Siproudhis L, Bellissant E, Juguet F, Allain H, Bretagne J F, Gosselin M
Gastroenterology Unit, Hôpital Pontchaillou, Rennes, France.
Aliment Pharmacol Ther. 1998 Aug;12(8):747-54. doi: 10.1046/j.1365-2036.1998.00361.x.
Despite their potential therapeutic benefit, the effects of cholinergic agents on anal function have been poorly investigated.
To analyse the effects of neostigmine and atropine on anorectal responses to rectal isobaric distension.
This was a placebo-controlled, randomized, double-blind crossover study, performed in 12 healthy volunteers who received intravenously, on 3 separate days, neostigmine, atropine or the placebo. During each day of the experiment, seven pressure steps (ranging from 1 to 31 mmHg) in three different protocols of rectal isobaric distension (phasic, stepwise and tonic) were applied using an electronic barostat. Manometric responses of the anal canal, adaptative volumes and perception scores of the rectum were recorded.
During stepwise distension, a significant drug effect was encountered at the anal level. No drug effect was observed on the other investigated parameters (rectal volumes and rectal perception scores) or for the other modes of distension. Compared to placebo, neostigmine significantly decreased pressures at the upper level of the anal canal for both recto anal inhibitory reflex and mean resting pressures. In contrast, atropine significantly increased pressures at the lower part of the anal canal but did not modify upper anal pressures.
The present study suggests that cholinergic effects result more from an indirect action on intermediate neurotransmitters and rectal myenteric neurons, than from a direct action on anal targets.
尽管胆碱能药物具有潜在的治疗益处，但其对肛门功能的影响尚未得到充分研究。
分析新斯的明和阿托品对直肠等压扩张时肛肠反应的影响。
这是一项安慰剂对照、随机、双盲交叉研究，在12名健康志愿者中进行，他们在3个不同的日子里分别静脉注射新斯的明、阿托品或安慰剂。在实验的每一天，使用电子恒压器在三种不同的直肠等压扩张方案（相位性、逐步性和持续性）中施加七个压力步骤（范围从1至31 mmHg）。记录肛管的测压反应、适应性容量和直肠的感知评分。
在逐步扩张期间，在肛门水平观察到显著的药物效应。在其他研究参数（直肠容量和直肠感知评分）或其他扩张模式中未观察到药物效应。与安慰剂相比，新斯的明显著降低了肛管上部在直肠肛门抑制反射和平均静息压力时的压力。相反，阿托品显著增加了肛管下部的压力，但未改变肛管上部的压力。
本研究表明，胆碱能效应更多地源于对中间神经递质和直肠肌间神经元的间接作用，而非对肛门靶点的直接作用。
