From the pathophysiological point of view, pro-kinetics seems a logical therapeutic approach. However, efficacy data for the whole group of prokinetic drugs are disappointing. Cisapride was shown to have some efficacy in esophageal acid-exposure duration,135 but it is now banned because of cardiac side-effects. Prucalopride, a 5-HT4 agonist, as been suggested has a possible option, but although the drug seems effective in adult constipation,136 its use was prohibited for children because of the extrapyramidal side-effects. Ondansetron is a 5-HT3 receptor antagonist that accelerates gastric emptying, inhibits chemotherapy-induced emesis, but prolongs colonic transit time.137 The most frequently reported adverse events of ondansetron were mild to moderate headache, constipation and diarrhea in patients receiving chemotherapy. Tegaserod is a partial 5-HT4 agonist that has been mostly studied in constipation-predominant irritable bowel syndrome in adults.138 Tegaserod was shown to accelerate small intestinal transit time, and to increase proximal colonic emptying. Tegaserod also improves gastric emptying and decreases GER,139 and may be a promising drug. However, to date there are no efficacy data published on the treatment of pediatric GER. Baclofen, 4-amino-3-(-chlorophenyl)-butanoic acid, is a y-aminobutyric acid (GABA)-B receptor agonist, which is used in children with extreme spasticity. Given orally, it has been shown to decrease GER in healthy adults.140 Administration in eight pediatric patients was reported to be safe.141 Alosetron is a 5-HT3 antagonist that increases colonic compliance to distension, delays (ascending) colonic transit time and increases basal fluid absorption. Alosetron induces severe constipation and causes ischemic colitis.
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.