motility measured in the absence of exogenous 5-HT. However, SB-207266 10-1000 pM concentration-dependently antagonized the ability of 5-HT (0.1 microM) to sensitize the peristaltic reflex and lower the distension threshold at which peristalsis was evoked. In mice, oral or subcutaneous (s.c.) doses of SB-207266 dose-dependently prevented the ability of the 5-HT precursor, 5-hydroxytryptophan (5-HTP, 10 mg kg-1 s.c.) to increase both the rate of defaecation of formed faecal pellets and their fluid content. SB-207266 was maximally active at 10 micrograms kg-1 s.c. and 1000 micrograms kg-1 p.o. SB-207266 may therefore represent a new class of therapeutic agent, capable of preventing the actions of an important sensitizer of gut function.

Topics: Administration, Oral; Animals; Defecation; Disease Models, Animal; Guinea Pigs; Humans; In Vitro Techniques; Indoles; Intestinal Diseases; Intestines; Male; Mice; Mice, Inbred Strains; Peristalsis; Piperidines; Serotonin Antagonists

Structure-activity relationship studies were pursued within N-substituted-trans-3,4-dimethyl-4-(3-hydroxyphenyl)piperidines in an effort to discover a peripherally selective opioid antagonist with high activity following systemic administration. Altering the size and the polarity of the N-substituent led to the discovery of 3 (LY246736). Compound 3 has high affinity for opioid receptors (Ki = 0.77, 40, and 4.4 nM for mu, kappa, and delta receptors, respectively). It is a potent mu receptor antagonist following parenteral and oral administration and distributes selectively (> 200-fold selectivity) to peripheral receptors. Thus, 3 has properties suitable for the clinical investigation of mu opioid receptor involvement in GI motility disorders.

Topics: Animals; Diarrhea; Gastrointestinal Motility; Guinea Pigs; In Vitro Techniques; Intestinal Diseases; Male; Mice; Piperidines; Radioligand Assay; Receptors, Opioid, mu; Structure-Activity Relationship

Hyperganglionosis or neuronal intestinal dysplasias (NID) and hypoganglionosis (HO) are intestinal diseases of difficult diagnosis and treatment and diverse evolution, despite identical histologic findings. The aim of this study was to discuss the therapeutic problems derived from the patients differing clinical course. Retrospective review of 14 patients with regard to diagnosis, manometry and histology (hematoxylin-eosin, acetylcholinesterase activity, immunohistochemistry and Smith's silver stain) was done. Six patients presented intestinal occlusion or sub-occlusion from the first months of life with impeded oral feeding. Ileostomy was performed in 5 and total colectomy with anastomosis in 1. All patients required parenteral nutrition; cisapride was added in 2. Three died from sepsis (3 NID). Of the 3 survivors, 2 have ileostomies (2 NID) and the other ileo-rectal anastomosis (NID). Of the remaining patients, two presented aganglionism and the finding of proximal hyperganglionism occurred post-surgery. Surgery was repeated in one patient. The remaining 6 (1 HO, 5 NID) were diagnosed between 3 and 10 years of age because of constipation. Four are under treatment with cisapride and 2 required partial colic resection. No relationship can be established between histologic findings and clinical manifestations. In chronic clinical courses, treatment with cisapride and cleaning enemas should be tried first. Acute clinical pictures (occlusion-sub occlusion) should be treated by decompressive ileostomy. Partial colic resection may lead to new intestinal failure.

Topics: Anastomosis, Surgical; Anti-Ulcer Agents; Child; Child, Preschool; Cisapride; Colectomy; Humans; Ileostomy; Infant, Newborn; Intestinal Diseases; Piperidines; Retrospective Studies

Topics: Cisapride; Constipation; Diarrhea; Domperidone; Dumping Syndrome; Gastric Emptying; Gastrointestinal Motility; Humans; Intestinal Diseases; Intestinal Pseudo-Obstruction; Intestine, Small; Metoclopramide; Motilin; Parasympathomimetics; Piperidines; Serotonin Antagonists; Stomach Diseases

A case of chronic intestinal pseudoobstruction secondary to systemic amyloidosis in a patient with multiple myeloma is described. Gastrointestinal symptoms and indices of nutrition improved markedly after commencing treatment with cisapride, which may have been responsible for relatively prolonged survival compared with similar reported cases.

