Advances in colonic manometry in adults with colonic motility disorders / 中华胃肠外科杂志

In recent years, colonic manometry has been gradually introduced into clinical practice. It helps clinicians to gain a better understanding of the physiology and pathophysiology of colonic contractile activity in healthy adults and patients with colonic dysfunction. More and more patterns of colonic motility are being discovered with the help of colonic manometry. However, the clinical significance of these findings still needs to be further investigated. This review enhances our understanding of colonic motility and the current state of development and application of colonic manometry, as well as the limitations, future directions and potential of the technique in assessing the impact of treatment on colonic motility patterns, by analyzing and summarizing the literature related to colonic manometry.

Effect of electroacupuncture combined with mosapride on gastric motility in diabetic gastroparesis rats / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis.@*METHODS@#Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected.@*RESULTS@#Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01).@*CONCLUSION@#Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.

Íleo paralítico em três bovinos: relato de caso / Paralytic ileus in three cattle: case report

O íleo paralítico é uma obstrução do tipo funcional, na qual o lúmen intestinal está patente, comprometendo a passagem da ingesta no intestino. Este relato objetiva descrever três casos em vacas com aptidão leiteira, atendidos na rotina hospitalar e diagnosticados com íleo paralítico. Em seus históricos, os proprietários queixavam-se que os animais apresentavam redução do apetite, timpania ruminal, diminuição da produção de leite e eliminação das fezes. Ao exame físico, alguns sinais clínicos apresentaram destaque, como apatia, desidratação, redução da motilidade ruminal e intestinal, fezes em pequena quantidade e com muco, distensão do abdômen e ao balotamento constatou-se a presença de líquido. Na análise do fluido ruminal todos os animais apresentaram o teor de cloreto elevado (>30 mEq/L), caracterizando, dessa forma, um processo obstrutivo. Diante dos achados, suspeitou-se inicialmente de um quadro de obstrução intestinal. Nos casos, a conduta adotada foi realizar uma laparotomia exploratória através do flanco direito, porém constatou-se, que não existia qualquer segmento com obstrução de natureza mecânica, que justificasse as alterações físicas e laboratoriais encontradas. Diante destes resultados, configurou-se um quadro clínico indicativo de íleo paralítico. As vacasforam submetidas a um protocolo terapêutico pós-cirúrgico composto por antibioticoterapia, anti-inflamatório, cálcio, procinético e tratamento de suporte. Os animais manifestaram uma resposta favorável a conduta terapêutica, com restabelecimento da função gastrointestinal e dos demais parâmetros fisiológicos, recebendo alta após uma evolução clínica variando entre dez a doze dias.

Paralytic ileus is an obstruction of the functional type, in which the intestinal lumen is patent, compromising the passage of the intake in the intestine. The objective of this study was to describe three cases in dairy cows treated in the hospital routine diagnosed with paralytic ileus. In their histories, the owners complained that the animals presented reduced appetite, ruminal tympany, decreased milk yield and elimination of faeces. At the physical examination, some clinical signs were prominent in both, such as apathy, dehydration, reduction of ruminal and intestinal motility, faeces were present in small quantity and with mucus present, abdominal enlargement and the succession produced sloshing sounds. In the analysis of the ruminal fluid, the chloride content in both was high (>30 mEq/L), characterizing an obstructive process. In the face of the findings, a diagnosis of intestinal obstruction was initially suspected. In animals, the adopted approach was to perform an exploratory laparotomy through the right flank, but it was verified that there was no segment with mechanical obstruction that justified the physical and laboratorial alterations found. In view of these results, a clinical diagnosis indicative of paralytic ileus was established. The three animals were submitted to a post-surgical therapeutic protocol consisting of antibiotic therapy, anti-inflammatory, calcium, pro-kinetic and supportive treatment. The animals showed a favourable response to therapeutic treatment, with restoration of gastrointestinal function and other physiological parameters, and was discharged after a clinical evolution ranging from ten to twelve days.

Validation of a new water-perfused high-resolution manometry system / Validação de um novo sistema de manometria de alta resolução por perfusão de água

ABSTRACT Background: High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. Aim: To validate normal values for a new water-perfusion high-resolution manometry system. Methods: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. Results: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. Conclusions: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.

RESUMO Racional: A manometria de alta resolução é mais custosa, porém clinicamente superior à manometria convencional. Sistemas por perfusão de água podem ter custo diminuído, mas não é certo se são tão eficazes quanto aos sistemas de estado sólido e se os valores de referência são intercambiáveis. Objetivo: Este estudo visa validar valores de normalidade para um novo sistema por perfusão de água. Método: Valores de normalidade para um sistema de manometria de alta resolução de 24 sensores por perfusão de água foram validados estudando 225 indivíduos submetidos à manometria de alta resolução por queixas clínicas. Pacientes foram divididos em quatro grupos: grupo 1 - doença do refluxo gastroesofágico; grupo 2 - acalasia; grupo 3 - doenças sistêmicas com possível doenças sistêmicas com comprometimento esofágico; e grupo 4 - pacientes com disfagia. Resultado: No grupo 1, esfíncter esofagiano inferior hipotônico foi encontrado em 49% dos indivíduos com pHmetria positiva e 28% daqueles com pHmetria negativa. Nos grupos 2 e 3, aperistalse foi encontrada em todos indivíduos. No grupo 4, somente um paciente (14%) tinha manometria normal. Conclusão: Os valores de normalidade definidos para este sistema de manometria de alta resolução por perfusão de água são discriminatórios da maioria das anormalidades da motilidade esofágica vistas na prática clínica.

