Environmental factors of cancer of the colon and rectum.
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Adult↗
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Dietary and purgation factors in the epidemiology of gastric cancer.
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Aged↗
Relationship of experimentally induced intestinal tumors to laxative ingestion.
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Animals↗
The barium enema: technique, value, and limitations.
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Adenocarcinoma↗
Colorectal cancer and bowel habits.
In a retrospective case-control study comparing 100 colorectal cancer patients with 100 age-, race-, and sex-matched hospital controls and 51 spouse controls, no significant differences were observed in the historical frequency of bowel movements, presence of constipation, or use of laxatives between cases and controls. There is a suggestion of greater suppository or enema use in both control groups as compared to patients with colorectal cancer.
Cathartics↗
A pilot comparison of purging and non-purging bulimics.
This study compared (1) purging bulimics (those who terminate binging with self-induced vomiting and/or excessive use of laxatives), N = 26; (2) non-purging bulimics, N = 24; and (3) control subjects (in whom no eating problems were apparent), N = 24. These groups were examined empirically on several personality and demographic variables. Additionally, procedures were taken to control for the effects that being overweight may have had on the personality characteristics, which surprisingly has not been undertaken in previous research on bulimia. The comparison of the bulimics (purging and non-purging bulimics grouped together) with the controls empirically confirmed former clinical observations that have linked bulimics with low self-esteem, high anxiety, external locus of control, and a high incidence of maternal and family obesity. With regard to the comparison between the purging and non-purging bulimics, no significant differences between them appeared on any of the dimensions examined here.
Adult↗
Anorexia nervosa "restricters" who purge: implications for subtyping anorexia nervosa.
It has not been clear from earlier studies whether it is binge eating per se or the compensatory behaviors frequently associated with binge eating (i.e., self-induced vomiting and/or laxative abuse) that provide the most relevant marker for subclassifying anorexia nervosa. The current study addressed this question by comparing the clinical and psychological features of three groups of anorexia nervosa patients: "pure restricting" patients who do not binge (by definition) and who also do not purge (AN-R, N = 116); "restricting-purging" patients who engage in purging behavior (AN-RP, N = 74); and anorexia nervosa "bulimics" who binge eat as defined in earlier studies (AN-B, N = 190). While all three groups displayed similar levels of psychological disturbance on many variables, the overall pattern of findings indicates that the AN-RP group displays significantly more psychopathology than the AN-R group and their profile of disturbance is very similar to that observed with the AN-B group. Thus, anorexia nervosa patients who purge, regardless of whether or not they report objective binge episodes, may be meaningfully distinguished from nonpurging patients. These results, combined with the medical risks associated with purging behaviors and the formidable problems associated with the definition of binge eating, support a sub-typing system for anorexia nervosa based on the presence or absence of purging rather than binge eating.
Adult↗
Bulimia nervosa: a population-based study of purgers versus nonpurgers.
There has been recent interest in the possibility of dividing bulimia nervosa into two subtypes based on the method of weight prevention utilized by the individual. In an attempt to see if such a division is justified, this study compared 54 purging bulimics with 69 nonpurging bulimics ascertained from a population-based register of Virginia female twins. A bulimic was defined as a "purger" if she engaged in vomiting or laxative abuse. These two groups were examined on a variety of demographic, weight, and personality measures after controlling for the presence of obesity. No significant differences were found between the two groups on any of the variables examined.
Adult↗
Borderline diagnosis and substance abuse in female patients with eating disorders.
To investigate whether alcohol and drug abuse are symptomatic of eating disorders or related to a concomitant borderline personality disorder, we reviewed all female inpatient medical records filed at the Department of Psychosomatic Medicine between 1978 and 1990. Over 300 records were assessable. The patients were reclassified according to DSM-III-R with regard to eating and borderline personality disorders. Alcohol and drug abuse were also taken into account. Nearly 5% of patients had a borderline personality disorder. Nearly 25% of patients suffered from eating disorders, and 11% of them had a concomitant borderline personality disorder. A detailed examination showed the frequency of abuse of alcohol and tranquilizers to be no higher, but that of laxatives and/or diuretics and/or anorexigenics to be significantly higher in borderline patients with concurrent eating disorder. However, the incidence of alcohol abuse was significant in borderline patients.
Body Weight↗
Prevalence of self-induced vomiting and laxative/medication abuse among female adolescents: a longitudinal study.
In order to assess the prevalence and stability of weight reduction techniques utilized by adolescent females, three comprehensive samples of middle school and high school students (ages 12-18) were surveyed in the springs of 1984, 1989, and 1992. All participants were enrolled in the same school district to ensure that the groups were demographically equivalent. The results demonstrated a significant decrease in the use of appetite suppressants among high school students. However, middle school females reported a significant increase in medication use and self-induced vomiting during the same 7-year period. Laxative abuse has persisted unchanged for a small segment of both populations.
