"--
The
idea for this study originated while caring
for a 34-year-old severely retarded, nonverbal,
epileptic man with diffuse hypotonia.
The
patient
had had a gastrostomy feeding tube placed because
of
recurrent aspiration and episodes
of
pneumonia.
He
had intractable constipation, which in spite
of
taking 36 doses
of
five
different laxatives per week,
receiving a high-fiber diet, and maintaining an ad-
equate fluid intake through the feeding tube peri-
odically required multiple
2-L
enemas and bisa-
codyl suppositories to get his bowels to move.
It
was noted
that
whenever the patient was
on
amoxicillin-clavulanate potassium for pulmonary
infections, his bowel function improved dramati-
cally. Diarrhea
is
a known side effect
of
this med-
ication. Amoxicillin-clavulanate potassium, how-
ever,
is
not
suitable for long-term therapy because
of
the high risk
of
developing resistant organisms.
The
beneficial effect noted with amoxicillin-clavu-
lanate potassium raised the question
of
whether
other, safer agents could be found to improve the
patient's constipation. Colchicine,
0.5
mg
three
times a day, was tried with good results.
The
pa-
tient
has had more regular bowel movements, a
decreased need for other laxatives, and
no
need for
high-volume enemas. This patient's success led to
the
hypothesis
that
colchicine could be a useful
treatment for severe refractory constipation.
Colchicine
is
an alkaloid
of
Colchicum
autumnale
(autumn crocus, meadow saffron).
It
has been used
for pain
of
articular origin since the 6th century .
AD.
It
is
currently used primarily for the treatment
of
acute attacks
of
gout,
but
it
can also be used long
term to prevent recurrent attacks
of
gout, pseudo-
gout, familial Mediterranean fever, and progres-
sion
of
amyloidosis.
The
usual dose
is
0.5
mg
to 2.0
mg
daily.5
It
is
known
to
enhance gastrointestinal
activity by neurogenic stimulation.
A literature search
of
the use
of
colchicine
to
treat constipation found only one citation.
In
a let-
ter
to
the Journal
of
the
Royal
Society
of
Medicine
in
1984, Sandyk and Gillman
6
reported the successful
use
of
colchicine to treat constipation in a patient
with Parkinson disease.
No
studies
of
the use
of
colchicine
to
treat constipation have been con-
ducted.
The
purpose
of
this study
was
to determine
whether daily colchicine administration could
im-
prove bowel function and reduce laxative use in
mentally and physically disabled patients with se-
vere, intractable constipation who currently
re-
quire large doses
of
multiple laxatives.
342
JABFP Sept.-Oct.
1998
Vol.
11
No.5
Methods
Patients were selected from the client population
of
five
state-supported individualized residential
alternative homes
(IRAs)
affiliated with the Finger
Lakes Developmental Disabilities
Services Orga-
nization (DDSO). Each IRA houses approximately
12
mentally and physically disabled patients in a
residential home and provides
24-hour
nursing
coverage.
All
of
the patients enrolled in this study
were incontinent and required diapers and person-
alized assistance with daily hygiene and feeding.
The
staff routinely recorded the number and doses
of
different laxatives used and the number
of
bowel
movements for each patient.
Study participants were selected from patients
in these homes who met the following criteria:
1.
Twenty-one years
of
age
or
older
2.
Chronic, severe constipation, defined
as
re-
quiring three
or
more different laxative agents
on
a regular basis for more than 6 months
3.
No
contraindication
to
colchicine, specifically
liver disease with a serum aspartate amino-
transferase (AST) greater than
40 mg/dL
or
re-
nal disease with a serum creatinine greater than
1.5
mg/dL
4.
Generally stable medical condition.
The
pa-
tients naturally had multiple medical
prob-
lems,
but
could
not
have been in a life-threat-
ening
situation
during
the
6
months
before
the study
or
could
not
have been expected
to
be
in
a crisis situation
in
the
6
months
after
the study
5.
Patients must weigh more than 60 pounds. Pa-
tients weighing between 60 and 99 pounds
were given colchicine and placebo at a reduced
dose twice a day instead
of
three times a day
6.
The
patient
must
have a
parent
or
legal
guardian capable
of
giving informed consent,
as
approved by the Institutional Review Board,
in accordance with the policies
of
the Finger
LakesDDSO
Twelve patients, 7 women and 5 men,
met
the
criteria and were enrolled
in the study.
Their
ages
ranged from
24
to
60 years. All patients had
pro-
found mental retardation and epilepsy. Five
of
the
12
had spastic quadriparesis.
One
patient was fed
through a gastrostomy feeding tube and the others
received a high-fiber chopped
or
pureed diet. All
of
these patients were taking
both
oral and rectal
laxatives.
Oral
laxatives were administered
on
a
routine basis, whereas rectal laxatives were given
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