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Neostigmine for Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a term for massive dilation of the colon without mechanical obstruction. This condition tends to occur in hospitalized patients and occasionally results in perforation and death. Building upon promising results of uncontrolled studies, researchers from the University of Washington randomized 21 patients with acute colonic pseudo-obstruction to receive either a 2-mg intravenous dose of neostigmine (an acetylcholinesterase inhibitor) or placebo. Cecal diameter ranged from 10 to 24 cm, and no patients had improved after 24 hours of conservative management.

Prompt colonic decompression occurred in 10 of 11 patients in the neostigmine group and none of 10 in the placebo group, a highly significant difference. Two of the initial neostigmine responders had recurrent distention. Seven of the placebo recipients crossed over to open-label neostigmine and all responded, as did the one neostigmine patient who had not initially responded. One patient in each group eventually required surgery after unsuccessful colonic decompression.

Comment: Neostigmine clearly hastens the resolution of acute colonic pseudo-obstruction. An editorialist recommends it for patients who fail to respond to conservative measures, as long as there are no contraindications such as bradycardia.

— AS Brett

Published in Journal Watch General Medicine July 27, 1999

Citation(s):

Ponec RJ et al. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 1999 Jul 15 341 137-141.

• Medline abstract (Free)

Laine L. Management of acute colonic pseudo-obstruction. N Engl J Med 1999 Jul 15 341 192-193.

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