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Extreme and severe cases of constipation can lead to faecal impaction. Current therapies are often both ineffective and unpleasant. The objective of this trial was to evaluate the efficacy and safety of Movicol, a polyethylene glycol (PEG) + electrolyte solution (PEG+E), as treatment for severe constipation and faecal impaction.56 patients (aged 17 to 88 years) with a history of chronic constipation and presenting with no bowel movement for three to four days (severe constipation), or no bowel movement for at least five days (faecal impaction), were enrolled at three centres in Taiwan. Faecal loading was confirmed in all patients by abdominal and rectal examination or abdominal radiography. Patients were excluded from the study if they had a gastrointestinal obstruction, evidence of delayed gastric emptying, or if their constipation was secondary to severe inflammatory bowel disease.All patients followed the same regimen: up to eight 13.8 g sachets of PEG+E (two at a time in 250 ml water; maximum of 1L/day) over a 4-6 h period each day, with 1-1.5 h between each dosing. Duration of treatment was for up to three days. EFFICACY ENDPOINTS AND RESULTS: Patients with either improvement (passage of a moderate to large volume of stool within four days of treatment initiation) or complete resolution (passage of moderate to large volumes of faecal matter plus the disappearance of palpable faecal masses in the abdomen and/or rectum) were considered responders. Based on bowel movement data recorded by the patients, an excellent response rate was obtained: 50/56 patients had a successful response to treatment (89.3%; 95% confidence intervals [CIs] 77.4% to 95.6%); there were 39 complete responders and 11 patients showed improvement. Investigator assessment of response was almost the same: 87.5% (95% CIs 75.3% to 94.4%). All bowel movement measurements (stool volume, number of evacuations, stool form and ease of evacuations) showed a positive improvement by Day 2. Median duration of treatment was two days. The incidence of adverse events was low, even for those side-effects such as abdominal pain and bloating, which are known undesirable consequences of PEG+E administration. No patient discontinued from the study because of an adverse event.PEG+E, administered orally at a dose equivalent to eight 13.8 g sachets (1 L) per day over three days, was a highly effective and well tolerated therapy for the treatment of severe constipation and faecal impaction.

Endoscopic variceal ligation (EVL) related complication is rarely reported. A case is presented of a 74 year old man with oesophageal variceal bleeding who developed oesophageal perforation following EVL and balloon tamponade. An oesophageal wall defect was induced by EVL and tissue repair was hindered by decompensated liver reserve and shock status; concomitant balloon tamponade precipitated oesophageal perforation. The case is reported to draw attention to oesophageal perforation after concurrent use of balloon tamponade and EVL.

The serum levels of proinflammatory cytokines have been reported to be significantly higher in severe acute pancreatitis compared with mild pancreatitis. Nitric oxide (NO) produced by cytokine-inducible NO synthase might be involved as the mechanisms for the progression of pancreatitis and the occurrence of systemic complications. The aim of the study was to evaluate the effects of a non-selective NO synthase inhibitor, nitro-L-arginine methyl ester (L-NAME), and an inducible NO synthase inhibitor, L-canavanine, on sodium taurodeoxycholate-induced acute necrotizing pancreatitis in rats.Twenty-eight rats were randomized into 3 groups to receive L-NAME 5 mg/kg/h, L-canavanine 20 mg/kg/h, and equivalent volume of saline, respectively, i.v. infusion after the induction of pancreatitis for 5 hours. The serum levels of amylase and lipase and mean arterial pressure and heart rate at baseline and 5 hours, and cardiac output, systemic vascular resistance, the amount of ascites and pancreatic histopathology at 5 hours were examined.Five hours after induction of pancreatitis, all rats treated with L-canavanine and all but 1 treated with saline survived; however, all rats treated with L-NAME died. As compared with the control group, L-canavanine significantly reduced serum levels of amylase and lipase, the severity of pancreatic edema and necrosis, and the volume of ascites in 5 hours. In addition, L-canavanine significantly improved the reduction of mean arterial pressure and systemic vascular resistance at 5 hours.L-NAME results in the mortality of acute necrotizing pancreatitis. L-canavanine reduces serum pancreatic enzymes and improves the changes of pancreatic histopathology and systemic hemodynamics at the early stage of acute pancreatitis. Inducible NO synthase inhibitor is beneficial for severe acute pancreatitis.