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Acute colonic pseudo-obstruction is a rare condition on which there are few randomised control trials. Although neostigmine has been shown to be effective acutely, the condition recurs in around a fifth of patients. The present study evaluated 32 patients with acute colonic pseudo-obstruction. Thirty were successfully treated with neostigmine or endoscopic decompression and randomly allocated to receive either polyethylene glycol (PEG) solution or placebo. Compared with placebo, over the 7 day study period PEG reduced colonic diameter, increased the number of bowel movements and flatus evacuations per day, and reduced the relapse rate, which was O/15 on PEG v 5/15 on placebo (see table
). There were no serious adverse events, although a few patients receiving PEG developed nausea and mild colicky abdominal pain. Although this is the first trial, the results are convincing and neostigmine followed by PEG should probably be the first line of management for such patients.
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