Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review.

BACKGROUND: Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects. PURPOSE: Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.

Anal electrical stimulation with long pulses increases anal sphincter pressure in conscious dogs.

PURPOSE: This study was designed to investigate the effects and mechanisms of anal electric stimulation with long pulses on anal sphincter pressure in conscious dogs. METHODS: The study was performed after enema in nine healthy female hound dogs and composed of four randomized sessions ("dose"-response, anal electric stimulation only, or with atropine or phentolamine). The anal sphincter pressure was measured by using manometry and quantified by using the area under the contractile curve (mmHg/sec). Anal electric stimulation was performed via a pair of ring electrodes attached to a manometric catheter. The stimulation parameters in all but dose-response sessions included a frequency of 20 ppm, pulse width of 200 ms, and amplitude of 3 mA. RESULTS: The anal sphincter pressure was 55.7 +/- 6 at baseline and increased by 37 percent to 76.4 +/- 6.5 during electric stimulation (P = 0.009). The increase of anal pressure during stimulation was positively correlated with the stimulation energy (r = 0.395; P < 0.01). The excitatory effect of electric stimulation was sustained for at least 20 minutes. Atropine did not alter anal pressure and did not abolish the excitatory effect of anal electric stimulation on the sphincter. Phentolamine reduced anal pressure from the baseline value of 50.5 +/- 4.7 to 33.1 +/- 5.4 (P = 0.019). The electric stimulation induced increase in anal pressure was dropped from 19 +/- 2.6 to 9.9 +/- 2.8 (P = 0.029) at the presence of phentolamine. CONCLUSIONS: Anal electric stimulation with long pulses increases anal sphincter pressure in an energy-dependent manner. The alpha-adrenergic but not the cholinergic pathway at least partially mediates the excitatory effect of anal electric stimulation.

Insertability and safety of a shape-locking device for colonoscopy.

BACKGROUND: Loop formation during colonoscopy insertion results in patient pain and delays in advancement of the colonoscope tip. AIM: To assess the insertability and safety of a novel shape-locking guide (ShapeLock, USGI, San Clemente, CA) that resists looping during colonoscopy. RESULTS: In 54 patients, both a disposable and a partly reusable version of the ShapeLock received high scores (mean scores >9.0 on 1-10 scale) for ease of insertion, and ability to maneuver the colonoscope through the shape locked device. No significant trauma resulted from use of the device. CONCLUSION: A novel shape-locking device for colonoscopy can be readily and safely inserted into the colon and locked. The device warrants controlled evaluation to determine in which, if any cases, it may be useful for either experienced colonoscopists and/or those with less or minimal experience.