Adolescent↗
Laxative withdrawal and anxiety in bulimia nervosa.
Symptoms of anxiety can be prominent during treatment of bulimia nervosa. Our experience is that bulimics who abuse laxatives have the most prominent symptoms of anxiety. We conducted ratings of anxiety in 23 bulimics who purge with laxatives and 17 who purge by vomiting. We found that the laxative-abusing group had higher levels of state but not trait anxiety and that they were more likely to be treated with medication for anxiety during hospitalization. These data suggest an association between laxatives and anxiety in bulimia nervosa.
Adult↗
Development of an eating disorder in a 40 year-old male lung transplant candidate: a case study.
This paper presents the treatment of a lung transplant candidate suffering from an eating disorder who refused communication between the Eating Disorders Clinic and the transplant team. The importance of psychiatric evaluation in transplantation and the need for the free flow of information among all health professionals working with the transplant patient are discussed. Explanations are proposed for the role of dieting in the development of the eating disorder and the patient's continued food restriction, vomiting, and laxative abuse after transplantation.
Adult↗
Incidence of laxative abuse in community and bulimic populations: a descriptive review.
Estimates of the incidence of laxative abuse in bulimics and in the community-at-large vary widely for various population samples. This review identified 73 studies in which laxative abuse could be assessed in bulimics, nonbulimics, and the community-at-large. Relative risk values for laxative abuse among population subsamples were estimated by moment methods statistical procedure based on mixed model analysis. Results indicated that the lifetime occurrence for laxative abuse behavior in the community-at-large was 4.18%. Bulimic behavior increased the risk for laxative abuse 3.57-fold to 14.94%. Several methodologic and population parameter characteristics are examined for their select impact on laxative abuse. Review of medical nomenclature for classifying laxative substances, iatragenic effects of laxative abuse, and assessment recommendations are also included.
Bulimia↗
Evidence for long-term pancreatic damage caused by laxative abuse in subjects recovered from anorexia nervosa.
OBJECTIVE: This study examined whether a prior history of laxative abuse results in long-term changes in gastrointestinal function. METHOD: The functioning of the enteroinsular axis was examined by measuring the insulin response to a standard meal. The study involved 18 subjects who had fully recovered from anorexia nervosa (AN) and an age and weight-matched control group. In the recovered group, 10 of 18 subjects had a history of laxative abuse. RESULTS: Subjects with a prior history of laxative abuse show a more gradual increase and decrease in insulin secretion, but no differences in glucose response or hunger ratings. DISCUSSION: Because there are no differences in the glucose response to the meal, it is hypothesized that the difference in insulin response is due to changes in the enteroinsular axis. These data indicate that chronic laxative abuse induces long-term changes in gastrointestinal function.
Adult↗
What is the role of stimulant laxatives in the management of childhood constipation and soiling?.
BACKGROUND: Constipation is extremely common in childhood and may lead to overflow soiling/encopresis. Standard treatment of the more severe case is to empty the bowels of impacted faeces by the use of oral or rectal laxatives and then maintain regular bowel movements by the continuation of osmotic and stimulant laxatives. OBJECTIVES: The objective of the review was to determine the effect of stimulant laxative treatment in children with chronic constipation who may also suffer from soiling / encopresis. SEARCH STRATEGY: The Cochrane database of randomised controlled trials was searched. Additional citations were sought by hand searching of paediatric journals and from contact with known professionals in the field. SELECTION CRITERIA: All identified randomised controlled trials (RCTs) which compare the administering of stimulant laxatives to children with either placebo or alternative treatment. DATA COLLECTION AND ANALYSIS: No trials were found that met the selection criteria. MAIN RESULTS: No trials were found that adequately met the selection criteria. REVIEWER'S CONCLUSIONS: The need exists to establish a secure footing for treatment decisions and adequately sized trials are required to provide comparative data on commonly used drugs.
Cathartics↗
Laxatives for the management of constipation in palliative care patients.
