td-5108 and Colonic-Pseudo-Obstruction

Chronic intestinal pseudo-obstruction is a disabling condition for which there are no established drug therapies. The condition is caused by a diverse range of intestinal myopathies and neuropathies.. To assess the therapeutic efficacy of prucalopride, a selective high-affinity 5-HT(4) receptor agonist, we employed a multiple n = 1 study design. Each patient acted as his/her own control, each day counting as one treatment episode, allowing comparison of 168 days on each of active drug and placebo.. Double-blind, randomised, placebo-controlled, cross-over trial of four 12-week treatment periods, with 2-4 mg prucalopride or placebo daily. In each of the first and second 6 months there was a prucalopride and a placebo treatment. Patients with proven chronic intestinal pseudo-obstruction, including dilated gut, were included. Evaluation was by patient diary and global evaluation.. Seven patients participated (mean 42 years, five female, median symptom duration 11 years). Three discontinued, two due to study length, and one on prucalopride due to unrelated malnutrition and bronchopneumonia. Four patients (three visceral myopathy and one visceral neuropathy) completed the study; prucalopride significantly improved pain in three of four patients, nausea in two, vomiting in one, bloating in four and analgesic intake. Bowel function was not changed substantially.. n = 1 studies in rare conditions allow drug efficacy assessment. Prucalopride relieves symptoms in selected patients with chronic pseudo-obstruction.

Topics: Adult; Aged; Benzofurans; Colonic Pseudo-Obstruction; Cross-Over Studies; Defecation; Double-Blind Method; Female; Gastrointestinal Transit; Humans; Male; Middle Aged; Research Design; Serotonin 5-HT4 Receptor Agonists; Treatment Outcome

Topics: Benzofurans; Colonic Pseudo-Obstruction; Defecation; Female; Gastrointestinal Transit; Humans; Male; Serotonin 5-HT4 Receptor Agonists

Acute colonic pseudo-obstruction is characterized by symptoms, signs and radiologic appearance of large bowel obstruction in the absence of a true mechanical obstruction. Several pharmacologic treatments have been proposed. We present a case of a patient with Guillain-Barré syndrome complicated by acute colonic pseudo-obstruction, who had a clinical response to tegaserod, a partial 5-hydroxytryptamine type-4 agonist. 5-Hydroxytryptamine type 4 agonists may be an option in the treatment of acute colonic pseudo-obstruction.

Topics: Acute Disease; Colonic Pseudo-Obstruction; Drug Partial Agonism; Guillain-Barre Syndrome; Humans; Indoles; Male; Middle Aged; Serotonin 5-HT4 Receptor Agonists