|
1
|
Zhao X, Yin J, Wang L, Chen JDZ. Diffused and sustained inhibitory effects of intestinal electrical stimulation on intestinal motility mediated via sympathetic pathway. Neuromodulation 2013; 17:373-79; discussion 380. [PMID: 23924055 DOI: 10.1111/ner.12099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/05/2013] [Accepted: 06/19/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aims were to investigate the energy-dose response effect of intestinal electrical stimulation (IES) on small bowel motility, to compare the effect of forward and backward IES, and to explore the possibility of using intermittent IES and mechanism of IES on intestinal motility. MATERIALS AND METHODS Five dogs implanted with a duodenal cannula and one pair of intestinal serosal electrodes were studied in five sessions: 1) energy-dose response study; 2) forward IES; 3) backward IES; 4) intermittent IES vs. continuous IES; 5) administration of guanethidine. The contractile activity and tonic pressure of the small intestine were recorded. The duration of sustained effect after turning off IES was manually calculated. RESULTS 1) IES with long pulse energy dose dependently inhibited contractile activity and tonic pressure of the small intestine (p < 0.001). 2) The duration of sustained inhibitory effect of IES on the small intestine depended on the energy of IES delivered (p < 0.001). 3) The potency of the inhibitory effect was the same between forward and backward IES. 4) The efficacy of intermittent IES was the same as continuous IES in inhibiting motility of the small intestine. 5) Guanethidine blocked the inhibitory effect of IES on intestinal motility. CONCLUSIONS IES with long pulses inhibits small intestinal motility; the effect is energy-dose dependent, diffused, and sustained. Intermittent IES has the same efficacy as the continuous IES in inhibiting small intestinal motility. Forward and backward IES have similar inhibitory effects on small bowel motility. This IES-induced inhibitory effect is mediated via the sympathetic pathway.
Collapse
Affiliation(s)
- Xiaotuan Zhao
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | |
Collapse
|
|
2
|
Angeli TR, O'Grady G, Paskaranandavadivel N, Erickson JC, Du P, Pullan AJ, Bissett IP, Cheng LK. Experimental and Automated Analysis Techniques for High-resolution Electrical Mapping of Small Intestine Slow Wave Activity. J Neurogastroenterol Motil 2013; 19:179-91. [PMID: 23667749 PMCID: PMC3644654 DOI: 10.5056/jnm.2013.19.2.179] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/16/2013] [Accepted: 01/23/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/AIMS Small intestine motility is governed by an electrical slow wave activity, and abnormal slow wave events have been associated with intestinal dysmotility. High-resolution (HR) techniques are necessary to analyze slow wave propagation, but progress has been limited by few available electrode options and laborious manual analysis. This study presents novel methods for in vivo HR mapping of small intestine slow wave activity. METHODS Recordings were obtained from along the porcine small intestine using flexible printed circuit board arrays (256 electrodes; 4 mm spacing). Filtering options were compared, and analysis was automated through adaptations of the falling-edge variable-threshold (FEVT) algorithm and graphical visualization tools. RESULTS A Savitzky-Golay filter was chosen with polynomial-order 9 and window size 1.7 seconds, which maintained 94% of slow wave amplitude, 57% of gradient and achieved a noise correction ratio of 0.083. Optimized FEVT parameters achieved 87% sensitivity and 90% positive-predictive value. Automated activation mapping and animation successfully revealed slow wave propagation patterns, and frequency, velocity, and amplitude were calculated and compared at 5 locations along the intestine (16.4 ± 0.3 cpm, 13.4 ± 1.7 mm/sec, and 43 ± 6 µV, respectively, in the proximal jejunum). CONCLUSIONS The methods developed and validated here will greatly assist small intestine HR mapping, and will enable experimental and translational work to evaluate small intestine motility in health and disease.
