Personality characteristics and medical impact of stimulant laxative abuse in eating disorder patients—a pilot study

Background Stimulant laxative abuse as a purging behavior can be profound in those with eating disorders. However, the psychopathology leading to stimulant laxative abuse is poorly understood. Furthermore, the medical impact of stimulant laxative abuse has not been studied in this population. Methods Six individuals abusing stimulant laxatives underwent a barium enema to assess for evidence of the cathartic colon syndrome and 29 individuals engaging in any purging behaviors completed the Tri-dimensional Personality Questionnaire-Short Form, Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Form, Beck Depression Inventory, and the State Trait Anxiety Inventory questionnaires. Results Three of the six patients completing the barium enema had the radiographic findings consistent with cathartic colon. Individuals engaging in laxative abuse showed higher Novelty Seeking compared to those engaging in other forms of purging, and those engaging in any form of purging behavior showed greater Sensitivity to Punishment compared to Sensitivity to Reward. There was also the presence of greater Harm Avoidance than Reward Dependence in this population. Conclusion There may be different psychopathology that contributes to the abuse of stimulant laxatives than that associated with other forms of purging. Regardless of the driving factor, further research is warranted to discover best therapeutic interventions given the potential to develop the cathartic colon syndrome with ongoing use of stimulant laxatives. Plain English Summary Cathartic colon is a condition whereby the colon, or lower intestine, is converted into an inert tube incapable of propagating fecal matter. It is thought to develop due to over-use of stimulant laxatives. However, it is unclear if this condition truly exists and whether it contributes to the constipation experienced by individuals with eating disorders who have extensive past histories of abusing laxatives. It is also unclear if laxative abuse presents with different medical complications than other forms of purging. The purpose of this study is to determine whether radiographic evidence of cathartic colon can be found in eating disorder patients abusing stimulant laxatives, whether there are different medical complications with laxative abuse versus other forms of purging, and to examine the psychological composition of individuals who engage in severe laxative abuse. Specifically, the authors investigated the interrelationship between Harm Avoidance and Reward Dependence, with emphasis on gaining a better understanding of Reward Dependence by examining both Sensitivity to Reward and Sensitivity to Punishment in patients who engage in severe laxative abuse. Our findings suggest that stimulant laxative abuse may cause the development of cathartic colon changes and that there may be unique psychopathology that contributes to the abuse of stimulant laxatives. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this purging behavior may be considered addiction-like in nature, which would have distinct treatment implications.

Superiority of mosapride citrate to picosulfate sodium as a laxative for withdrawal from regular enemas in children with severe functional constipation

Background: Severe functional constipation (FC) with low bowel movement frequency (BMF) of ?1 day/week and hard stools oftenrequires regularly repeated enemas or often leads to enema dependency (ED). Aim: The current study aimed to compare the efficacy of mosapride citrate (Mo) with the traditional stimulant laxative picosulfate sodium (Pi) for withdrawal from ED in children with severe FC. Results: Twenty-four treatment-naïve patients who met the Rome IV diagnostic criteria for FC seen at our center for 8 years from 2012 were enrolled. Glycerin enema was repeated until the BMF was ?3.5 days/week. Simultaneously, Mo at 0.3 mg/kg/day (n=11) or Pi at 0.25 mg/kg/day (n=13) was administered concomitantly with magnesium oxide or lactulose. The proportion of withdrawal from ED was significantly higher in the Mo group than Pi group during the 4 months observational period (90.9% vs. 46.2%, respectively; p=0.034) and shorter in time to withdraw from ED (0 vs. 3.5 months, respectively; p=0.015). Conclusion: Mo is more effective than Pi for withdrawal from ED in children with severe FC.

