Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.

Revisão sistemática e metanálise do uso de procinéticos no refluxo gastroesofágico e na doença do refluxo gastroesofágico em Pediatria / Systematic review and meta-analysis of the use of prokinetics in gastroesophageal reflux and in gastroesophageal reflux disease in Pediatrics

OBJETIVO: Avaliar, por meio de revisão sistemática e metanálise, estudos randomizados que comparam os procinéticos domperidona, bromoprida, metoclopramida e betanecol ao placebo no tratamento do refluxo gastroesofágico (RGE) e da doença do refluxo gastroesofágico (DRGE) em crianças. MÉTODOS: BUsca bibliográfica de ensaios clínicos randomizados (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). O desfecho primário foi eficácia na modificação dos sintomas de refluxo, conforme definição de autores das fontes primárias. Outras variáveis de interesse foram: complicações relacionadas ao RGE, alterações nos exames laboratoriais de controle, qualidade de vida, eventos adversos e abandono do tratamento. RESULTADOS: Foram incluídos quatro estudos com domperidona, dois com metoclopramida, um com betanecol. Nenhum estudo com bromoprida foi localizado. O risco de não resposta ao tratamento foi significativamente menor para os procinéticos quando comparados ao placebo (RR 0,35; IC95 por cento 0,14-0,88). A vantagem terapêutica individual em relação ao placebo se manteve para a domperidona (n=126; RR 0,27; IC95 por cento 0,14-0,52; NNT 3; I2 0 por cento) e betanecol (n=44, RR 0,19, IC95 por cento 0,05-0,55, NNT 2), mas não para metoclopramida (n=71; RR 0,63; IC95 por cento 0,07-5,71, I2 92,2 por cento). CONCLUSÕES: A evidência para o uso de procinéticos no RGE e na DRGE em crianças é limitada, pois os poucos estudos são ensaios preliminares de resposta em curto prazo e com limitações metodológicas.

OBJECTIVE: To evaluate, by systematic review and meta-analysis, randomized studies comparing the prokinetics (domperidone, bromopride, metoclopramide and bethanechol) to placebo in the treatment of gastroesophagic reflux (GER) and gastroesophagic reflux disease (GERD) in children. METHODS: Bibliographic search for randomized clinical trials (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). The primary outcome was the modification of reflux symptoms. Other outcomes were: GER-related complications, alterations in control exams, life quality, adverse events and abandon of treatment. RESULTS: The metanalysis included four studies on domperidone, two on metoclopramide, and one on bethanechol. No study of bromopride was retrieved. The risk of non-response to the treatment was significantly smaller in children that received prokinetics in comparison to placebo (RR 0.35, 95 percentCI 0.14-0.88). Individual therapeutic advantage regarding placebo was related to domperidone (n=126; RR 0.27; 95 percentCI 0.14-0.52, NNT 3; I2 0 percent) and bethanechol (n=44; RR 0.19; 95 percentCI 0.05-0.55; NNT 2), but not to metoclopramide (n=71; RR 0.63; 95 percentCI 0.07-5.71; I2 92.2 percent). CONCLUSIONS: The evidence for prokinetic use in GER and GERD in children is limited because the few studies report preliminary trials that evaluate short-term responses and show methodological limitations.

The Effect of Bethanechol Chloride with an alpha-adrenergic Blocker in Patients with Impaired Detrusor Contractility / 대한비뇨기과학회지

