Efficacy and optimal dose of dally polyethylene glycol 3350 (PEG) for treat of chronic coastipation and encopresis in children

(IBS-D), The control group consisted of 15 subjects without gastrointestinalsymptoms (mean age 49 years, range 24-73 years) who underwent a colonoscopy becauseof anemia, control after polypectomi or took part as healthy controls in a barostat study (9 females, 6 males; mean age 49 years, range 24-73 years). For analysis (Radioimmunoassay) of vasnactive intestinal peptide (VIP), substance P (SP), peptlde YY (PYY) and neuropeptideY (NPY) three biopsies from the ascending (Asc) and descending (Desc) part of the colon, respectively. were taken in each subject as well as biopsies from different parts of the colon to exclude inflammatory changes in the 18S patients. Results: The IBS patients had lower levels of PYY in Desc than the controls (42±5.3 vs 64_+12 pmoi/O (mean, SEM); p
4049 Relationship between Large Bowel Transit, Rectal Sonaitivth/oral Abdominal Pain in Functional Constipation. Danilo Bediali, Giancarlo Bauseno, Patrizia Magdni, Enrico Corazziari,Dept Science Cliniche, Universita' La Sapienza,Rome Italy

4051 Soil-Titration of Rapid Rectal Distension Thresholds Before and After Repeated Rectal Inflations in IBS Patients and Healthy Controls Clive H. Wilder-Smith, GastroenterologyGroup Practice, Berne Switzerland; Daniel Schindler, GI Physiology Lab, Berne Switzerland Visceral sansitisation induced by repetitive intestinal stimulation inconsistently affects sensory thresholds in iBS patientsand healthycontrols. Rapidrectaldistension is assumedto differentiate better between IBS patients and controls than other distension paradigms due either to stimulus hypervigiianceor different processingof sensoryinput from deeperintestinalafferents in IBS. Methods: 10 female healthy controls (mean age 31 _+lOy) and 10 female IBS patients (37_+10y; Rome 2; 5 each with diarrhoea 16S-dor constipation IBS-c) self-titrated their rectal 1st sensation, urge, pain detection and pain tolerance thresholds using the keyboard of a G&J barostat (rapid ramp: 27mi/s). Thresholds were re-tifrated after 10 rectal distensions with pain detection+10% pressures lasting 30s each (sensitieation). Results: 19 subjects completed the specified protocol. The 52ram FtG cut-off was reached before pain tolerance pre* and post-sensit~oo in 5 & 1 of 9 controls, 5 & 4 of 5 IBS-c, and 3 & 1 of 5 IBS-d patients, reap. Pro- and post-sensifisation thresholds are shown in table. Conclusions: IBS patients as a group and 16S-c/dsubgroups were not hypersensitiveor hyperalgesiccompared to controls using rapid rectal distension before or after repeatedpainful intestinal inflations. SeH-titrattoomay daveeliminated hypervigilanceeffects seenwith non-self-controlled inflation protocols. The visceral sensitisatioo (agodynia) seen only in healthy controls after repeated distensions indicatesdifferent stimulus-responsecharacteristicsin IBS, limited to the nociceptire stimulus range. Nocicaptive and non-nociceptive stimuli (discomfort) therefore appear to be processed differenthj. Supported by AstraZeneca AB, Molndal, Sweden Meanseif-lJbatedrectaldistensionsensorythresholdspre-lpost-sensifisation mm Hf

Aim of this study was to evaluatethe relationship, if any, between (a) the different patterns of large bowel transit, (b) rectal sensitivity and abdominal pain in functional constipation. Two hundred and thirty-one patients (F:147; mean age: 38±15 yrs) seeking medical advice for functional constipation as defined with Rome II criteria~ were interviewed by means of a standardized questionnaire. Abdominal pain was referred by 175 pts (76%); subjects with and without abdominal pain did not differ for age (38___15vs 38-+16 yrs); the female/male ratio was significantly higher in the painful, than in the painless, group (147/28 vs 38/18; p
4O5O Combination of Lactulose Hydrogen Breath Test with 13C-acetate Breath Test for Diagnosing Gastrointestinal Motility Disorders. Yoshihisa Urita, NaotakaTorii, Kazuo Hike, Yoshinobu Kikuchi, Eiko Kanda, Masahiko Sasajima, KazumasaMiki, First Dept of Internal Medicine, Toho Univ, Tokyo Japan Background: We designed a new method of measuring both gastric emptying and Orocecal transit time(OCl-I) at the same time to assessthe influence of gastric emptying upon OCTr. Patients and Methods: Twenty-five dyspeptic patients ( six men, 19 women) with a mean age of 64.8( range 25-80) years were studied. The patients receiveda liquid test meal containing lOOmg of 13C-acetateand 12g of lactulose in the sitting position after an overnight fast. Breath samples were collected at 10 min-intervals for 120 min and both 13C02 and hydrogen(H2) levels were measured. Thereafter H2 concentrations were measured at 30 rainintervals for a total of 240 min. The results of gastric emptying were expressedas the time of peak 13C02 excretion. OCTr was defined as the period betweenthe ingestion of lactulose and a H2 peak rise of 5 ppm above the basal value. Results: The onset of H2 enrichment in the breath began at 90-110 rain, whereas 13C02 levels increased from the beginning and peak enrichment values were reachedafter 60-80 min. OCTTwas relatedto 13(;02 peaktime. In 5 of 25 subjects, H2 breath enrichment in the lO-min sample was more than 5ppm over baseline. All these five patients had double or triple peaksin serial breath H2 concentrations. Conclusions: The combination of lactulose hydrogen breath test(LHBT) with 13C-acetate breath test(ABT), which requires only breath samples, gives us many informations of the gastrointestinal tract; gastric emptying, OCTT, bacterial overgrowth in the small intestine, colonic fermentation, and oropharyngealflora.