Topics: Amyloidosis; Cisapride; Female; Humans; Intestinal Diseases; Intestinal Pseudo-Obstruction; Middle Aged; Piperidines; Serotonin Antagonists; Stomach Diseases

Attempts have previously been made to reduce adhesion formation by promoting early intestinal motility. The prokinetic agent Cisapride was used in an animal model of end-to-end large bowel anastomoses. Twenty Wistar rats receiving Cisapride 1 mg/kg subcutaneously (sc) twice daily for two days post-operatively were compared with 20 controls receiving saline 0.2 mL in a similar regimen. The points of adhesion of the anastomosis to the following structures were enumerated: tubal fat; mesentery; omentum; caecum; small bowel; and abdominal wall. The treatment group had significantly fewer adhesions: 2.8 +/- 0.9 v 4.3 +/- 1.0. This was mainly in the number of small bowel attachments, 3.8% compared with 37.8%. The study was repeated using small bowel anastomoses. Cisapride again reduced the number of adhesions compared with controls: 2.1 +/- 0.4 v 4.2 +/- 1.4. Cisapride therapy resulted in greater post-operative stool weights and food consumption: control, 3.87 +/- 1.1 stool, 17.04 +/- 4.3 g food; Cisapride 4.43 +/- 0.9 g stool, 19.8 +/- 4.7 g food. The enhanced motility did not affect the anastomotic strength of the small bowel; bursting pressures at a constant inflation rate of 1.1 mL/min were: control 212.8 +/- 56.0 mmHg; Cisapride, 215.8 +/- 58.9 mmHg (NS).

Topics: Administration, Cutaneous; Anastomosis, Surgical; Animals; Cisapride; Disease Models, Animal; Female; Intestinal Diseases; Intestinal Obstruction; Piperidines; Postoperative Complications; Random Allocation; Rats; Rats, Inbred Strains; Tissue Adhesions

Paralytic ileus and intestinal adhesions are common events following intra-abdominal surgery. The theoretical hypothesis 'that stimulation of the postoperative bowel will reduce intestinal adhesions' was studied in a rat model for intestinal adhesions in which postoperative bowel motility was pharmacologically manipulated. Immediate postoperative stimulation of gastrointestinal motility by the prokinetic agent, Cisapride, resulted in a significant reduction in both the number and extent of adhesions. Inhibition of postoperative intestinal motility with the anticholinergic agent, atropine, resulted in a greater number of more dense adhesions involving an increased length of bowel.

Topics: Animals; Cisapride; Female; Gastrointestinal Motility; Intestinal Diseases; Intestinal Pseudo-Obstruction; Piperidines; Postoperative Complications; Rats; Rats, Inbred Strains; Serotonin Antagonists; Tissue Adhesions

Topics: Adolescent; Adult; Aminopyrine; Benzophenones; Colic; Dipyrone; Drug Combinations; Female; Humans; Intestinal Diseases; Kidney Diseases; Male; Middle Aged; N-Methylscopolamine; Parasympatholytics; Piperidines; Scopolamine Derivatives

Topics: Adult; Chronic Disease; Colonic Diseases, Functional; Diarrhea; Female; Humans; Intestinal Diseases; Loperamide; Male; Middle Aged; Piperidines

Topics: Antidepressive Agents; Butyrophenones; Carbamates; Catecholamines; Chlorpromazine; Diagnosis, Differential; Drug Synergism; Fluorine; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Ileum; Intestinal Diseases; Neostigmine; Paralysis; Piperidines; Pyridinium Compounds; Trifluperidol

Topics: Benzilates; Child; Child, Preschool; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Intestinal Diseases; Parasympatholytics; Phenobarbital; Piperidines

Topics: Benzilates; Diarrhea; Disease; Double-Blind Method; Humans; Intestinal Diseases; Intestines; Parasympatholytics; Piperidines