Structural bases of gastrointestinal motility changes in parkinson's disease: study in rats / Bases estruturais das alterações da motilidade gastrintestinal na doença de parkinson: estudo em ratos

ABSTRACT Background: Gastrointestinal disorders are frequently reported in patients with Parkinson's disease whose disorders reduce the absorption of nutrients and drugs, worsening the clinical condition of patients. However, the mechanisms involved in modifying gastrointestinal pathophysiology have not yet been fully explained. Aim: To evaluate its effects on gastrointestinal motility and the involvement of the vagal and splanchnic pathways. Methods: Male Wistar rats (250-300 g, n = 84) were used and divided into two groups. Group I (6-OHDA) received an intrastriatal injection of 6-hydroxydopamine (21 µg/animal). Group II (control) received a saline solution (NaCl, 0.9%) under the same conditions. The study of gastric emptying, intestinal transit, gastric compliance and operations (vagotomy and splanchnotomy) were performed 14 days after inducing neurodegeneration. Test meal (phenol red 5% glucose) was used to assess the rate of gastric emptying and intestinal transit. Results: Parkinson's disease delayed gastric emptying and intestinal transit at all time periods studied; however, changes in gastric compliance were not observed. The delay in gastric emptying was reversed by pretreatment with vagotomy and splanchnotomy+celiac gangliectomy, thus suggesting the involvement of such pathways in the observed motor disorders. Conclusion: Parkinson's disease compromises gastric emptying, as well as intestinal transit, but does not alter gastric compliance. The delay in gastric emptying was reversed by truncal vagotomy, splanchnotomy and celiac ganglionectomy, suggesting the involvement of such pathways in delaying gastric emptying.

RESUMO Racional: Distúrbios gastrintestinais são frequentemente relatados em pacientes com doença de Parkinson cujos distúrbios reduzem a absorção de nutrientes e fármacos, agravando o quadro clínico dos pacientes. No entanto, os mecanismos envolvidos na alteração da fisiopatologia gastrintestinal ainda não foram totalmente elucidados. Objetivo: Avaliar os seus efeitos sobre a motilidade gastrintestinal e o envolvimento das vias vagal e esplâncnica. Métodos: Ratos Wistar machos (250-300 g, n=84) foram utilizados e divididos em dois grupos. O grupo I (6-OHDA) recebeu injeção intraestriatal de 6-hidroxidopamina (21 µg/animal). O grupo II (controle) recebeu solução salina (NaCl, 0,9%) nas mesmas condições. O estudo do esvaziamento gástrico, trânsito intestinal, complacência gástrica e operações (vagotomia e esplancnotomia) foram realizadas 14 dias após a indução da neurodegeneração. Refeição teste (vermelho de fenol+glicose 5%) foi utilizada para avaliar a taxa de esvaziamento gástrico e o trânsito intestinal. Resultados: A doença de Parkinson retardou o esvaziamento gástrico e o trânsito intestinal em todos os tempos estudados; porém, alterações da complacência gástrica não foram observadas. O retardo do esvaziamento gástrico foi revertido por pré-tratamento com vagotomia e esplancnotomia+gangliectomia celíaca, sugerindo assim, o envolvimento de tais vias nos distúrbios motores observados. Conclusão: A doença de Parkinson compromete o esvaziamento gástrico, bem como o trânsito intestinal, mas não altera a complacência gástrica. O retardo do esvaziamento gástrico foi revertido pela vagotomia troncular, esplancnotomia e gangliectomia celíaca, sugerindo o envolvimento de tais vias no retardo do esvaziamento gástrico.

Enhanced cyclooxygenase-2 activity leads to intestinal dysmotility following hemorrhagic shock

ABSTRACT PURPOSE: To test whether hemorrhagic shock (HS) increases the Cyclooxygenase-2 (COX-2) expression in the intestine and whether this enhanced COX-2 expression mediates the intestinal dysmotility after HS. METHODS: Male Wistar rats were randomly divided into HS sham group and HS group. At 180 min following HS establishment, the duodenum samples were harvested to assess the motility function, protein expression of COX-2 and the downstream products of COX-2, prostaglandins. RESULTS: Examination of motility function ex vivo showed that the contractile response to acetylcholine of smooth muscle strips of rats subjected to HS was significantly suppressed. A COX-2 inhibitor, NS-398, abolished this depressed contractile response after HS. Western blotting revealed an increased protein expression of COX-2 in intestinal tissues of HS rats. Immunohistochemical examination indicated that intestine tissues of HS rats were manifested by part of villous expansion and disruption, a large amount of COX-2 positive cells appearance in lamina propria and submucosa. Furthermore, the contents of prostaglandin E2 was significantly increased in intestinal tissues of HS rats. CONCLUSION: The enhanced COX-2/ prostaglandin E2 involves in the hemorrhagic shock induced intestinal dysmotility.

