Efficacy of oral pyridostigmine for the treatment of acute colonic pseudo-obstruction - a prospective, randomized, placebo-controlled trial.

This trial aims to investigate the efficacy of oral pyridostigmine, a medication currently used to treat Myasthenia Gravis, in the treatment of acute colonic pseudo-obstruction (ACPO). Acute colonic pseudo-obstruction occurs when the large intestine becomes dilated in the absence of downstream mechanical obstruction, and often occurs in the setting of hospitalized patients who are non-mobile, and/or are on significant amounts of opioid medications. Current treatment options for ACPO include the use of medications such as intravenous neostigmine, which is effective but requires cardiac monitoring due to the risk of cardiac arrhythmias, endoscopic decompression, or surgery. A recently published case series has suggested that oral pyridostigmine is effective in treating patients with ACPO, without the need for cardiac monitoring, unlike neostigmine. However, strong evidence in this field is still lacking, which this study aims to help address.