PURPOSE: Bethanechol enhances detrusor contraction and alpha1-blockers reduce bladder outlet resistance. We evaluated the effects of bethanechol with doxazosin in patients with impaired detrusor contractility. MATERIALS AND METHODS: Fifty-six patients that had confirmed detrusor underactivity with at least 150ml of postvoid residual urine volume(PVR) based on a urodynamic study were enrolled. The initial dosage of bethanechol given was 75mg/day, and the dosage was gradually increased to 150mg/day if necessary. Doxazosin gastro-intestinal therapeutic system(GITS)(4mg) was also given. The effect of the treatment was evaluated by a urine flow test, the amount of PVR, and frequency of clean intermittent catheterization(CIC). RESULTS: The mean follow-up period was 6 months(range, 1 to 9 months). After treatment, the mean PVR decreased from 251.8+/-149.6ml to 136.4+/-153.2ml(p<0.001) and was less than 100ml in 22(39%) of the 38 patients that showed a decrease. The maximum flow rate(Qmax) increased from 8.7+/-4.7ml/s to 11.1+/-5.6ml/s(p=0.024) and was more than 5ml/s in 13 patients(23%). Five of the 18 patients that previously required CIC could discontinue this treatment and another nine patients showed a decrease in the frequency. The mean daily frequency of CIC was reduced from 3.2 to 1.5(p=0.004). Ten of the 12 patients that were not able to void became capable of voluntary voiding. Five patients(9%) complained of adverse reactions and four of them were taken off the medication. CONCLUSIONS: The combination therapy of bethanechol with doxazosin improved emptying ability in patients with impaired detrusor contractility.

The Effects of Pyridostigmine and Levosulpiride on the Contraction of Rabbit Urinary Bladders / 대한비뇨기과학회지

PURPOSE: This study was performed to identify the effects of bethanechol, pyridostigmine and levosulpiride, on the contraction of rabbit bladder strip tissue in a single agent administration, and to investigate the synergistic effects in a mixed administration. MATERIALS AND METHODS: Smooth muscle strips of bladder were prepared using female, New Zealand white, rabbits. After an equilibration period, dose response curves to each agent, with cumulative administration, were performed in the basal tension state of the strips. Each strip was then pretreated with the agent at the maximal concentration that would not induce a bladder contraction, and second dose-response curves for the other agents were obtained. Following this, the maximal stimulation with bethanechol was performed, and during the tonic response, pyridostigmine or levosulpiride was administrated to observe any synergistic effects of the agents. Similar experiments were repeated for the pyridostigmine and levosulpiride. RESULTS: Each agent elicited a dose-dependent contractile response, in the order; bethanechol (0-4.49g/100mg tissue), pyridostigmine (0-1.58g/100mg tissue) and levosulpiride (0-0.44g/100mg tissue). In the presence of pyridostigmine (3x10(-6)M) or levosulpiride (10(-4)M), no additive effects were noted after the cumulative stimulation with bethanechol (10(-10)-10(-4)M). During the tonic response of bethanechol (10(-4)M) or pyridostigmine (10(-2)M), the addition of levosulpiride (10(-2)M) induced a significant increase in the bladder strip contractions, but the addition of pyridostigmine (10(-2)M) or bethanechol (10(-4)M) decreased the maximal response (p<0.05). CONCLUSIONS: These results imply that pyridostigmine may be useful for impaired detrusor contractility management. Synergistic effects can also be expected when administrating levosulpiride, in addition to bethanechol, in improving bladder contractility.

The Effect of Oral Premedication Using Bethanechol on Bladder Dysfunction Following Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Urinary retention is one of the most common complications after spinal anesthesia, and its inadequate management can result in serious outcomes. Overdistended bladder due to urinary retention should be catheterized. This study determined whether the prophylactic medication of oral bethanechol, a parasympathomimetic drug, results in reduction in the frequency of catheterization due to urinary retention. METHODS: Twenty-seven healthy male patients undergoing lower extremity operation under spinal anesthesia were subjected and randomly allocated into three groups according to the drug which was given. Group I (n = 9) had no medication, Group II (n = 9) and Group III (n = 9) were given bethanechol 50 mg or bethanechol 100 mg orally, respectively, before anesthesia. We measured the number of catheterized patients, the frequency of catheterization per catheterized patient, and perioperative cardiovascular complications in each group after their operations. RESULTS: The number of catheterized patients was nine (100%) in Group I, three (33%) in Group II, and two (22%) in Group III (P < 0.002). There was a significant statistical difference among the groups (P < 0.002). As the dosage of bethanechol increased, its effect increased relatively (P < 0.001). CONCLUSIONS: Prophylactic oral medication of 50 100 mg bethanechol reduces the frequency of catheterization in urinary retention after spinal anesthesia.