The participatinn of the nitrergic pathway in icreased rate of transitory relaaxation of lower esophageal sphincter induced by rectal distension in dogs / A participação da via nitrérgica no aumento da taxa de relaxamento transitório do esfíncter esofágico inferior induzida pela distensão retal em cães

Context The rectal distension in dogs increases the rate of transitory lower esophageal sphincter relaxation considered the main factor causing gastroesophageal reflux. Objectives The aim of this study was evaluate the participation of the nitrergic pathway in the increased transitory lower esophageal sphincter relaxation rate induced by rectal distension in anesthetized dogs. Methods Male mongrel dogs (n = 21), weighing 10-15 kg, were fasted for 12 hours, with water ad libitum. Thereafter, they were anesthetized (ketamine 10 mg.Kg-1 + xylazine 20 mg.Kg-1), so as to carry out the esophageal motility evaluation protocol during 120 min. After a 30-minute basal period, the animals were randomly intravenous treated whith: saline solution 0.15M (1ml.Kg-1), L-NAME (3 mg.Kg-1), L-NAME (3 mg.Kg-1) + L-Arginine (200 mg.Kg-1), glibenclamide (1 mg.Kg-1) or methylene blue (3 mg.Kg-1). Forty-five min after these pre-treatments, the rectum was distended (rectal distension, 5 mL.Kg-1) or not (control) with a latex balloon, with changes in the esophageal motility recorded over 45 min. Data were analyzed using ANOVA followed by Student Newman-Keuls test. Results In comparison to the respective control group, rectal distension induces an increase in transitory lower esophageal sphincter relaxation. Pre-treatment with L-NAME or methylene blue prevents (P<0.05) this phenomenon, which is reversible by L-Arginine plus L-NAME. However, pretreating with glibenclamide failed to abolish this process. Conclusions Therefore, these experiments suggested, that rectal distension increases transitory lower esophageal sphincter relaxation in dogs via through nitrergic pathways. .

Contexto A distensão retal aumenta a taxa de relaxamento transitório do esfíncter esofágico inferior em cães, sendo o relaxamento transitório do esfíncter esofágico inferior considerado o principal fator responsável pelo refluxo gastroesofágico. Objetivos Avaliar a participação da via nitrérgica no aumento da taxa relaxamento transitório do esfíncter esofágico inferior induzida por distensão retal em cães anestesiados. Métodos Cães sem raça definida, machos (n = 21), pesando entre 10-15 kg, foram mantidos em jejum durante 12 horas, no entanto, com água ad libitum. Depois disso, eles foram anestesiados (cetamina 10 mg.Kg-1 + xilazina 20 mg.Kg-1), para a realização do protocolo de avaliação da motilidade esofágica durante 120 minutos. Após um período basal de 30 minutos, os animais foram aleatoriamente tratados intravenosa com: solução salina 0,15 (1 ml.Kg-1), L-NAME (3 mg.Kg-1), L-NAME (3 mg.Kg-1) + L-arginina (200 mg.Kg-1), glibenclamida (1 mg.Kg-1) e azul de metileno (3 mg.Kg-1). Quarenta e cinco minutos após os pré-tratamentos, o reto foi distendido com um balão de látex (DR, 5 mg.Kg-1) ou não (grupo controle), e as variações da motilidade esofágica foram registradas e gravadas ao longo dos 45 minutos seguintes. Os dados foram analisados utilizando-se ANOVA seguido pelo teste de Student Newman-Keuls. Resultados Em comparação com o respectivo grupo controle, a distensão retal demonstrou induzir um aumento na taxa de relaxamento transitório do esfíncter esofágico inferior. O pré-tratamento com L -NAME ou azul de metileno impediu (P<0,05) este fenômeno, que foi reversível após a administração de L-Arginina + L-NAME. No entanto, o pré-tratamento com a glibenclamida não ...

Nutrição precoce de neonatos prematuros estáveis e pequenos para a idade gestacional: um ensaio clínico randomizado / Very early feeding in stable small for gestational age preterm infants: a randomized clinical trial

