Joo J S, Ehrenpreis E D, Gonzalez L, Kaye M, Breno S, Wexner S D, Zaitman D, Secrest K
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA.
J Clin Gastroenterol. 1998 Jun;26(4):283-6. doi: 10.1097/00004836-199806000-00014.
Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use. Because some have questioned whether this is a real entity, we investigated changes occurring on barium enema in patients ingesting stimulant laxatives. Our study consisted of two parts. In part 1, a retrospective review of consecutive barium enemas performed on two groups of patients with chronic constipation (group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was presented to a radiologist who was blinded to the patient group. A data sheet containing classic descriptions of cathartic colon was completed for each study. Chronic stimulant laxative use was defined as stimulant laxative ingestion more than three times per week for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive patients who were chronic stimulant laxative users underwent barium enema examination, and data sheets for cathartic colon were completed by another radiologist (part 2). Colonic redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2, 23.1%) were frequent radiographic findings in both patient groups and were not significantly different in the two groups. Loss of haustral folds, however, was a common finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2 (13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon of 2 (13.3%) patients. Loss of haustra was seen in patients chronically ingesting bisacodyl, phenolpthalein, senna, and casanthranol. We conclude that long-term stimulant laxative use results in anatomic changes in the colon characterized by loss of haustral folds, a finding that suggests neuronal injury or damage to colonic longitudinal musculature caused by these agents.
泻剂性结肠是一个历史术语，用于描述因长期使用刺激性泻药导致的结肠解剖结构改变。由于有人质疑这是否是一种真实存在的病症，我们对服用刺激性泻药的患者进行钡剂灌肠检查时出现的变化进行了研究。我们的研究分为两个部分。在第一部分中，将两组慢性便秘患者（第1组，使用刺激性泻药[n = 29]；第2组，未使用刺激性泻药[n = 26]）连续进行的钡剂灌肠检查结果回顾性呈现给一位对患者分组不知情的放射科医生。为每项研究填写一份包含泻剂性结肠经典描述的数据表。长期使用刺激性泻药的定义为每周服用刺激性泻药超过三次，持续1年或更长时间。为了证实回顾性研究的结果，18名连续的长期使用刺激性泻药的患者接受了钡剂灌肠检查，另一位放射科医生填写了泻剂性结肠的数据表（第二部分）。结肠冗长（第1组，34.5%；第2组，19.2%）和扩张（第1组，44.8%；第2组，23.1%）在两组患者中都是常见的影像学表现，且两组之间无显著差异。然而，结肠袋消失在第1组中是常见表现（27.6%），而在第2组中未见（p < 0.005）。在研究的两个部分中，总共15名（40.5%）使用刺激性泻药的患者出现结肠袋纹消失，其中6名（40%）患者出现在左半结肠，2名（13.3%）患者出现在右半结肠，5名（33.3%）患者出现在横结肠，2名（13.3%）患者出现在全结肠。长期服用比沙可啶、酚酞、番泻叶和卡森烷醇的患者出现结肠袋消失。我们得出结论，长期使用刺激性泻药会导致结肠出现解剖学变化，其特征为结肠袋消失，这一发现提示这些药物导致了神经元损伤或结肠纵行肌损伤。
