Better efficacy of tegaserod in constipated patients with slow colonic transit, absent pelvic floor dyssynergy and absent impaired rectal sensation

Abstract

Objective: Functional constipation comprises of slow transit and pelvic floor dyssynergy. Tegaserod has been shown to be effective in patients with functional constipation. We aimed at identifying the subgroup of constipated patients who responded the best to tegaserod treatment. Design: 250 patients were randomized for tegaserod or placebo treatment. Colonic transit time and anorectal manometry were performed and available for analysis in 216 and 75 patients, respectively before the randomization period. Responders were defined as a mean increase of complete spontaneous bowel motion ≥1/week compared with the baseline. Slow colonic transit was defined as >67 hours, pelvic floor dyssynergy defined as paradoxical contraction or a failure to relax during anorectal manometry together with the feeling of outlet blockade and/or digital evacuation, impaired rectal sensation defined arbitrarily as greater than or equal to the mean balloon volume of the first sensation. Results: Demographic data were comparable in the treatment and placebo groups. The responder rate was 41% vs 20.9% (p=0.048) in slow transit, 51.4% vs 34.4% (p=0.047) in normal transit; 50% vs 30% (p=0.22) with pelvic floor dyssynergy, 54.2% vs 26.7% (p=0.087) without; 40% vs 22.2% (p=0.26) with impaired rectal sensation, 60% vs 35.3% (p=0.11) without; for the treatment and placebo groups respectively. The improvement in responder rate comparing the treatment to placebo group was best seen in those with absent pelvic floor dyssynergy, absent impaired rectal sensation, but in slow transit instead of normal transit. Conclusion: Tegaserod treatment is useful in constipated patients with slow colonic transit.