OBJETIVO: Examinar o efeito da nutrição precoce sobre o tempo para atingir a nutrição completa em neonatos prematuros (PIG) estáveis pequenos para a idade gestacional. MÉTODO: Os neonatos prematuros com idade gestacional inferior a 37 semanas e peso ao nascer inferior a 10% foram alocados aleatoriamente para um regime de nutrição precoce (nas primeiras 24 horas de vida) ou tardia (após as primeiras 24 horas de vida). Todos os neonatos apresentaram uma evidência intrauterina de fluxo diastólico reverso ou ausente. Os neonatos incapazes de iniciar uma nutrição precoce foram excluídos. O tempo para a alimentação completa, a progressão da nutrição e morbidez correspondente foram comparados. A eletrogastrografia (EGG) foi utilizada para mensurar a motilidade gástrica pré e pós-prandial no segundo e no sétimo dias após o início da nutrição. RESULTADOS: Foram incluídos 60 neonatos no estudo, sendo 30 em cada grupo. Os neonatos incluídos no regime de nutrição precoce atingiram a nutrição enteral completa antes dos neonatos do grupo de controle (98±80-157 em comparação a 172±1 23-261 horas de idade, respectivamente; p = 0,004) e recebiam alta hospitalar antes (p = 0,04). Nenhuma enterocolite necrosante (ECN) foi comprovada em ambos os grupos de estudo. A motilidade gástrica melhorou no sétimo dia após o início da nutrição em ambos os grupos de estudo, sem diferença entre eles. CONCLUSÕES: Os neonatos prematuros PIG estáveis em regime de nutrição precoce atingiram alimentação enteral completa e receberam alta hospitalar significativamente antes que aqueles em regime de nutrição tardio, sem morbidez excedente.

OBJECTIVE: To examine the effect of initiating very early feeding on time-to-reach full feeding in stable, small for gestational age (SGA) preterm infants. METHOD: Preterm infants with gestational age below 37 weeks and birth weight below the 10th percentile were randomly allocated to a very early (within 24 hours of birth) feeding regimen or delayed (after 24 hours of birth) feeding. All infants had in utero evidence of absent or reverse diastolic flow. Infants unable to start early feeding were excluded. Time-to-reach full feeding, feeding progression, and related morbidity were compared. Electrogastrography (EGG) was used to measure pre- and postprandial gastric motility on the second and seventh day after feeding initiation. RESULTS: Sixty infants were included in the study, 30 in each group. Infants included in the very early feeding regimen achieved full enteral feeding sooner than controls (98±80-157 vs. 172±123-261 hours of age, respectively; p = 0.004) and were discharged home earlier (p = 0.04). No necrotizing enterocolitis (NEC) was documented in both study groups. Gastric motility was improved at day seven after feeding initiation in both study groups, with no difference between groups. CONCLUSIONS: Stable SGA preterm infants on a very early feeding regimen achieved full enteral feeding and were discharged home significantly earlier than those on a delayed regimen, with no excess morbidity.

Mecanismos e fatores associados aos sintomas gastrointestinais em pacientes com diabetes melito / Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

OBJETIVOS: Apresentar a frequência, os principais fatores causadores dos sintomas gastrointestinais em pacientes portadores do diabetes melito e controvérsias quanto à sua ocorrência em crianças e adolescentes. FONTES DOS DADOS: Revisão não sistemática nas bases de dados MEDLINE/PubMed e SciELO (1983-2011), além de capítulos de livros relevantes. Foram selecionados os artigos mais atuais e representativos do tema. SÍNTESE DOS DADOS: A prevalência do diabetes melito vem aumentando ao longo dos anos em vários países do mundo. No sistema digestório, é conhecida a ocorrência de complicações do diabetes melito, entre elas os sintomas gastrointestinais (náuseas, vômitos, dor abdominal, azia, disfagia, constipação, diarreia e incontinência fecal). A patogênese das alterações das funções gastrointestinais no diabetes melito está ainda sob investigação, e o papel do sistema nervoso entérico e seus neurotransmissores tem ganhado significância. Em decorrência do comprometimento do sistema digestório, com danos ao sistema nervoso entérico, portadores do diabetes melito podem apresentar quadros específicos de distúrbios de motilidade, alguns de grande relevância clínica, como gastroparesia diabética, constipação e diarreia. A disfunção deste sistema contribui para aumentar a morbidade desta doença e piora a qualidade de vida de seus portadores. CONCLUSÕES: O diabetes melito, ao longo dos anos, afeta o sistema digestório. Por ser uma condição que piora a qualidade de vida dos portadores e também pode indicar complicação da doença, deve ser valorizada no acompanhamento e tratamento do paciente com diabetes melito. Na infância e na adolescência, ainda existem poucos estudos que abordam o problema.

OBJECTIVES: To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents. SOURCES: Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases (1983-2011), as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. SUMMARY OF THE FINDINGS: Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. CONCLUSIONS: There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus.

Motilidad intestinal y microflora / Intestinal motility and microflora

La microflora es el conjunto de colonias microbacterianas que cubren la superficie del tubo digestivo. Cada sujeto humano alberga unos 100 billones de colonias de unas 400 especies distintas, biodiversidad que facilita la vida y el desarrollo del conjunto. La concentración de bacterias va aumentando a lo largo del tubo digestivo, alcanzando concentraciones de 1012 UFC/ml. en el colon. La motilidad del intestino delgado es propulsiva con una fase de barrido que no permite el crecimiento de bacterias. Por el contrario, la motilidad del colon es muy lenta y no propulsiva durante el ayuno y el sueño. Sólo en vigilia y en período postprandial existen ondas de contracción de alta amplitud y rápidamente progresivas en dirección oral-anal. La interacción entre las bacterias presentes en el lumen y las ondas de contracción motora es muy difícil de evaluar. Este efecto se ha estudiado en base a los fármacos que alteran la motilidad y que al aumentar ésta, barren con la flora bacteriana presente. En ese sentido se sabe que el uso de cisaprida acelera el tránsito, reduciendo la densidad de bacterias metanogénicas con un aumento de la excreción de hidrógeno. En cambio, loperamida disminuye el tránsito, aumentando la flora metanogénica (hecho que representa lo que sucede a pacientes constipadas, que tienen flora mayoritariamente productora de metano). Conclusión: La interacción entre motilidad y flora bacteriana es compleja y está poco estudiada fundamentalmente debido a dificultades técnicas.