A Clinical Trial of Multi Herbal Preparation (EZCol) Syrup for Constipation in Pakistani Population

Background: Constipation is one of the symptoms of intestinal syndrome which would be happened along with some other disease in patients. There are several treatment available to cure the constipation but use of stimulant laxative in chronic and acute constipation is more safe and useful of any age patients. In this cross sectional study we clinically observed the efficacy of multi herbal extract (Cassia senna, Rheum palmatum and Cuscuta reflexa) in constipation. We have used local company syrup (EZCol syrup). This syrup contains multi herbs and senna leaves extract is main ingredient of this syrup. The active constituents of enna leaves are Sennosides which considered as an effective treatment for constipation. Sennosides increase the transfer rate of materials from the large intestine. We aimed to assure the effect of senna leaves extract along with other herbal extract (Rheum palmatum and Cuscuta reflexa) for the treatment of constipation. Materials and Methods: In this study, 35 patients were observed after taking the syrup (dose 15 mL 2 time/daily for 3 days). A questionnaire (ROUTE2-003) was developed and distributed to the patients after prescription of EZCol syrup. The study was approved form ethical committee of Rashid Lateef Medical College and Arif Memorial Teaching Hospital, Lahore Pakistan. Results: Treatment was continued for 3 days and data was compiled and result shown significant cure in constipation. Maximum patients felt relief from constipation just within 3 days. Some patients felt diarrhea at third day. Moreover no further significant complications were found in patients. Conclusion: Senna is an FDA-approved over-the-counter (OTC) laxative. Senna leaves extract is a safe, effective and well-tolerated herbal supplement for the treatment of constipation having no significant adverse effect.

Effect of Basil (Ocimum americanum L.) Proportion on Physical and Organoleptical Properties of Basil Cracker

Basil contains flavonoid, saponin, tannin, and essential oils namely sineol and eugenol. Basil has been known as appetite stimulant, laxative, fragrance, and breast milk stimulator. This study aimed to determine the effect of basil addition to linear expansion, crispiness, color, and organoleptic of basil cracker. Complete Randomized Design was used in this research with 4 treatments and 5 replications i.e. T1 (10% basil, 90% tapioca), T2 (15% basil, 85% tapioca), T3 (20% basil, 80% tapioca), T4 (25% basil, 75% tapioca). Linear expansion was measured using ruler, hardness/crispiness using texture analyzer, color using digital colormeter, and organoleptic testing was done by 25 panelists. The research showed that basil cracker had linear expansion of 166-235%; hardness of 1264.8-1837.6 gF; L* value of 22,47-40,40 and a* value of -20.73 to -12.67. Variation of basil proportion gave significant effects to linear expansion, crispiness, and color of basil cracker. The best treatment was T2 (15% basil, 85% tapioca) because it had high linear expansion and bright color, was crispy, and preferred by panelists.

More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer.

211 Background: Constipation is a distressing physical symptom inadequately assessed in patients with cancer. Total opioid consumption may impact opioid-induced constipation (OIC) prevalence. This study examined total daily opioid consumption on self-reported constipation in patients with cancer. Methods: We performed a retrospective analysis in patients who had a histologically-confirmed cancer diagnosis and completed at least 2 outpatient PC visits at an academic palliative care (PC) clinic. At each PC visit, we collected self-reported constipation scores (11-point scale, 0 [no symptom] to 10 [worst symptom]) and 24-hour oral morphine equivalents (OME) for up to 5 visits. Spearman correlation examined the association between OME and presence of constipation rated ≥3 and Wilcoxan-Mann-Whitney examined OME between patients with or without constipation. Univariable logistic regression examined associations of independent variables on constipation. Results: We identified 404 patients with cancer (mean age 55.5±14.3 years, 61.9% women, 89% metastatic disease). The most common cancer types were gastrointestinal (n = 115; 31%) and gynecologic (n = 47; 13%). Stimulant laxative use was observed in 172 (44.9%) patients. Across all visits, we observed a weak association between OME and patient-reported constipation score (r = 0.16-0.24, p < 0.05 for 4 of 5 visits). Mean OME increased, while mean constipation score decreased across visits. At the first visit, higher mean OME was seen in patients who self-reported constipation (128.8 vs 92.3; p < 0.05). In contrast, for each subsequent clinic visit there was no difference in mean OME in patients with or without constipation. Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation. Conclusions: A weak association was observed between OME and self-reported constipation in cancer patients across multiple palliative care visits. Except for the first clinic visit, there was no difference in OME and self-reported constipation scores. These results suggest a lack of a clear association between total opioid consumption and patient-reported constipation.

