["Alternative" therapy methods in functional disorders of the gastrointestinal system]. / "Alternative" Behandlungsmethoden bei funktionellen Erkrankungen des Gastrointestinaltraktes.

Patients with functional disorders of the gastrointestinal tract often respond poorly to standard therapeutic regimes. Therefore, "alternative" forms of treatment (e.g. homocopathy, acupuncture, phytotherapy, diet modifications, psychotherapy, hypnosis) often come into play. Critical assessment of these forms of therapy is difficult: placebo response is high in functional disorders of the gastrointestinal tract and usually no placebo-controlled studies are available to prove the efficacy of these forms of therapy. Up to now no data was able to prove the efficacy of homoeopathy and phytotherapy, and the efficacy of acupuncture has to be questioned. In contrast to this, hyponosis, psychotherapy and some forms of diet modification seem to be useful at least in some patients with functional disorders of the gastrointestinal tract.

[Conservative therapy of fecal incontinence]. / Konservative Therapie der Stuhlinkontinenz.

Fecal incontinence is not diagnosis, but a symptom which can result from multiple causes. Therefore, therapy should attempt to treat the underlying disorder whenever possible. If this is not possible, therapy becomes symptom oriented. Besides drug treatment anal biofeedback training is the most important basis of medical therapy. Except for special situations surgery is indicated only if medical therapy has failed.

[Therapeutic strategy in constipation]. / Therapeutische Strategie bei Obstipation.

Therapy of constipation is complex. It is mainly based on general rules and treatment with dietary fibres. If drugs are necessary they should be applied according to the type of constipation as evidenced by the results of special diagnostic procedures. Surgical treatment is only the last choice. The aim of therapy is to relieve the patient from his symptoms and achieve a habit of regular defecation, if possible without the application of laxatives. The foremost problem in the treatment of constipation is to interrupt the vicious circle 'constipation/abuse of laxatives.' Many patients only consult a physician when they are already in that problem. Therapy then becomes difficult. Information on bowel movements and on how to prevent constipation by the way of living, therefore, should be widely spread in the general population in order to minimize constipation as a medical problem.

Anal incontinence: evaluation and biofeedback therapy.

Incontinence is a very stigmatizing symptom in our society. About 1% of the adult population is affected by fecal incontinence. In the evaluation anorectal manometry and defecography play a major role. Therapy often is still disappointing. In recent years simple retaining or biofeedback therapy have been reported to improve about 70% of incontinent patients. Within one year we treated 19 patients. Success was achieved in 69%. Biofeedback training, therefore, should be attempted prior to considering surgery.

[Irritable colon and colonic disease due to laxatives]. / Colon irritabile und Laxantienkolon.

Diarrhea of colonic origin is fairly common in irritable colon and after long term abuse of laxatives. This form of diarrhea causes difficulties not only in diagnosis but also in treatment. Irritable colon is a functional disorder sometimes involving other segments of the bowel. The term "irritable bowel disease" is thus more appropriate. Extraintestinal symptoms are in addition quite common. Although the diagnosis can be established with great reliability using an index we consider some laboratory tests, recto-sigmoidoscopy and abdominal sonography essential to rule out organic lesions. Therapy comprises (small) psychotherapy, dietary measures and eventually transient medication. Symptoms usually persist but tolerance of the disorder should be improved. Laxative-induced colonic dysfunction results usually from false assumptions about normal defecation. Loss of water and potassium deteriorates the symptomatology leading to a vicious circle. Alterations of neurons in the enteric nervous system of the colon can be the cause but eventually the consequence of chronic intake of laxatives. Hidden abuse of laxatives can cause great diagnostic difficulties. The therapy of choice is weaning which usually is only possible gradually. Cisapride can be a useful adjuvant.

[Biofeedback training in fecal incontinence]. / Biofeedback-Behandlung bei Stuhlinkontinenz.

In 19 patients with incontinence of various causes a treatment programme was instituted in which by biofeedback training they would learn how to increase the force of contraction of the external anal sphincter in response to balloon distension of the rectum. The degree of incontinence was objectified by anorectal manometry before and after training, as well as 3-6 months after the end of training. This programme significantly increased the force of contraction of the sphincter and pelvic-floor musculature. Twelve patients became continent and have remained so at follow-up. The training regimen was especially successful in patients with an organic cause of the incontinence and those most highly motivated. The investigation also demonstrated that anorectal manometry is a suitable method for the diagnosis of and monitoring the response to treatment of anal incontinence.

Effect of sennosides on colon motility in cats.

The actions of sennosides on colonic motility are incompletely understood. We therefore studied the effects of sennosides A + B on colonic myoelectric activity and transit of a radio-opaque meal in 7 conscious cats. Intraduodenal application of sennosides (2 mg/kg body weight) accelerated the half colon transit time from 60 +/- 10 (SEM) to 43 +/- 7 min. At the same time the ratio of long-spike bursts to short-spike bursts was changed from 0.22 to 10.1. Loperamide, an antidiarrheal agent, had the opposite effect. The overall spike activity was not altered by sennosides, but increased by loperamide. It is concluded that the propulsive action of sennosides in the colon is reflected by myoelectric patterns and not by the total number of spikes.

Effects of oral laxatives on colonic motor complexes in dogs.

The effect of oral laxatives on the organisation of colonic motor complexes was investigated in four conscious dogs. Six strain gauge transducers were implanted on the colon of each dog. After a control period of two to three hours, dogs were orally dosed with 1, 2, or 4 ml/kg of castor oil, or 0.5 g/kg magnesium citrate. Oral olive oil, 4 ml/kg, was used as control. The recording was continued for another 10 hours or until defecation occurred. Each dog showed spontaneous cyclic bursts of contractions (contractile states) at all recording sites during the control period. Contractile states migrating orad or caudad over at least half the length of the colon were called colonic migrating motor complexes (CMMC). Castor oil and magnesium citrate significantly increased the period of colonic motor complexes, but olive oil had no significant effect. None of the above substances changed the percentage of orad migrating motor complexes, as compared with the control values. Periods in which colonic motor activity was completely absent for at least 60 min over at least three consecutive recording sites occurred more frequently after all of the substances. The occurrence of these periods of inhibition, however, was not a consistent feature and there seemed to be no relationship between the occurrence of inhibitory periods and defecation during the recording period. The dogs defecated within 10 hours after administration of magnesium citrate, 1, 2, and 4 ml/kg of castor oil in 12.5, 25, 37.5, and 88.8% of experiments respectively, but never with olive oil. Defecation was generally accompanied by giant migrating contractions in the colon. We conclude that oral laxatives, magnesium citrate and castor oil have a profound effect on colonic motor complexes and colonic motor activity. The period of CMMC is significantly prolonged after their oral administration because of an increased number of non-migrating motor complexes or periods of inhibition of motor activity.

Effects of high dose antacids on bowel motility.

The effect of two antacid preparations containing magnesium and aluminum (Riopan, Maaloxan) on stool frequency, stool consistency, stool weight and oro-anal transit time was tested in a randomized, controlled, double-blind study in 10 healthy volunteers. Both antacids increased stool weight and stool frequency, and lowered stool consistency. The oro-anal transit time was not affected. Antacid-induced diarrhea apparently depends more on changes of transmural fluid transport than on changes of intestinal motility. Thus, secretory and osmotic diarrhea can occur without accompanying changes in gastrointestinal motility.