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TreatmentofGIDysmotilityinSclerodermaWiththeNewEnterokineticAgentPrucalopride

G.E.Boeckxstaens,M.D.,Ph.D.,J.F.W.M.Bartelsman,M.D.,L.Lauwers,M.D.,andG.N.J.Tytgat,M.D.,Ph.D.DivisionofGastroenterologyandHepatology,AcademicMedicalCenter,Amsterdam,TheNetherlands;andJanssenResearchFoundation,Beerse,Belgium

ABSTRACTSclerodermaisamultisystemdisorderfrequentlyresultingindisturbedGImotility.Although,especiallyearlyinthedisease,symptomaticimprovementisachievedwithproki-neticagents,moresevereGImanifestationsofsclerodermamaybedifficulttotreat,leadingtoparenteralfeedingandhospitalization.Recently,anewserotonin(5-HT4)receptoragonistprucalopridewasshowntohaveremarkableproki-neticproperties,resultinginsymptomaticimprovementandincreasedfrequencyofdefecationinpatientswithchronicfunctionalconstipation.Herewereporttwocasesofsclero-dermawithGImanifestationinwhichpreviousprokinetictreatmentfailed,butwherethepatientsweresuccessfullytreatedwithprucalopride.Ourdatasuggestthatprucalo-pridemaybeapromisingandeffectivedrugtotreatGImotilitydisordersinscleroderma.However,furtherplace-bo-controlleddoubleblindstudiesareneededforfulldoc-umentationoftheusefulnessofprucaloprideinpatientswithscleroderma.(AmJGastroenterol2002;97:194–197.©2002byAm.Coll.ofGastroenterology)

INTRODUCTIONSclerodermaorprogressivesystemicsclerosisisamultisys-temdisorderofthesmallarteriesresultinginskinabnor-malities,Raynaud’sdisease,polyarthritis,andlung,heart,andkidneyinvolvement(1).About90%ofthepatientswilldevelopGImanifestations,mostcommonlyinvolvingtheesophaguswithdysphagiaandgastroesophagealreflux.Also,gastricemptyingcanbedelayedbecauseofsluggishmotilityofthestomachin57–75%ofthepatients(2).Involvementofthesmallintestine,occurringinapproxi-mately40–50%ofthepatients,resultsinabdominalbloat-ing,distension,nausea,andvomiting(3).Inaddition,ab-normalitiesorevenabsenceofphaseIIIactivityofthemigratingmotorcomplexandimpairedcontractilitymayresultinintestinalstasiswithbacterialovergrowth(4).Pa-tientscanalsopresentwithepisodesofileusincaseofpseudo-obstruction.Finally,constipation(5)oranalincon-tinenceduetoinvolvementoftheinternalanalsphincteroccursin10–50%ofthepatients(1,3).Treatmentofthesemotilitydisordersisoftendifficult.Prokineticagentssuchasmetoclopramide(6),erythromycin(7),andcisapride(8)havebeenshowntobeeffectiveinsomepatients,especiallyintheearlycourseofthedisease.However,inmoreadvanceddisease,thetherapeuticeffectoftheseagentsoftenattenuatesdramatically,necessitatinghospitalizationandparentalfeeding.Recently,thenewserotonin(5-HT4)receptoragonistprucalopridewasshowntohaveremarkablecolonicproki-neticproperties,acceleratingcolonictransitinhealthyvol-unteers(9),andtoinducemassmovementsindogs(10).Thesepropertiesresultedinsymptomaticimprovementandinincreasedfrequencyofdefecationinpatientswithchronicfunctionalconstipation(11).Herewereportontheeffectofthisnewprokineticagentintwopatientswithsclerodermaanddisorderedintestinaltransitinwhomprevioustreatmentwithlaxatives,otherprokinetics,oroctreotidehasfailed.PrucalopridetreatmentincreasedGImotility,whichledtosubjectiveimprovement.CASEREPORTSCase1Thefirstpatientwasa60-yr-oldfemalewitharterialhyper-tension,chronicobstructivepulmonarydisease,andahis-toryofhysterectomyandovariectomy.Shewasalsoknowntohavelong-standingscleroderma,firstdiagnosed19yrago,withskininvolvement,severeconstipation,andincon-tinenceduetoparadoxicaldiarrhea.Atpresentationthepatientdidnothavespontaneousdefecation,withoutlaxa-tives,despitehighfiberintake.Shealsocomplainedofdysphagia,pyrosis,earlysatiety,andabdominaldistension.Becauseoffecalincontinence,shewasmarkedlysociallydisabled.Aphysicalexaminationrevealedthickenedskin,atbothhands,butnotypicalsclerodermafacies.Nootherabnormalitieswerefound.Bloodpressurewas140/90mmHg.Sheweighed74kgforalengthof168cm.Aroutinelaboratoryexaminationrevealednoabnormal-ities.Antinuclearantibodies,antiribonucleoprotein,anti–SS-A,andanti–SS-Bwerenegative.Aplainabdominalx-rayshowedadilatedcolonfilledwithstool.Onesopha-gealmanometry,atypicalpictureofabsentperistalsisandabsentloweresophagealpressurewasnoted.Anorectalma-