The Effect of Oral Premedication Using Bethanechol on Bladder Dysfunction Following Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Urinary retention is one of the most common complications after spinal anesthesia, and its inadequate management can result in serious outcomes. Overdistended bladder due to urinary retention should be catheterized. This study determined whether the prophylactic medication of oral bethanechol, a parasympathomimetic drug, results in reduction in the frequency of catheterization due to urinary retention. METHODS: Twenty-seven healthy male patients undergoing lower extremity operation under spinal anesthesia were subjected and randomly allocated into three groups according to the drug which was given. Group I (n = 9) had no medication, Group II (n = 9) and Group III (n = 9) were given bethanechol 50 mg or bethanechol 100 mg orally, respectively, before anesthesia. We measured the number of catheterized patients, the frequency of catheterization per catheterized patient, and perioperative cardiovascular complications in each group after their operations. RESULTS: The number of catheterized patients was nine (100%) in Group I, three (33%) in Group II, and two (22%) in Group III (P < 0.002). There was a significant statistical difference among the groups (P < 0.002). As the dosage of bethanechol increased, its effect increased relatively (P < 0.001). CONCLUSIONS: Prophylactic oral medication of 50 100 mg bethanechol reduces the frequency of catheterization in urinary retention after spinal anesthesia.

The Effects of Bethanechol on Anticholinergic Side Effects of Haloperidol / 대한정신약물학회지

OBJECTIVES: Haloperidol has been widely used for treating schizophrenia with somewhat limitation due to the side effects. Some of these side effects are anticholinergic side effects such as dry mouth, constipation, urinary difficulty, blurred vision, sexual dysfunction, etc. Some kinds strategies to minimize these side effects are tried, one of which is the use of bethanechol. The authors studied the effects of bethanechol on the anticholinergic side effects of typical antipsychotics. METHODS: The subjects of this study consisted of 60 chronic schizophrenics who had used haloperidol since 4 weeks before the study and whose score of 'Askers side effects rating scale' was above 7. They were assigned evenly to three groups (placebo group, bethanechol 40mg group, bethanechol 80mg group). Benztropin had been washed out for 2 weeks before the study. The authors measured ASRS for evaluating the anticholinergic side effect and BPRS for evaluating the effects of bethanechol on the psychopathology, at baseline, the 2nd week and the 4th week from baseline, respectively. RESULTS: At baseline, the mean age of patients was 38.00(+/- 10.55) years, the mean duration of illness was 11.12(+/- 8.09) years, and the mean dosage of the haloperidol was 15.07(+/- 6.03)mg. At baseline, mean score of BFRS was 50.25(+/- 5.24), and mean score of ASRS was 9.27 (+/- 3.04). There were no significant differences of ages, duration of illness, dosage of haloperidol, scores of BPRS and ASRS among 3 groups at baseline. There were no significant changes in BPRS at the 2nd week and the 4th week as compared with baseline, and also there were no changes among groups. The total sums of ASRS showed the statistically significant changes in the 80mg group at the 2nd week and the 4th week. The 80mg group showed statistically significant changes in dry mouth, constipation and urinary difficulty dom the 2nd week, and orthostatic symptoms from the 4th week. CONCLUSION: The authors found that the use of bethanechol for the chronic schizophrenics treating with haloperidol greatly improved the anticholinergic side effects with no change in psychopathology. The 80mg group showed more significant results than the placebo group and the 40mg group, especially in dry mouth, constipation, urinary diffculty and orthostatic symptoms. The authors suggest that high doses of bethanechol decrease the anticholinergic side effects and increase the drug compliance of chronic schizophrenics with anticholinergic side effects.