Microflora is the set of microbacterium colonies covering the digestive tract surface. Each human subject hosts ca. 100 billions of colonies of 400 different species, b23wiodiversity that facilitates life and development of the whole. Bacteria concentration increases throughout the digestive tract, reaching concentrations of 1012 CFU/ml in the colon. Motility of the small intestine is propulsive with a sweeping phase, allowing for the growth of bacteria. On the contrary, motility of the colon is very slow and non-propulsive during fasting and sleeping. Only during wakefulness and postprandial period there are wide-ranging and quickly progressive contraction waves in oral-anal direction. Interaction between bacteria present in lumen and the contraction waves is very hard to assess. This effect has been studied based on drugs that alter motility, and when it increases, they sweep the existing gut flora. In this sense, it is known that the use of cisapride accelerates the transit, reducing the density of methanogenic bacteria with an increase in the hydrogen excretion. On the other hand, loperamide slows down transit, causing an increase of the methanogenic flora (which represents what happens to constipated patients with flora that produces mainly methane). Conclusion: Interaction between motility and gut flora is complex and has not been enough studied mainly due to technical difficulties.

Possible links between intestinal permeablity and food processing: a potential therapeutic niche for glutamine

Increased intestinal permeability is a likely cause of various pathologies, such as allergies and metabolic or even cardiovascular disturbances. Intestinal permeability is found in many severe clinical situations and in common disorders such as irritable bowel syndrome. In these conditions, substances that are normally unable to cross the epithelial barrier gain access to the systemic circulation. To illustrate the potential harmfulness of leaky gut, we present an argument based on examples linked to protein or lipid glycation induced by modern food processing. Increased intestinal permeability should be largely improved by dietary addition of compounds, such as glutamine or curcumin, which both have the mechanistic potential to inhibit the inflammation and oxidative stress linked to tight junction opening. This brief review aims to increase physician awareness of this common, albeit largely unrecognized, pathology, which may be easily prevented or improved by means of simple nutritional changes.

Gender differences in proximal esophageal contractions / Influência do gênero nas contrações do esôfago proximal

Context: There are reports showing that gender has an influence on swallowing and on the contractions of the distal esophageal body. Objective: In this investigation we studied the effect of gender on proximal esophageal contraction. Methods: We studied 20 men (22-68 years old, median 39 years) and 44 women (18-61 years old, median 41 years) without symptoms and without gastrointestinal or respiratory diseases. We measured the time interval between the onset of pharyngeal contraction 1 cm proximal to the upper esophageal sphincter and the onset of the proximal esophageal contraction 5 cm from the pharyngeal recording. We also measured the amplitude, duration and area under the curve of the proximal esophageal contractions. The recording was performed by the manometric method with continuous perfusion. The contractions were recorded in duplicate after swallows of a 5 mL bolus of water. Results: There were no differences between men and women in the interval between the onset of pharyngeal and of esophageal contractions or in the amplitude of esophageal contractions. The duration of contractions was longer in women (2.35 ± 0.60 s) than in men (2.07 ± 0.62 s) but the difference did not reach statistical significance (P = 0.087). The area under the curve of the esophageal contraction was higher in women (130.2 ± 55.2 mm Hg x s) than in men (97.4 ± 49.4 mm Hg x s, P = 0.026). Conclusion: We conclude that there is a difference between men and women in the proximal esophageal contractions in response to wet swallows, although this difference is of no clinical relevance.

Contexto: Há trabalhos que demonstram a existência de diferenças entre homens e mulheres na deglutição e nas contrações em parte distal do esôfago. Objetivo: Neste trabalho estuda-se a influência do gênero nas contrações em parte proximal do esôfago de pessoas assintomáticas. Método: Incluíram-se 20 homens (22-68 anos, mediana 39 anos) e 44 mulheres (18-61 anos, mediana 41 anos) sem doenças gastrointestinais, neurológicas ou respiratórias. Mediu-se o intervalo de tempo entre o início da contração em faringe 1 cm proximal ao esfíncter superior do esôfago e o início da contração em esôfago proximal 5 cm distal ao registro da faringe, e a amplitude, duração e área sob a curva da contração esofágica proximal. Utilizou-se o método manométrico com perfusão contínua. As contrações foram registradas em duplicata após a deglutição de 5 mL de água. Resultados: Não se observaram diferenças entre homens e mulheres no intervalo entre a contração da faringe e do esôfago proximal, e na amplitude da contração do esôfago. A duração da contração foi maior nas mulheres (2,35 ± 0,60 s) do que nos homens (2,07 ± 0,62 s) mas o resultado não atingiu significância estatística (P = 0,087). A área sob a curva das contrações esofágicas foi maior nas mulheres (130,2 ± 55,2 mm Hg x s) do que nos homens (97,4 ± 49,4 mm Hg x s, P = 0,026). Conclusão: Observou-se que há diferença entre homens e mulheres nas contrações em esôfago proximal quando da deglutição de água, o que não deve ter importância clínica.

