Evidence map›Paper›PMID 27077119›Full record

ArticleEBioMedicine2016

Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study.

Susanna Every-Palmer, Mike Nowitz, James Stanley, Eve Grant, Mark Huthwaite, Helen Dunn, Pete M Ellis

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EBioMedicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 4 pooled it
8.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 4 syntheses or guidelines pooled it, 103 citations in OpenAlex.

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  3. Pharmacological treatment for antipsychotic-related constipation.The Cochrane database of systematic reviews · 2017
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Susanna Every-PalmerTe Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
Mike NowitzDepartment of Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
James StanleyBiostatistics Group, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
Eve GrantTe Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand.
Mark HuthwaiteDepartment of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
Helen DunnPharmacy Department, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand.
Pete M EllisDepartment of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand.
University of Otago · NZCapital and Coast District Health Board · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGastrointestinal side effects are particularly common with clozapine and occur with other antipsychotics, ranging from mild constipation to fatal bowel obstruction and/or ischemia. While this adverse-effect spectrum has been attributed to 'gastrointestinal hypomotility', gastrointestinal transit times in antipsychotic-treated patients have not previously been measured, making this mechanism speculative.

methodsUsing standardized radiopaque marker ('Metcalf') methods we established colonic transit times of antipsychotic-treated psychiatric inpatients and compared them with population normative values. We analyzed results by antipsychotic type, antipsychotic dose equivalent, anticholinergic load, duration of treatment, gender, ethnicity, and age. OUTCOMES: For patients not prescribed clozapine, median colonic transit time was 23 h. For patients prescribed clozapine, median transit time was 104.5 h, over four times longer than those on other antipsychotics or normative values (p < 0.0001). Eighty percent of clozapine-treated patients had colonic hypomotility, compared with none of those prescribed other antipsychotics (olanzapine, risperidone, paliperidone aripiprazole, zuclopenthixol or haloperidol). In the clozapine group, right colon, left colon and rectosigmoid transit times were all markedly abnormal suggesting pan-colonic pathology. Hypomotility occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Transit times were positively correlated with clozapine plasma level (rho = 0.451, p = 0.045), but not with duration of treatment, total antipsychotic load or demographic factors.

interpretationClozapine, unlike the other antipsychotics examined, causes marked gastrointestinal hypomotility, as previously hypothesized. Pre-emptive laxative treatment is recommended when starting clozapine.

Indexed as

AdultAntipsychotic AgentsClozapineCross-Sectional StudiesDiagnostic Techniques, Digestive SystemDose-Response Relationship, DrugFemaleGastrointestinal DiseasesGastrointestinal TractHumansInpatientsMaleMiddle AgedRadiography, AbdominalTime FactorsYoung AdultAntipsychotic AgentsClozapineAntipsychotic agentsClozapineConstipationGastrointestinal motilityGastrointestinal tractLaxatives

Identifiers

PMID27077119
PMCPMC4816835
OpenAlexW2287216968

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.