Department of Surgery, Flinders Medical Centre and Flinders University, Bedford Park, South Australia.
Colorectal Dis. 2010 Jun;12(6):540-8. doi: 10.1111/j.1463-1318.2009.01838.x.
Disorders of colonic motility, such as severe constipation and pseudo-obstruction, remain difficult to treat. The pathophysiology of these conditions is not completely understood, but previous studies suggest a deficiency of cholinergic innervation and an imbalance in autonomic regulation of colonic motor function as contributing factors. Therefore, increasing the availability of acetylcholine in the bowel wall with a cholinesterase inhibitor, such as pyridostigmine, may improve symptoms.
We studied thirteen patients with severe constipation (slow transit type) or recurrent pseudo-obstruction. The six patients with slow transit constipation had mechanical obstruction and pelvic floor dysfunction excluded, and normal calibre colon and slow transit confirmed. These patients were offered pyridostigmine in an attempt to avoid surgery. The seven patients with pseudo-obstruction had dilated bowel on imaging, and mechanical obstruction was excluded. These patients received pyridostigmine when symptoms recurred, despite previous treatments. Pyridostigmine was initiated at 10 mg b.i.d. and increased if required.
One of the six patients with slow transit constipation reported improvement of symptoms and had concurrently weaned anti-psychotic medications. Pyridostigmine was ceased in the remaining five patients due to lack of efficacy and/or side effects. Four patients proceeded to surgery for refractory symptoms. All seven patients with pseudo-obstruction had some improvement of symptoms with few side effects. Of these, two later had surgery for recurrent symptoms.
In patients with slow transit constipation, treatment with pyridostigmine does not improve symptoms. However, it does improve symptoms in patients with recurrent pseudo-obstruction with few side effects, offering an extra treatment option for these patients.
结肠运动障碍，如严重便秘和假性梗阻，仍然难以治疗。这些疾病的病理生理学尚未完全了解，但先前的研究表明，胆碱能神经支配不足和结肠运动功能自主调节失衡是促成因素。因此，通过使用胆碱酯酶抑制剂（如吡啶斯的明）增加肠壁中乙酰胆碱的可用性，可能会改善症状。
我们研究了 13 名患有严重便秘（传输缓慢型）或反复假性梗阻的患者。6 名患有传输缓慢型便秘的患者排除了机械性梗阻和骨盆底功能障碍，并证实了结肠正常口径和传输缓慢。这些患者接受吡啶斯的明治疗，以避免手术。7 名患有假性梗阻的患者在影像学上显示有扩张的肠管，并且排除了机械性梗阻。这些患者在症状复发时接受吡啶斯的明治疗，尽管之前已经进行了治疗。吡啶斯的明起始剂量为 10mg，每日两次，如果需要可以增加剂量。
6 名患有传输缓慢型便秘的患者中有 1 名报告症状改善，并同时减少了抗精神病药物的使用。由于缺乏疗效和/或副作用，其余 5 名患者停止了吡啶斯的明治疗。4 名患者因难治性症状而行手术治疗。7 名患有假性梗阻的患者中有 4 名症状均有一定程度的改善，副作用较少。其中，2 名患者后来因症状复发而行手术治疗。
在传输缓慢型便秘患者中，吡啶斯的明治疗并不能改善症状。然而，对于反复发生的假性梗阻患者，它确实可以改善症状，且副作用较少，为这些患者提供了另一种治疗选择。