Collapse
Affiliation(s)
- Timothy R Angeli
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand. ; Riddet Institute, Palmerston North, New Zealand
| | | | | | | | | | | | | | | |
Collapse
|
|
3
|
Guo X, Huang X, Wu YS, Liu DH, Lu HL, Kim YC, Xu WX. Down-regulation of hydrogen sulfide biosynthesis accompanies murine interstitial cells of Cajal dysfunction in partial ileal obstruction. PLoS One 2012; 7:e48249. [PMID: 23133623 PMCID: PMC3486862 DOI: 10.1371/journal.pone.0048249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/21/2012] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the role of endogenous hydrogen sulfide (H2S) in partial obstruction-induced dysfunction of the interstitial cells of Cajal (ICC) in mice ileum. Materials and Methods Partial intestinal obstruction was induced surgically in male imprinting control region (ICR) mice. ICC networks were studied by Immunohistochemistry. Electrical activity was recorded by intracellular recording techniques. The expression of ICC phenotype marker c-kit receptor tyrosine kinase (c-kit), membrane binding stem cell factor (mSCF), the endogenous H2S biosynthesis enzymes cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE) was studied by Western blotting. The expression of tumor necrosis factor-α (TNF-α) mRNA was observed by using real-time polymerase chain reaction. Results Partial intestinal obstruction resulted in ICC networks were disrupted above obstruction 14 days after the operation. The slow waves of intestinal smooth muscles in the dilated region were significantly suppressed and their amplitude and frequency were reduced, whilst the resting membrane potentials were depolarized. The expression of c-kit and mSCF was significantly decreased, also suggesting the disruption of the ICC network. The expression of TNF-α was significantly increased in the tunica muscularis of the obstructed intestine. Treatment of cultured intestinal smooth muscle cells with TNF-α caused dramatic down regulation of mSCF. The expression of CBS and CSE was significantly decreased in the tunica muscularis of the obstructed intestine. Intraperitoneal injection (i.p) of DL-propargylglycine, an irreversible inhibitor of CSE, and aminooxyacetic acid, an inhibitor of CBS, elevated the expression of TNF-α mRNA in the tunica muscularis of the ileum. Obstruction-induced over expression of TNF-α was significantly improved by supplementation of NaHS, but not the expressions of mSCF and c-kit. Conclusions The down regulation of endogenous H2S biosynthesis is related to over expression of TNF-α in obstructed small intestine. TNF-α-mediated mSCF down-regulation is not the only reason of partial intestinal obstruction-induced loss of ICC.
Collapse
Affiliation(s)
- Xin Guo
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Urology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xu Huang
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-song Wu
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong-hai Liu
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong-li Lu
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-chul Kim
- Department of Physiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Wen-xie Xu
- Department of Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail:
| |
Collapse
|
|
4
|
Sun Y, Song G, Yin J, Chen J, Chen JH, Song J, Chen JDZ. Effects and mechanisms of electroacupuncture on glucagon-induced small intestinal hypomotility in dogs. Neurogastroenterol Motil 2010; 22:1217-23, e318. [PMID: 20723072 DOI: 10.1111/j.1365-2982.2010.01565.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known on the effect of electroacupuncture (EA) (Br Med J, 2, 1976, 1225) on intestinal motility. The aim of this study was to investigate effects and mechanisms of EA on small intestinal contractions, transit, and slow waves in dogs. METHODS Six dogs were equipped with two intestinal cannulas for the measurement of small intestinal contractions and transit. Glucagon was used to induce postprandial intestinal hypomotility. Each dog was studied in five randomized sessions: Control, glucagon, glucagon + EA, glucagon + EA + naloxone, and glucagon + EA + atropine. KEY RESULTS 1 In the fasting state, EA induced intestinal contractions during motor quiescence (contractile index or CI: 4.4 ± 0.8 VS 8.3 ± 0.7, P < 0.05). 2 In the fed state, EA improved glucagon-induced intestinal hypomotility (CI: 3.8 ± 0.4 VS 6.1 ± 0.6, P < 0.05). 3 Electroacupuncture accelerated intestinal transit delayed by glucagon (67.9 ± 4.3 VS 40.2 ± 5.0 min, P < 0.05). 4 There was a negative correlation between the CI and the total transit time (R(2) = 0.59, P < 0.05). 5 The excitatory effect of EA was blocked by naloxone and partially blocked by atropine. 6 The percentage of normal slow waves was reduced with glucagon (70 ± 2%VS 98 ± 1% at baseline, P = 0.0015). Electroacupuncture normalized impaired slow waves and the effect was blocked by naloxone. CONCLUSIONS & INFERENCES Electroacupuncture enhances intestinal contractions during Phase I of the migrating motor complex and glucagon-induced hypomotility in the fed state, and accelerates intestinal transit via the opioid and cholinergic pathways in dogs. Electroacupuncture may have a therapeutic potential for intestinal hypomotility.
