Chronic constipation in diabetes mellitus is associated with colonic motor dysfunction and is managed with laxatives.
Cholinesterase inhibitors increase colonic motility.
Dr Adil Bharucha from Minnesota, USA evaluated the effects of a cholinesterase inhibitor on gastrointestinal and colonic transit and bowel function in diabetic patients with constipation.
After a 9-day baseline period, 30 patients with diabetes mellitus and chronic constipation without defecatory disorder were randomized to oral placebo or pyridostigmine, starting with 60 mg three times a day, increasing by 60 mg every third day up to the maximum tolerated dose or 120 mg three times a day.
This dose was maintained for 7 days.
The research team evaluated gastrointestinal and colonic transit and bowel function at baseline and the final 3 and 7 days of treatment, respectively.
Treatment effects were compared using analysis of covariance, with gender, body mass index and baseline colonic transit as covariates.
|14 of 16 patients randomiized to pyridostigmine tolerated 360 mg daily|
The team of doctors found that 19 patients had moderate or severe autonomic dysfunction, and 16 had diabetic retinopathy.
The team observed that 14 of 16 patients randomiized to pyridostigmine tolerated 360 mg daily, and 2 patients took 180 mg daily.
Compared with placebo, pyridostigmine accelerated overall colonic transit at 24 hours, but not gastric emptying or small-intestinal transit.
The researchers examined that treatment effects on stool frequency, consistency and ease of passage were significant.
Cholinergic side effects were somewhat more common with pyridostigmine than with placebo.
Dr Bharucha's team commented, "Cholinesterase inhibition with oral pyridostigmine accelerates colonic transit and improves bowel function in diabetic patients with chronic constipation."