A Case of Neurogenic Constipation Relieved with Prucalopride Succinate
Bibliographic record
Abstract
Purpose: Prucalopride succinate is an enterokinetic of a new class, the dihydrobenzofurancarboxamide, with high affinity for 5-HT4 receptor. Its main action is to stimulate myenteric neurons to release acetylcholine, calcitonin gene related-peptide, and azote monoxide which result in an increase of intestinal contractility and peristalsis. This medication was proven efficient to treat chronic idiopathic constipation in three randomized-controlled trials. Considering the effects of prucalopride succinate on digestive motility, other utilizations come to mind. However, only one controlled double-blind pilot study of 11 patients with chronic constipation secondary to spinal cord trauma found an increased number of stool and a decreased transit time with prucalopride succinate. Only one case report was found on a 54-yearold man with acute pseudo-obstruction secondary to paraplegia treated with success with prucalopride 2 mg PO die where decompression colonoscopy, neostigmine and Prostigmine® proved inefficient. We encountered a similar case in our institution. A 68-year-old man presented for neoplastic spinal cord compression with progressive lower limb paresis and paresthesias over one week. He was found to suffer from IgA multiple myeloma with plasmacytoma and had emergent surgical decompression of his spinal cord. In the days following his surgery, he developed urinary and fecal retention with an increased abdominal volume and loss of appetite. An Ogilvie syndrome with a 10 cm right colonic distension was diagnosed fifteen days after his admission. At that moment, he was on narcotics for his recent spinal surgery, he was about to receive his third chemotherapy regimen (Velcade®/Decadron®) and was immobilized secondary to his lower limb paresis. He was on docusate 200 mg PO bid and bisacodyl 10 mg IR qd. He resumed partially his Ogilvie syndrome with neostigmine 2 mg IV and was then put on prucalopride succinate 2 mg PO qd for 3 days with incomplete bowel movement and persistent abdominal discomfort. Prucalopride succinate was increased to 4 mg PO qd with addition of Lax-A-Day® 17 g PO qd with satisfactory bowel movement and increased well-being and appetite. He passed stool regularly with resolution of his colonic distension. Ultimately, after a total of 16 days, he regained ambulation and the prucalopride succinate was stopped without recurrence of pseudo-obstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".