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar / Effects of conventional treatment of chronic functional constipation on total and segmental colonic and orocecal transit times

OBJETIVO: Avaliar o efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito colônico total e segmentar e no tempo de trânsito orocecal. MÉTODOS: Foram incluídos 34 pacientes com constipação funcional atendidos consecutivamente em ambulatório especializado. O tempo de trânsito colônico total e segmentar foi avaliado com marcadores radiopacos. O tempo de trânsito orocecal da lactulose e do feijão foi avaliado com teste do hidrogênio no ar expirado. O tratamento constou de desimpactação, orientações gerais e de consumo de dieta rica em fibra alimentar e administração de óleo mineral. RESULTADOS: Na admissão, dismotilidade colônica foi encontrada em 71,9 por cento (23/32) dos pacientes. Todos os pacientes que realizaram corretamente o tratamento apresentaram melhora clínica na sexta semana do tratamento quando 82,6 por cento (19/23) daqueles com dismotilidade na admissão apresentaram normalização ou diminuição da gravidade no padrão de trânsito colônico. Observou-se redução do tempo de trânsito (medianas) entre a admissão e a oitava semana de tratamento: trânsito orocecal da lactulose (de 70 para 50 minutos, p = 0,002), orocecal do feijão (de 240 para 220 minutos, p = 0,002) e colônico total (de 69,5 para 37,0 horas, p = 0,001). A necessidade de uso de óleo mineral para controle da constipação aos 12 meses de tratamento associou-se com persistência de trânsito colônico total superior a 62 horas na oitava semana de tratamento (p = 0,014). CONCLUSÃO: O programa terapêutico convencional proporcionou bons resultados independentemente da presença ou não de dismotilidade colônica na admissão ao estudo. As anormalidades da motilidade digestiva na constipação funcional da criança podem apresentar reversibilidade e ser de natureza secundária.

OBJECTIVE: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. METHODS: A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. RESULTS: At admission, colonic dysmotility was found in 71.9 percent (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6 percent (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). CONCLUSION: The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

Interstitial cells of Cajal and intestinal function in Trinidadian children / Células intersticiales de Cajal y función intestinal en niños trinitenses

OBJECTIVE: This study was carried out to compare the density of the interstitial cells of Cajal (ICCs) in the bowel wall of children with Hirschsprung's disease (HD), anorectal malformations (ARM) and normal controls in Trinidad and Tobago. SUBJECTS AND METHOD: Segments of bowel wall excised from eight children with HD, three controls and two children with ARM were immunostained with c-Kit primary antibody. Cells with features of ICCs were counted. RESULTS: All three controls and the two children with ARM had dense distribution of ICCs. Most children (6/8;75%) with HD had markedly reduced counts in aganglionic bowel. Two (25%) also had a decrease in ganglionic bowel. Possible influences were patient age and gender and the level of bowel sectioned. CONCLUSION: Analysis of this sample suggests that immunostaining for c-Kit positive cells might be a useful screening test in the assessment of bowel motility disorders. The possible effects of age, gender and the level of bowel sampled await determination.

OBJETIVO: Este estudio se llevó a cabo con el propósito de comparar la densidad de las células intersticiales de Cajal (CIC) en las paredes intestinales de niños con la enfermedad de Hirschprung (EH), y malformaciones anorectales (MAR), frente a controles normales en Trinidad Tobago. SUJETOS Y MÉTODOS: Segmentos de las paredes intestinales les fueron extirpados a ocho niños con EH; tres controles y dos niños con MAR fueron inmunoteñidos con anticuerpo primario c-kit. Se contaron las células con características de CIC. RESULTADOS: Los tres controles y los dos niños con MAR presentaban una distribución densa de CICs. La mayor parte de los niños (6/8; 75%) con EH tuvieron conteos marcadamente reducidos de intestino agangliónico. Dos niños (25%) también tuvieron una disminución de intestino gangliónico. Entre las influencias posibles se cuentan la edad y el género del paciente así como el nivel de intestino seccionado. CONCLUSIÓN: El análisis de esta muestra sugiere que la inmunotinción para células c-kit positivas podría ser un útil test de pesquisaje a la hora de evaluar desórdenes en la motilidad intestinal. Los efectos posibles de la edad, el género y el nivel de intestino muestreado, están pendientes de determinación.

