Farmacoriflessioni
Nuovi farmaci per vecchi problemi: stipsi e polietilenglicole
NEW DRUGS FOR OLD PROBLEMS: CONSTIPATION AND POLYETHYLENE GLYCOL
MASSIMO FONTANA, LAURA MARTELLI, VALENTINA CONDÒ
Unità Operativa di Pediatria, Ospedale dei Bambini “Vittore Buzzi”, Milano
Dicembre 2004 - pagg. 706
Abstract
Drugs which are commonly used to soften the stools include mineral oils and osmotic
laxatives. While the former are not recommended in paediatric patients, the latter, such as
lactulose and lactitol, which are equivalent, must be given at significantly higher dosage
than recommended by Italian manufacturers and their effect is at least partially due to
modification of bacterial flora. Polyethylene glycols (PEG) are molecules of diverse weight
which cannot be absorbed nor metabolized. PEG (either PEG 3350 or PEG 4000), at the
concentration of 7.1 percent keeps the accompanying water in the intestine without any
further drawing in of water from the intestinal wall, thus avoiding the risk of dehydration.
High volumes of PEG can be used for complete intestinal lavage, as for colonoscopy, or for
treating severe foecal impaction. Low volumes, on average 1 g/kg/die, i.e.15 ml/kg/die
solution to be increased or reduced depending on effect, are effective in the great majority
of cases for treating chronic constipation. In PEG products manufactured in Italy salts give
an unpleasant flavour which is not present in a product recently marketed in the US, which
contains only pure PEG.
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Levine MD. Children with encopresis: a descriptive
analysis. Pediatrics 1975;56:412-6.
2. Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: Evaluation and treatment. J Pediatr Gastroenterol Nutr 1999;29:312-626.
3. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9.
4. Pontes FA, Silva AT, Cruz AC. Colonic transit time and the effect of lactulose or lactitol in hospitalized patients. Eur J Gastroenterol Hepatol 1995;7:441-5.
5. Camma C, Fiorello F, Tinè F, Marchesini G, Fabbri A, Pagliaro L. Lactitol in treatment of chronic hepatic encephalopathy. A metaanalysis. Dig Dis Sci 1993;38:916-22.
6. Blanc P, Daures JP, Rouillon JM, et al. Lactitol or lactulose in the treatment of chronic hepatic encephalopathy: results of a metaanalysis. Hepatol 1992;15:222-8.
7. Pitzalis G, Deganello F, Mariani P, et al. Lactitol in chronic idiopathic constipation in children. Pediatr Med Chir 1995;17:223-6.
8. Kontula P, Suihko ML, Von Wright A, Mattila- Sandholm T. The effect of lactose derivatives on intestinal lactic acid bacteria. J Dairy Sci 1999;82:249-56.
9. Henning T, Littau C. Polyethylene glycols (Macrogoals, PEGs) in laxatives. Drugs 2001; 44:43-5
10. DiPiro JT, Michael KA, Clarck BA, et al. Absorption of polyethylene glycol after administration of a PEG-electrolyte lavage solution. Clin Pharm. 1986;5:153-5.
11. Brady CE, DiPalma JA, Morawski SG, Santa Ana CA, Fordtran JS. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology 1986;90: 1914-8.
12. Sondheimer JM, Sokol RJ, Taylor SF, Silverman A, Zelasney B. Safety, efficacy and tolerance of intestinal lavage in pediatric patients undergoing diagnostic colonoscopy. J Pediatr 1991;119:148-52.
13. Herve S, Leroi AM, Mathiex-Fortunet H, et al. Effects of polyethylene glycol 4000 on 24- h manometric recordings of left colonic motor activity. Eur J Gastroenterol Hepatol 2001; 13:647-54.
14. Goldeman J, Reichelderfer M. Evaluation of rapid colonoscopy preparation using a new gut lavage solution. Gastrointest Endosc 1982; 28:9-11.
15. Einstoff JJ, Howard DA, Marshall JB, et al. A randomised blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoscopy and barium enema. Gastroenterology 1983; 84:1512-6.
16. Gremse DA, Sacks AI, Raines S. Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr 1996;23:586-90.
17. Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomised, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol 1999;94:3497-501.
18. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 1980;78:991-5.
19. Andorsky RL, Goldner F. Colonic lavage solution (Polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol 1990;85:261-5.
20. Corazziari E, Badiali D, Habib FI, et al. Small volume isosmotic polyethylene glycol electrolyte balance solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci 1996;41:1636-42.
21. Attar A, Lemann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44:226- 30.
22. Corazziari E, Badiali D, Bazzocchi G, et al. Long term efficacy, safety, and tolerability of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution solution (PMF-100) in the treatment of functional chronic constipation. Gut 2000;46:522-6.
23. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr 2002;41:225-9.
24. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr 2001;139:428-32.
25. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr 2002;34:372-7.
26. Pashankar DS, Loening-Baucke V, Bishop WP. Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Arch Pediatr Adolescent Med 2003;157:661- 664.
27. Turrini A, Saba A, Lintas C. Study of the Italian reference diet for monitoring food constituents and contaminants. Nutr Res 1991;11: 861-73.
28. Leclercq C and Ferro-Luzzi A. Total and domestic consumption of salt and their determinants in three regions of Italy. Eur J Clin Nutr 1991;45:151-9.
29. EC Commission, 1993. Nutrient and energy intakes for the European Community. Reports of the Scientific Committee for Food. Thirthy-first series. Office for Official Publications of the European Communities. Luxembourg.