Constipation needs to be treated

The article presents etiology, pathophysiology and epidemiology of constipation. The main groups of drugs that are used for this pathology are described in the section Treatment of Constipation. Stimulant laxatives are the most commonly demanded by the patients. The article provides the analysis of the use of sodium picosulfate in various clinical studies. Sodium picosulfate is one of the main drugs from the stimulant laxative group.

Efficacy and tolerability of various bowel preparations in diabetic patients: a randomized controlled trial

Background and study aims Diabetes mellitus (DM) is an independent risk factor for poor bowel preparation prior to colonoscopy. Bisacodyl is a stimulant laxative that may mitigate colonic dysmotility associated with diabetes. We hypothesized that adding bisacodyl to split-dose bowel preparation (SDBP) would improve the quality of bowel preparation among patients with diabetes. Patients and methods Adult outpatients aged 18 to 80 years undergoing colonoscopy were recruited. One hundred and eighty-six patients with diabetes were randomly assigned to 1 of 3 treatment arms: 1) conventional 4 L of polyethylene glycol electrolyte lavage solution (PEG-ELS; conventional bowel preparation [CBP]); 2) split-dose of 4 L PEG-ELS (split-dose bowel preparation [SDBP]); or 3) split-dose of 4 L PEG-ELS preceded by 10 mg of oral bisacodyl 10 (SDBP-B). The primary outcome measure was bowel cleansing as indicated by Boston Bowel Preparation Scale (BBPS) score. Endoscopists were blinded to the preparation used. Secondary outcome measures were safety and patient tolerability. Results Of the 212 patients randomized, only 186 received assigned bowel preparation. There were no differences among the three study groups with regard to age, indication, duration of DM, insulin use, narcotic use, or presence of end-organ diabetic complications. There was a trend toward better bowel preparation quality among those receiving SDBP and SDBP-B compared to those receiving CBP, but the trend was not statistically significant ≥ 6 BBPS; 67 % vs. 83 % vs. 75 %, P = 0.1). In terms of safety and tolerability, there were no differences among the three groups. Conclusion Adding bisacodyl to SDBP does not improve the quality of bowel preparation in patients with DM. Further efforts are needed to optimize colonoscopy bowel preparation in this population.

Effect of Basil (Ocimum americanum L.) Proportion on Physical and Organoleptical Properties of Basil Cracker

Basil contains flavonoid, saponin, tannin, and essential oils namely sineol and eugenol. Basil has been known as appetite stimulant, laxative, fragrance, and breast milk stimulator. This study aimed to determine the effect of basil addition to linear expansion, crispiness, color, and organoleptic of basil cracker. Complete Randomized Design was used in this research with 4 treatments and 5 replications i.e. T1 (10% basil, 90% tapioca), T2 (15% basil, 85% tapioca), T3 (20% basil, 80% tapioca), T4 (25% basil, 75% tapioca). Linear expansion was measured using ruler, hardness/crispiness using texture analyzer, color using digital colormeter, and organoleptic testing was done by 25 panelists. The research showed that basil cracker had linear expansion of 166-235%; hardness of 1264.8-1837.6 gF; L* value of 22,47-40,40 and a* value of -20.73 to -12.67. Variation of basil proportion gave significant effects to linear expansion, crispiness, and color of basil cracker. The best treatment was T2 (15% basil, 85% tapioca) because it had high linear expansion and bright color, was crispy, and preferred by panelists.