Revisión crítica de los métodos utilizados en el estudio del tránsito colónico / Colonic transit assesment: a chritical review

Functional constipation is a disorders frequently observed in clinical practice. In the management of a group of patients who do not respond to established medical treatment, is important to investigate colonic transit A critical review of the main technical approach for colonic transit estimation is presented. Two main methods are actually availables: isotopic markers, and radiological techniques with radiopaque markers, the last one being the most extensively used. The most basic technique consist in a single administration of markers and a plain abdominal Rx. Information about percentage of markers observed five days after ingestion (normal 20%) and distribution, provide important information: diffuse overall the colon (slow transit constipation) or localized distally (outlet obstruction).Using repeated doses of markers and one or more Rx, colonic transit time segmental or total can be established. This information may be useful in the assessment of certain pathological conditions, pharmacological effects and diets.

La constipación funcional es una manifestación clínica frecuente. En algunos pacientes que no responden a las. medidas terapéuticas habituales, es necesario para su manejo contar con una evaluación del tránsito colónico. Revisamos en forma crítica en esta presentación las principales técnicas utilizadas en la actualidad con este fin. Existen principalmente dos métodos: el uso de marcadores isotópicos y técnicas radio lógicas con marcadores radiopacos, esta última es la más ampliamente utilizada. La técnica con marcadores radiopacos más simple consiste en utilizar una dosis de marcadores y una radiografía, informa sobre el porcentaje de retención de marcadores (normal 20% a los 5 días) y su distribución: difusa (constipación por tránsito lento), localizada distalmente, que sugiere un trastorno del tracto de salida. Usando dosis repetidas de marcadores y una o más radiografías, se puede establecer el tiempo de tránsito para los diferentes segmentos del colon y total, lo que puede ser de utilidad en la evaluación de determinadas condiciones patológicas, fármacos y dietas.

Roles of calcium and IP3 in impaired colon contractility of rats following multiple organ dysfunction syndrome

The purpose of the present study was to explore changes in rat colon motility, and determine the roles of calcium and inositol (1,4,5)-triphosphate (IP3) in colon dysmotility induced by multiple organ dysfunction syndrome (MODS) caused by bacteria peritonitis. The number of stools, the contractility of the muscle strips and the length of smooth muscle cells (SMC) in the colon, the concentration of calcium and IP3 in SMC, and serum nitric oxide were measured. Number of stools, fecal weight, IP3 concentration in SMC and serum nitric oxide concentration were 0.77 ± 0.52 pellets, 2.51 ± 0.39 g, 4.14 ± 2.07 pmol/tube, and 113.95 ± 37.89 mumol/L, respectively, for the MODS group (N = 11) vs 1.54 ± 0.64 pellets, 4.32 ± 0.57 g, 8.19 ± 3.11 pmol/tube, and 37.42 ± 19.56 mumol/L for the control group (N = 20; P < 0.05). After treatment with 0.1 mM acetylcholine and 0.1 M potassium chloride, the maximum contraction stress of smooth muscle strips, the length of SMC and the changes of calcium concentration were 593 ± 81 and 458 ± 69 g/cm³, 48.1 ± 11.8 and 69.2 ± 15.7 muM, 250 ± 70 and 167 ± 48 percent, respectively, for the control group vs 321 ± 53 and 284 ± 56 g/cm³, 65.1 ± 18.5 and 87.2 ± 23.7 muM, 127 ± 35 and 112 ± 35 percent for the MODS group (P < 0.05). Thus, colon contractility was decreased in MODS, a result possibly related to reduced calcium concentration and IP3 in SMC.

Endoscopia gastroduodenal após administração de nimesulida, monofenilbutazona e meloxicam em cães / Gastroduodenal endoscopy after nimesulide, monophenylbutazone and meloxicam administration in dogs

Avaliaram-se os aspectos da mucosa gastroduodenal em cães tratados experimentalmente com nimesulida, monofenilbutazona e meloxicam. Foram formados quatro grupos com oito cães. Os grupos 1, 2 e 3 receberam, respectivamente, tratamento com nimesulida, monofenilbutazona e meloxicam durante 21 dias, e o grupo 4 foi utilizado como controle. Todos os animais foram avaliados por exames endoscópicos do estômago e duodeno antes do experimento e aos 10 e 21 dias de tratamento. Os cães não manifestaram qualquer alteração clínica ou laboratorial durante o período de estudo. A avaliação endoscópica da mucosa gastroduodenal apresentou apenas lesões consideradas de baixo grau. Esses antiinflamatórios mostraram-se seguros para o trato gastrintestinal de cães clinicamente saudáveis

The gastroduodenal mucosa in dogs experimentally treated with nimesulide, monophenylbutazone and meloxicam was evaluated. There were four groups with eight dogs in each. Groups one, two and three were given nimesulide, monophenylbutazone and meloxicam, respectively, during 21 days and group four was used as control. All animals were evaluated by gastroduodenoscopy before the study and on the 10th and 21st days. The dogs did not show any clinical or laboratorial changes during the study. The endoscopic evaluation of gastroduodenal mucosa showed only low degree lesions. These anti-inflammatory drugs showed to be safe for the gastrointestinal tract in healthy dogs

The distribution of interstitial cells of Cajal in the ileum is not altered by infection with Schistosoma mansoni.