30. Nat Res Council, 1989. Recommended Dietary Allewances. 10a ed. Washington, DC. National Academy Press.
31. Geraint M. Letter to the editor. J Pediatr Gastroenterol Nutr 2002;35:707.
32. Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr 2002; 141:410-4.
33. Liangthanasarn P, Nemet D, Sufi R, Nussbaum E. Therapy for pulmonary aspiration of a polyethylene glycol solution. J Pediatr Gastroenterol Nutr 2003;37:192-4.
34. Bell EA, Wall GC. Pediatric constipation therapy using guidelines and polyethylene glycol 3350. Ann Pharmacother 2004;38:686- 93.
35. Michail S, Gendy E, Preud Homme D, Mezoff A. Polyethylene glycol for constipation in children younger than eighteen months old. JPGN 2004;39:197-9.
2. Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: Evaluation and treatment. J Pediatr Gastroenterol Nutr 1999;29:312-626.
3. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9.
4. Pontes FA, Silva AT, Cruz AC. Colonic transit time and the effect of lactulose or lactitol in hospitalized patients. Eur J Gastroenterol Hepatol 1995;7:441-5.
5. Camma C, Fiorello F, Tinè F, Marchesini G, Fabbri A, Pagliaro L. Lactitol in treatment of chronic hepatic encephalopathy. A metaanalysis. Dig Dis Sci 1993;38:916-22.
6. Blanc P, Daures JP, Rouillon JM, et al. Lactitol or lactulose in the treatment of chronic hepatic encephalopathy: results of a metaanalysis. Hepatol 1992;15:222-8.
7. Pitzalis G, Deganello F, Mariani P, et al. Lactitol in chronic idiopathic constipation in children. Pediatr Med Chir 1995;17:223-6.
8. Kontula P, Suihko ML, Von Wright A, Mattila- Sandholm T. The effect of lactose derivatives on intestinal lactic acid bacteria. J Dairy Sci 1999;82:249-56.
9. Henning T, Littau C. Polyethylene glycols (Macrogoals, PEGs) in laxatives. Drugs 2001; 44:43-5
10. DiPiro JT, Michael KA, Clarck BA, et al. Absorption of polyethylene glycol after administration of a PEG-electrolyte lavage solution. Clin Pharm. 1986;5:153-5.
11. Brady CE, DiPalma JA, Morawski SG, Santa Ana CA, Fordtran JS. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology 1986;90: 1914-8.
12. Sondheimer JM, Sokol RJ, Taylor SF, Silverman A, Zelasney B. Safety, efficacy and tolerance of intestinal lavage in pediatric patients undergoing diagnostic colonoscopy. J Pediatr 1991;119:148-52.
13. Herve S, Leroi AM, Mathiex-Fortunet H, et al. Effects of polyethylene glycol 4000 on 24- h manometric recordings of left colonic motor activity. Eur J Gastroenterol Hepatol 2001; 13:647-54.
14. Goldeman J, Reichelderfer M. Evaluation of rapid colonoscopy preparation using a new gut lavage solution. Gastrointest Endosc 1982; 28:9-11.
15. Einstoff JJ, Howard DA, Marshall JB, et al. A randomised blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoscopy and barium enema. Gastroenterology 1983; 84:1512-6.
16. Gremse DA, Sacks AI, Raines S. Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr 1996;23:586-90.
17. Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomised, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol 1999;94:3497-501.
18. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 1980;78:991-5.
19. Andorsky RL, Goldner F. Colonic lavage solution (Polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol 1990;85:261-5.
20. Corazziari E, Badiali D, Habib FI, et al. Small volume isosmotic polyethylene glycol electrolyte balance solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci 1996;41:1636-42.
21. Attar A, Lemann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44:226- 30.
22. Corazziari E, Badiali D, Bazzocchi G, et al. Long term efficacy, safety, and tolerability of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution solution (PMF-100) in the treatment of functional chronic constipation. Gut 2000;46:522-6.
23. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr 2002;41:225-9.
24. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr 2001;139:428-32.
25. Loening-Baucke V. Polyethylene glycol without electrolytes for children with constipation and encopresis. J Pediatr Gastroenterol Nutr 2002;34:372-7.
26. Pashankar DS, Loening-Baucke V, Bishop WP. Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Arch Pediatr Adolescent Med 2003;157:661- 664.
27. Turrini A, Saba A, Lintas C. Study of the Italian reference diet for monitoring food constituents and contaminants. Nutr Res 1991;11: 861-73.
28. Leclercq C and Ferro-Luzzi A. Total and domestic consumption of salt and their determinants in three regions of Italy. Eur J Clin Nutr 1991;45:151-9.
29. EC Commission, 1993. Nutrient and energy intakes for the European Community. Reports of the Scientific Committee for Food. Thirthy-first series. Office for Official Publications of the European Communities. Luxembourg.
30. Nat Res Council, 1989. Recommended Dietary Allewances. 10a ed. Washington, DC. National Academy Press.
31. Geraint M. Letter to the editor. J Pediatr Gastroenterol Nutr 2002;35:707.
32. Youssef NN, Peters JM, Henderson W, Shultz-Peters S, Lockhart DK, Di Lorenzo C. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr 2002; 141:410-4.
33. Liangthanasarn P, Nemet D, Sufi R, Nussbaum E. Therapy for pulmonary aspiration of a polyethylene glycol solution. J Pediatr Gastroenterol Nutr 2003;37:192-4.
34. Bell EA, Wall GC. Pediatric constipation therapy using guidelines and polyethylene glycol 3350. Ann Pharmacother 2004;38:686- 93.
35. Michail S, Gendy E, Preud Homme D, Mezoff A. Polyethylene glycol for constipation in children younger than eighteen months old. JPGN 2004;39:197-9.