BACKGROUND: Constipation is a common problem for palliative care patients which can generate considerable suffering for patients due to both the unpleasant physical symptoms and psychological preoccupations that can arise. There is uncertainty about the 'best' management of constipation in palliative care patients and variation in practice between palliative care settings. OBJECTIVES: To determine the effectiveness of laxative administration for the management of constipation in palliative care patients, and the differential efficacy of the laxatives used to manage constipation. SEARCH STRATEGY: We searched The Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue four, 2005), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), CANCERLIT, PUBMED, Science Citation Index, CINAHL, The Cochrane Library, SIGLE, NTIS, DHSS-DATA, Dissertation Abstracts, Index to Scientific and Technical Proceedings and NHS-NRR and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing laxatives for constipation in palliative care patients. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted patient-reported data measuring changes in stool frequency and ease of passing stools, using objective and validated scales. Tolerance or adverse effects of laxatives used were also sought. The appropriateness of synthesizing data from the controlled trials depended upon the clinical and statistical homogeneity of studies identified. If the controlled trials were homogeneous, a meta-analysis would be attempted. MAIN RESULTS: Four trials involving 280 people were included. Between these trials, the laxatives lactulose; senna; danthron combined with poloxamer (Co-danthramer); Misrakasneham; magnesium hydroxide combined with liquid paraffin (Milpar) were evaluated. All four trials included number and frequency of bowel movements and relative ease of defecation as part of the assessment of laxative efficacy. All of the laxatives demonstrated a limited level of efficacy, although a significant number of participants required rescue laxatives in each of the studies. The only significantly different treatments were in the trial where lactulose plus senna were more effective than danthron combined with poloxamer. Patient preference did not favour either treatment option. Other related systematic reviews have similarly identified that there is a lack of evidence to support the use of one laxative, or combination of laxatives, over another. AUTHORS' CONCLUSIONS: The treatment of constipation in palliative care is based on inadequate experimental evidence, such that there are insufficient RCT data. Recommendations for laxative use can be related to costs as much as to efficacy. There have been few comparative studies, equally there have been few direct comparisons between different classes of laxative and between different combinations of laxatives. There persists an uncertainty about the 'best' management of constipation in this group of patients.
Cathartics↗
Laxatives for the treatment of hemorrhoids.
BACKGROUND: Symptomatic hemorrhoids are a common medical condition, which increase in prevalence in women during pregnancy and postpartum. Although the evidence appears to be inconclusive, narrative reviews and clinical practice guidelines recommend the use of laxatives (and fiber) for the treatment of hemorrhoids and relief of symptoms. This is due to their safety and low cost. OBJECTIVES: To evaluate the impact of laxatives on a wide range of symptoms in people with symptomatic hemorrhoids. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CINAHL (1982 to 2005), BIOSIS, and AMED (Allied and Alternative Medicine Database), for eligible trials (including conference proceedings). We sought missing and additional information from authors, industry, and experts in the field. SELECTION CRITERIA: We selected all published and unpublished randomised controlled trials that compared any type of laxative to placebo or no therapy in any patient population. DATA COLLECTION AND ANALYSIS: Two authors independently screened studies for inclusion and retrieved all potentially relevant studies. Data were extracted from studies that met our selection criteria on study population, intervention used, pre-specified outcomes, and methodology. We extracted methodological information for the assessment of internal validity: existence and method of generation of the randomization schedule, and method of allocation concealment; blinding of caregivers and outcomes assessors; numbers of and reasons for participants lost to follow up; and use of validated outcome measures. MAIN RESULTS: Seven randomised trials enrolling a total of 378 participants to fiber or a non-fiber control were identified. Meta-analyses using random-effects models showed that laxatives in the form of fiber had a beneficial effect in the treatment of symptomatic hemorrhoids. The risk of not improving hemorrhoids and having persisting symptoms decreased by 53% in the fiber group (risk reduction (RR) 0.47, 95% CI 0.32 to 0.68). These results are compatible with large treatment effects regarding prolapse, pain, itching, although the pooled analyses showed a tendency toward no-effect for these parametres. The effect on bleeding showed a significant difference in favour of the fiber (RR 0.50, 95% CI 0.28 to 0.89). Studies including data on multiple follow ups (usually after six weeks and three months) showed consistent results over time. However, we have to stress two possible limitations of this review: the risk of publication bias, and only moderate study quality. AUTHORS' CONCLUSIONS: The use of fiber shows a consistent beneficial effect for relieving overall symptoms and bleeding in the treatment of symptomatic hemorrhoids.
Cathartics↗
Phenolphthalein induces chromosome aberrations in human and Chinese hamster liver cells (CHEL) cultured in vitro.
Phenolphthalein is a nonprescription laxative agent that has been widely used during this century. Recent studies in animal models have shown that phenolphthalein has carcinogenic activity. In order to assess cytogenetic effects on human cells in vitro, we tested phenolphthalein in a chromosome aberration assay in human embryo cells derived from amniotic fluid. Our results show that phenolphthalein induces a significant increase in the frequency of chromosome aberrations in human cells. The lowest dose level at which the clastogenic effect is evident is 23.2 microg/ml. Similar positive results were obtained in a Chinese hamster liver cell line, which is metabolically competent to activate different classes of promutagens and procarcinogens into biologically active metabolites. Instead, parallel experiments in Chinese hamster ovary cells did not show any clastogenic effect due to phenolphthalein. These latter data suggested that phenolphthalein acts as a promutagen and must be metabolically activated to exert its clastogenic effect. Teratogenesis Carcinog. Mutagen. 20:209-217, 2000.
Amniotic Fluid↗