BACKGROUND & OBJECTIVES: The interstitial cells of Cajal (ICC) act as pacemakers that generate slow waves and function as a relay between smooth muscle cells of the gastrointestinal (GI) tract. Recent reports indicate the crucial role played by the ICC in defining GI motility during human disease status like pyloric stenosis, Hirschsprung's disease and ulcerative colitis. Experimental data showed that Nippostrongylus infection in the rat caused an altered GI motility pattern accompanied by a complete loss of ICC-deep muscular plexus. The aim of the present study was to delineate if ICC were similarly affected during Schistosoma mansoni infections, thereby responsible for the disturbed GI motility patterns triggered in the afflicted mammalian host. METHODS & RESULTS: Immunohistochemistry was done using whole mounts and sections from naive and S. mansoni infected mice ileum. Primary antibodies detected Kit-immunoreactivity (Kit-ir representing ICC), PGP-9.5 (protein gene product 9.5 representing a neuronal marker), SK3 (ionic channel marker for non-Kit fibroblast like cells), and Cx43 (gap junction protein representing a muscle marker). Single/double immunofluorescence staining and confocal microscopy depicted that muscle thickness (Cx43-ir) and inflammatory infiltrate increased with infection. Kit-ir ICC and SK3-ir fibroblast like cells (FLC) were present at all normal locations as seen in controls and during acute and chronic stages of infection. INTERPRETATION & CONCLUSION: No disappearance of either ICC population was noted. A preferential (although not exclusive) location of inflammatory infiltrate in contact with SK3-ir FLC in the muscle layer was observed. The present study thus delineated that ICC are not affected during S. mansoni infections, and thereby may not be responsible for mediating the disturbed GI motility patterns caused by schistosomiasis.

An experimental study of the electrical activity of the bypassed stomach in the Roux-en-Y gastric bypass

BACKGROUND: Surgical options for morbid obesity are diverse, and the Roux-en-Y gastric bypass, initially described by Fobi has gained popularity. Knowledge about the physiology of the bypassed stomach is limited because this newly produced segment of the stomach is inaccessible to endoscopic or contrast radiological studies. AIM: To evaluate the myoelectric activity of the bypassed stomach and its reply to the feeding. METHODS: An experimental protocol was conducted to evaluate postoperative gastric bypassed motility in dogs submitted to the Roux-en-Y gastric bypass procedure. Two groups of five animals were studied on postoperative fasting and after a standard meal, recording electrical response and control activity. Both control and Roux-en-Y gastric bypass operated study group had a pair of electrodes placed on three points of the remaining stomach: fundus, body and antrum. Data registration was performed after complete ileus resolution, and analysed with DATA Q Inst. series 200. RESULTS: The results achieved on the conditions of this study suggest that: 1. the remaining stomach maintain the same pattern of motility; 2. there is a reduced fasting electromyography activity following the Roux-en-Y gastric bypass procedure; 3. significantly reduced fasting electric control activity when compared both groups, and a markedly reduced fasting response electric activity and; 4. the electric response to the feeding kept the same standard of the stomach, however in a statistically reduced way. CONCLUSION: The electrical activity of the bypassed stomach of Roux-en-Y gastric bypass procedure kept the same pattern but in a statistically reduced number of contraction.

RACIONAL: Dentre a grande diversidade de opções cirúrgicas para obesidade mórbida, a gastroplastia vertical com reconstituição em Y-de-Roux, tornou-se extremamente popular. Dados concernentes à fisiologia do estômago excluído são limitados, desde que este segmento produzido pela cirurgia é inacessível a qualquer endoscopia ou para estudos de radiológicos de contraste. OBJETIVO: Avaliar a atividade de mioelétrica do estômago excluído e sua resposta à alimentação. MÉTODOS: Um protocolo experimental foi conduzido para avaliar no pós-operatório a motilidade do estômago excluído em cães submetidos ao procedimento de gastroplastia vertical com reconstituição em Y-de-Roux. Dois grupos de cinco animais foram estudados durante o período de jejum e pós-prandial, registrando-se a resposta elétrica e atividades de controle. Ambos, o grupo de controle e o grupo operado, receberam três pares de eletrodos colocado em três pontos do estômago excluso: fundo, corpo e antro. O registro de dados foi executado depois da completa resolução de íleo paralítico e analisado com DATAQ Inst série 200. RESULTADOS: Sob as condições deste estudo sugerem: 1. o estômago excluso mantém o mesmo padrão de motilidade; 2. a atividade elétrica de controle e a atividade elétrica de resposta foi significativamente reduzida durante o jejum quando comparados ambos os grupos e 3. a atividade elétrica de resposta mantém os mesmos padrões do estômago normal, embora de maneira estatisticamente reduzida. CONCLUSÕES: A atividade elétrica do estômago excluso durante o procedimento de gastroplastia vertical com reconstituição em Y-de-Roux manteve o mesmo padrão do estômago íntegro, mas com número estatisticamente reduzido de contrações.