THEAMERICANJOURNALOFGASTROENTEROLOGYVol.97,No.1,2002©2002byAm.Coll.ofGastroenterologyISSN0002-9270/02/$22.00PublishedbyElsevierScienceInc.PIIS0002-9270(01)03958-2

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中药敷脐联合耳穴贴压治疗老年性慢性心力衰竭患者便秘临床研究

中药敷脐联合耳穴贴压治疗老年性慢性心力衰竭患者便秘临床研究

中药敷脐联合耳穴贴压治疗老年性慢性心力衰竭患者便秘临床研究邵海波;张雅丽;崔屹;王晶;肖文秀;黄威莉;陈凌【摘要】Objective To observe the clinical effects of Chinese medicine umbilical compression combined with ear point tapping on treatment of senile constipation patients with chronic heart failure (CHF).Methods A total of 88 senile patients with CHF hospitalized in the department of Cardiology of our hospital were selected (8 cases fell off), finally 80 cases were divided into two groups according to the random table method.The control group (n=40) were treated by Congrong-tongbian oral liquid, and the treatment group were treated by Chinese medicine umbilical compression combined with ear point tapping.The clinical effects were evaluated after 5 d treatment in two groups.The first defecation time, stool traits and the scores of Barthel index were compared between two groups.Results The total effective rate in treatment group (90.00%) was superior to that in control group (77.50%, P<0.05).The first defecation time in treatment group was shorter than that in control group, and the stool traits was significantly improvement, with statistical differences(P<0.05).The scores of Barthel index after treatment were increased in two groups (P<0.05), and the increase in treatment group was better than control group (P<0.05).Conclusion The Chinese medicine umbilical compression combined with earpoint tapping can effective regulation the gastrointestinal function of elderly patients with CHF, can effectively solvethe occurrence of constipation.%目的观察中药敷脐联合耳穴贴压治疗老年性慢性心力衰竭患者便秘的临床疗效.方法选择在我院心内科住院的老年性慢性心力衰竭患者88例,脱落8例,实际入组患者80例,按照随机表法分为2组.对照组40例予苁蓉通便口服液治疗,治疗组予中药敷脐联合耳穴贴压治疗.2组均治疗5 d后统计临床疗效,并比较2组首次排便时间、大便性状及Barthel指数评分情况.结果治疗组总有效率90.00%,对照组总有效率77.50%,2组比较差异有统计学意义(P<0.05),治疗组疗效优于对照组.治疗组首次排便时间较对照组明显缩短,大便性状明显改善,比较差异均有统计学意义(P<0.05).2组治疗后Barthel指数评分均升高(P<0.05),且治疗组升高优于对照组(P<0.05).结论中药敷脐联合穴位贴压能有效调节老年性慢性心力衰竭患者胃肠功能,有效解决患者便秘的发生.【期刊名称】《河北中医》【年(卷),期】2017(039)003【总页数】5页(P347-350,355)【关键词】心力衰竭;并发症;便秘;预防和控制;耳穴贴压;脐;穴位疗法【作者】邵海波;张雅丽;崔屹;王晶;肖文秀;黄威莉;陈凌【作者单位】上海中医药大学附属曙光医院重症监护室,上海 200021;上海中医药大学附属曙光医院护理部,上海 200021;上海中医药大学附属曙光医院护理部,上海200021;上海中医药大学附属曙光医院重症监护室,上海 200021;上海中医药大学附属曙光医院重症监护室,上海 200021;复旦大学附属上海市第五人民医院抢救室,上海 200240;上海中医药大学附属曙光医院重症监护室,上海 200021【正文语种】中文【中图分类】R541.610.6;R574.62便秘是一种功能性肠道疾病，一般指大便秘结不通，排便时间延长、排便次数减少(一般2～3 d或更长时间)；或有便意，每天一便但粪便干燥艰涩难排，粪便不干但排出不畅有便不尽之感，且常伴有腹胀、腹痛、紧张感等多种症状[1]。