tat xnuUon 19-+2/ 17-+2 21_+1120...+1 22.~2/ 21-+1 19-+2/20-+2

IB~zH IBS-c IBS-d

Urge

Pain detection

Pain tolerance

29.~3/ 24-+2 34_+2/31-+2= 36_+3/ 32~3 32-+3/ 30_~'4

42J:P/ 33-+3 44_+2/40..+2 ~ 48#:2141~,~ 41i4 / 40_+4

49_+2~/42-+3 50_~1/ 51-+1b 52~0 / 52_-~P 49-+2/ 50~:1c

•p
Bfleaicy i 0pUml Dose ef Oally Polyethylene Glycol 3350 (PEG) for Treatment of Chmla CoNUp~on and FJN:Opresisin Children. Warren P. Bishop, Oinesh Pashankar,Univ of Iowa, Iowa City, IA BACKGROUND:Constipafionin childhood responds well to stool softener therapy. Most stool softeners are poorly palatable,resulting in compliance problems. PEG (Miralax) is a tasteless, inert osmotic agent with no significant toxicity or absorption. Daily low-dose PEG is approved for treatment of constipafion in adult patients. Becauseminimal dataare available,we designed a study to determine the efficacy and optimal dose of daily PEG for chronic constipation in children. METHODS:23 children, ages 18 mo-ll years, with chronic constipation (duration 0.7-9 yr), 8 with encopresis, were treated with PEG for 8 weeks. PEG was given at an initial dose of 1 g/ko/day, in 2 divided doses, preparedas 17g of PEG (1 capful) in 240 ml of any clear beverage.Carngiverswere told to adjust the volume up or down by 20% every 3 days until 2 soft stools/day resulted. A daily diary was kept to monitor dose, stool frequency and consistency, and associated symptoms. Stool consistency was rated from 1 (hard) to 5 (watery). At 0 and 8 weeks, families were interviewed, diaries were reviewed, and subjects were examinedfor presenceof abdominalfecal mass, rectal impaction, and dilation of rectum. Interviewsassessedbowel habits, palatability,and adverseeffects of PEG.RESULTS:4 patients failed to complete the study. All of the other 19 patients found PEG to be palatable,and all were satisfied with the treatment. 4 reported minor side-effects (2-gas, 1-bloating, 1-fever). Stool consistency improved from 1.27 ± .11 to 3.24 -+ .14 (p<.0001); stool frequency from 2.31 _+ ,39/wk to 16.1 _+ .16t~vk (p<.O001), and soiling frequency declined from 8.63 ± 2.29/wk to 1.44 _+ .78/wk (p-<.01). Symptoms and exam findings improved dramatically (see table). The mean dose required was 0.83 ± .06 g/kg/day. CONCLUSION:Daily PEG at a dose of 0.8 g/kg is an effective and palatableagent for chronic constipation in children. Sym~n~SIgn

Pain~l s~o~s Fear of de~-caboo Abdominal fecal mass Stool in rectal vault O,atod rectum

Start of mdy ~)

End of study ~)

15 (79%) 14 (74%) 8 (42%) 15 (79%) t4 (74%1

0 0 0 5 (27%) t (5%)

4o53 F.pidemilogical Long Term Follow Up in Functional Dyspepsia: Characteristics of Non-Responders Hans-Dieter Ailescher, Tech Univ, Muenchen Germany; Paul Enck, Univ of Tueblngen, Tuabingen Germany; Guido Adler, Univ of UIm, Ulm Germany; Roll Dieti, Omnicare, Kneln Germany; Joachim Hartung, Univ, Dortmund Germany; Michael Peter Manns, Univ, Hannover Germany; Juergen Ferdinand Riemann, Martin Wienbeck, Meinhard Classen, Tech Univ, Muenchen Germany Functional dyspepsia is characterizedby upper abdominal symptoms and associatedwith a severe reduction of quality of life (0ol). Methods:3001 patients with functional dyspepsia were recruited in 983 primary care centers, and 1979 (65.9%) could be followed for 2 years with no selection bias. Dyspepticsymptoms and well being was rated by patients and doctors and Qoi was assessed using self-administered PGWBi at the initial visit and after 1, 6, 12, 18, 24 months. Socioeconomicdata and patient management,which was up to the physicians'

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