Efficacy of Bethanechol in Antipsychotics Induced Anticholinergic Side Effects / 대한정신약물학회지

OBJECTIVES: This study was designed to evaluate bethanechol's efficacy in urinary difficulty, constipation, dry mouth and blurred vision and to evaluate the bethanechol's effect on psychopathology. METHODS: Thirty-two schizophrenic patients who have been treated with antipsychotics and the total score of anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5 were assigned to three group(controlled group, bethanechol 30 mg/day group, 60 mg/day group). These patients were entered on 6 weeks open trial. Anticholinergic side effects were assessed by 'Rating scale for side effect' and psychopathology by BPRS at base, 2nd week & 4th week. After 4weeks administration of bethanechol, 30 mg/day group was increase to 60 mg/day and 60 mg/day group was decreased to 30 mg/day for 2 weeks for evaluation of dose difference. And then anticholinergic side effects were reassessed at 6th week. RESULTS: There were significant correlations between blurred vision and age. There were no significant improvement of anticholinergic side effect in placebo group but significant improvement of urinary difficulty and dry mouth in 30 mg/day group and significant improvement of urinary difficulty, constipation and dry mouth in 60 mg/day group at 4th week evaluation. In the case dose up(bethanechol 30 mg/day to 60 mg/day) for 2 weeks, dry mouth was more improved. In the case of dose down (60 mg/day to 30 mg/day), the improvements of urinary difficulty and dry mouth were sustained but constipation was aggravated. There were no BPRS changes by bethanechol administration. CONCLUSION: These findings suggest that more than 30 mg/day of bethanechol made improvements in urinary difficulty, constipation, dry mouth, when the total score of Anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5, although 60 mg/day of bethanechol was more effective than 30 mg/day. Moreover bethanechol administration does not influence psychopathology.

Effect of bethanechol chloride on rabbit bladder neck contractility: In-vitro study / 대한비뇨기과학회지

Bethanechol promotes bladder emptying by acting on postganglionic parasympathetic effector cells within detrusor muscle to elicit a contraction and is widely used to enhance bladder emptying for incomplete lower motor neuron lesion, idiopathic hypotonic bladder end postoperative urinary retention. However its effects on bladder outlet is inconclusive. Therefore, in vitro study for the effects of bethanechol on the muscle strip from the rabbit bladder neck were undertaken. Ten male white rabbit bladders were divided into body, base and neck and contractile responses of three strips were done. Bethanechol chloride produces most potent contractile response on the bladder body and comparatively less on the bladder base and bladder neck in a dose-dependant manner. Maximal contractile pressures of bladder body and bladder neck were 6.29+/-0.72 and l.22+/-0.53gm tension respectively. Norepinephrine produce maximal contractile responses of 2.09+/-0.49gm tension on bladder body. 1.15+/-0.39 on bladder base and 2.6+/-0.55 on bladder neck. Contractile response or the bladder neck to bethanechol was 50% of those to norepinephrine. These results indicated that bethanechol produce contractile response on the rabbit bladder neck in some degree but weaker than those by norepinephrine.

Significance of Bethanechol Chloride Induced Voiding Cystourethrography in the Detection of Subclinical Vesicoureteral Reflux / 대한비뇨기과학회지

VUR is usually diagnosed by standard voiding cystourethrography(VCU). However, we are sometimes puzzled not being able to find VUR on VCU in the group of patients in whom VUR is highly suspected from accompanying obvious clinical, urographic and endoscopic features. For the purpose of detecting this type of VUR or 'subclinical VUR, VCU was performed after subcutaneous injection of bethanechol chloride in 3 patients who were highly suspected of VUR and two were diagnosed as subclinical VUR . Case 1 was diagnosed left VUR(grade II ) and case 2 was diagnosed right VUR(grade II) on VCU after' subcutaneous injection of bethanechol chloride. Both underwent unilateral ureteroneocystostomy and are on follow-up. Bethanechol chloride induced voiding cystourethrography is suggested to be a highly method to detect subclinical vesicoureteral reflux.