Randomized Contolled Study Shows Neostigmine Is An Effective Treatment For Acute Colonic Pseudo-Obstruction

Researchers at the University of Washington School of Medicine have performed the first randomized controlled clinical trial showing that a painful and even life-threatening bowel condition called acute colonic pseudo-obstruction can be effectively treated with intravenous neostigmine.

Results of the study will be published in the July 15 issue of the New England Journal of Medicine. However, the journal is releasing the study seven weeks early on its Web site, http://www.nejm.org, to ensure that doctors who treat the condition are notified as quickly as possible. The article is entitled "Neostigmine for the Treatment of Acute Colonic Pseudo-Obstruction."

Acute colonic pseudo-obstruction occurs in some hospitalized patients following surgery or severe medical illness. The condition is caused by a loss of normal motility or spontaneous bowel action. Also called Ogilvie's syndrome, it causes a severely distended colon (large intestine).

If conservative treatments to restore normal bowel function are not successful, some patients require colonic decompression by emergency colonoscopy or surgery, to prevent ischemia (cutoff of blood supply to the bowel) or perforation of the bowel. Some 3 percent of patients with the condition suffer a perforated bowel and half of those patients die.

In this prospective, double-blind, placebo-controlled trial, Drs. Robert J. Ponec, Michael D. Sanders and Michael B. Kimmey of the Division of Gastroenterology at University of Washington Medical Center confirm earlier uncontrolled studies showing that treatment with intravenous neostigmine is effective in relieving the condition.

The UW study involved 21 patients with a wide range of medical and surgical diagnoses, who had marked abdominal distention and dilated colon and who had failed to improve after 24 hours of conservative treatment. (Conservative treatment included nothing by m

Contact: Laurie McHale
University of Washington

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