Clinical Briefs

By Louis Kuritzky, MD

Use of Colchicine to Treat Severe Constipation in Developmentally Disabled Patients

The developmentally disabled often suffer some of the worst difficulties with constipation, since they more commonly also experience hypotonia, autonomic dysfunction decreasing bowel motility, physical inactivity, and polypharmacy. Based upon an n = 1 experience with a person suffering chronic constipation refractory to traditional measures, Frame and colleagues successfully managed this patient with colchicine 0.5 mg tid. Following this success, Frame et al performed a prospective double-blind crossover study of colchicine vs. placebo for eight weeks in developmentally disabled patients who required three or more laxatives to manage chronic constipation.

As defined by an increased number of bowel movements and/or decreased requirement for laxatives, Frame et al found that eight out of 11 patients were improved while on colchicine, and no clinically important side effects occurred.

Colchicine is known to stimulate gastrointestinal activity through neurogenic stimulation. In these patients, treatment produced an average of 4.27 more bowel movements per patient over eight weeks time.

Colchicine can cause adverse effects, but serious toxicity is rare and usually confined to those with renal or hepatic insufficiency. Frame et al suggest that although colchicine is not suggested as a first-line laxative, persons with refractory constipation to standard methods, as are commonly found among the developmentally disabled or nursing home populations, may merit consideration for this intervention.

Frame PS, et al. J AM Board Fam Pract 1998;11:341-346.

Sinusitis in the Common Cold

Bacterial sinusitis is generally treated with antibiotics. Sinusitis, as determined, may be of diverse origin. During the common cold, if symptoms suggest sinusitis and sinus films are obtained, sinusitis seen on such films might prompt antibiotic use, as differentiation of bacterial from viral sinusitis is difficult. As part of a trial of fluticasone propionate in treatment of the common cold, Puhakka and associates studied sinus radiographs of 197 young healthy adult men and women on days 1, 7, and 21 of a common cold, and followed patients for three weeks clinically beyond that time.

Radiographs showed sinusitis in 14.2% of patients on day 1, 38.8% on day 7, and 11.3% on day 21. Common radiographic findings included mucosal thickening greater than 5 mm, air-fluid levels, and total opacification.

Overall, 57% of study subjects had sinus abnormalities during the first 21 days. All patients made full clinical recoveries, and no patient with radiologic sinusitis was treated for it with antibiotics.

Sinusitis is common, as defined radiographically, during the common cold. Puhakka et al suggest that, with few exceptions, sinus films should not be obtained during the typical evolution of the common cold, as such films lead to unnecessary irradiation, cost, and likelihood of superfluous antibiotic therapy.

Puhakka T, et al. J Allergy Clin Immunol 1998;102:403-408.

Potassium Supplementation on BP in patients with Essential Hypertension

A variety of diverse pieces of information suggest that potassium (K) status is related to blood pressure (BP). Dietary K intake correlates inversely with BP, and meta-analyses show significant BP reduction with supplementation.

Kawano and colleagues studied, in a randomized crossover design method, 55 hypertensive Japanese men and women given 2500 mg/d K supplementation divided in four doses for four weeks by office BP measurement, home self measurement, and 24-hour ambulatory measurement. Serum K, though not deviating from normal, increased from a mean of 4.15 to 4.42. Similarly, urinary potassium excretion increased from 54 to 96 mmol/d. All BP measurement techniques showed lower BP during K supplementation periods, to a highly statistically significant degree. Overall decreases in BP were modest: home BP decreased 3.6/1.6, 24 hr BP 3.4/1.2, and office BP 2.9/1.3. These changes were consistent whether the patient was receiving pharmacotherapeutic treatment and did not differ by class of antihypertensive agent.

Supplementation of K for hypertensive patients produces small but significant changes in BP.

Kawano Y, et al. Am J Hypertens 1998;11:1141-1146.