通腑合剂治疗肛肠疾病术后便秘的效果观察

通腑合剂治疗肛肠疾病术后便秘的效果观察

通腑合剂治疗肛肠疾病术后便秘的效果观察何芝;刘贵学;唐情;肖婉晴【摘要】目的探讨肛肠疾病术后便秘患者实施通腑合剂治疗的效果.方法选取150例肛肠疾病术后便秘患者进行研究,采取随机数表法将患者分为传统组(n=75)和干预组(n=75),对所有传统组患者实施常规缓泻剂麻仁软胶囊治疗,对所有干预组患者实施通腑合剂治疗,统计分析两组患者的治疗效果及安全性.结果干预组患者治疗总有效率与传统组相比明显较高,干预组患者治疗后临床症状积分、首次排便大便干结、便意未尽、排便费时症状发生率与传统组相比明显较低,差异有统计学意义(P<0.05).干预组患者治疗后用药不良反应发生率与传统组相比差异无统计学意义.结论肛肠疾病术后便秘患者实施通腑合剂治疗效果优良.【期刊名称】《当代医学》【年(卷),期】2018(024)015【总页数】3页(P24-26)【关键词】肛肠疾病;术后便秘;通腑合剂;缓泻剂【作者】何芝;刘贵学;唐情;肖婉晴【作者单位】浏阳市中医医院,湖南浏阳 410300;浏阳市中医医院,湖南浏阳410300;浏阳市中医医院,湖南浏阳 410300;浏阳市中医医院,湖南浏阳 410300【正文语种】中文便秘是临床常见的复杂症状，便秘不是一种疾病，而是指粪便干结、排便次数减少、粪便量减少、排便费力的一系列症候群[1-2]。

便秘是肛肠疾病手术患者术后最常见的并发症，而术后一旦发生便秘症状，则必然加重创面疼痛、术口水肿、创面出血等并发症。

故而加强对患者术后便秘的早期治疗，及时改善患者临床症状是当前肛肠疾病术后治疗的重点。

临床多采取缓泻剂治疗术后便秘，但患者治疗效果仍待提升[3]。

当前中药在临床上的运用越来越多，通腑合剂是本院院内制剂，临床上用于治疗各种便秘，且因其剂型合理，不仅用于口服，还可经肛门保留灌肠，疗效显著。

本研究对75例术后便秘的患者采取了通腑合剂口服治疗，并与常规缓泻剂的治疗效果实施了对比。

以下就治疗过程行回顾性总结。

2018年FDA批准上市的505b2药物清单

2018年FDA批准上市的505b2药物清单


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必利类药物

必利类药物

必利类药物Sulpiride舒必利消化系统>镇吐药>pride类;神经系统>抗精神病药>苯甲酰胺类;Clebopride氯波必利消化系统>胃肠道动力药;消化系统>镇吐药>pride类;Flubepride氟贝必利消化系统>镇吐药>pride类; Isosulpride异舒必利消化系统>镇吐药>pride类; Alepride阿来必利消化系统>镇吐药>pride类; Cinitapride西尼必利消化系统>镇吐药>pride类; Cipropride环丙必利消化系统>镇吐药>pride类;Alizapride阿立必利消化系统>胃肠道动力药;消化系统>镇吐药>pride类;Lorapride氯拉必利消化系统>镇吐药>pride类; Tinisulpride替磺必利消化系统>镇吐药>pride类; Dazopride达佐必利消化系统>镇吐药>pride类; Trazolopride三唑必利消化系统>镇吐药>pride类;Etacepride 依他必利消化系统>镇吐药>pride类;神经系统>抗精神病药>苯甲酰胺类;Irolapride伊咯必利消化系统>镇吐药>pride类; Zacopride扎考必利消化系统>镇吐药>pride类;Dobupride多布必利消化系统>镇吐药>pride类;神经系统>抗精神病药>苯甲酰胺类;Mezacopride 美扎必利消化系统>镇吐药>pride类;Denipride地尼必利抗青光眼药;消化系统>镇吐药>pride类;Renzapride 伦扎必利消化系统>镇吐药>pride类; Batanopride 巴他必利消化系统>镇吐药>pride类;Pancopride泮考必利消化系统>镇吐药>pride类;神经系统>抗焦虑药>苯甲酰胺类;Levosulpiride左舒必利消化系统>镇吐药>pride类;神经系统>抗精神病药>苯甲酰胺类;Itopride伊托必利消化系统>镇吐药>pride类; Lintopride林托必利消化系统>镇吐药>pride类; Mosapride莫沙必利消化系统>镇吐药>pride类; Prucalopride普卡必利消化系统>镇吐药>pride类;Alizapride Hydrochloride 盐酸阿立必利消化系统>胃肠道动力药;消化系统>镇吐药>pride类;红色表示未查到药品国内外上市信息。