Collapse
Affiliation(s)
- Y Sun
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA
| | | | | | | | | | | | | |
Collapse
|
|
5
|
El Nakeeb A, Fikry A, El Metwally T, Fouda E, Youssef M, Ghazy H, Badr S, Khafagy W, Farid M. Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg 2009; 7:206-9. [PMID: 19332156 DOI: 10.1016/j.ijsu.2009.03.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/04/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study assesses the safety outcome of early oral feeding and reports on the factors affecting early postoperative feeding after colorectal procedures. PATIENTS AND METHODS Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis and were then randomized into two groups. The early feeding group began fluids on the first postoperative day while the regular feeding group was managed in the traditional way - nothing by mouth until the resolution of ileus. RESULTS The majority of patients (75%) tolerated the early feeding. The times to first passage of flatus (3.3+/-0.9 days vs 4.2+/-1.2 days) and stool (4.1+/-1.2 days vs 4.9+/-1.2 days) were significantly quicker in group 1. Hospital stay was also significantly shorter in the early feeding group (6.2+/-0.2 days vs 6.9+/-0.5 days). Operative time and amount of blood loss had an impact on the tolerability of early feeding while age, gender, type of operation and previous abdominal operation had no such impact. CONCLUSION Early oral feeding after colorectal surgery is safe and tolerated by the majority of patients. Operative time and amount of blood loss do, however, have an impact on the tolerability of early feeding.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Mansoura University Hospital, General Surgery Department, Mansoura, Egypt.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
6
|
Akkawi R, Eksborg S, Andersson A, Lundeberg S, Bartocci M. Effect of oral naloxone hydrochloride on gastrointestinal transit in premature infants treated with morphine. Acta Paediatr 2009; 98:442-7. [PMID: 19046344 DOI: 10.1111/j.1651-2227.2008.01128.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Opioids are common drugs for pain treatment in preterm newborn infants, in spite of several adverse effects. Constipation is a frequent problem when opioids are used in both adults and neonates. Although several studies indicate that the oral administration of naloxone hydrochloride (NH) improves intestinal motility during opioid therapy, there is still a lack of evidence in newborns. AIM The aim of this study was to assess the efficacy of NH against reduced intestinal motility during opioid treatment. METHODS A retrospective cohort study was performed. We analysed the medical records of fifteen infants (Group 1) treated with continuous morphine (MO) infusion and fourteen infants (Group 2) treated with both oral NH (3 microg/kg 4 times daily) and MO. RESULTS There was no statistically significant difference in the total MO dose. Infants treated both with NH and MO had a tendency to improve their mean stool frequency/day. A statistically significant improvement was observed in the mean total food intake (mL/kg/day) of the infants treated with NH (p = 0.014). No difference in the mean food retention between the two groups was observed. CONCLUSION Orally administrated NH seems to improve intestinal motility resulting in increased food intake/day and improved stool frequency/day in premature newborn infants treated with MO. Further studies are needed to corroborate these findings.
Collapse
Affiliation(s)
- Ranaa Akkawi
- Karolinska Pharmacy, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
|
7
|
Chen J, Chen H, Sanders KM, Perrino BA. Regulation of SRF/CArG-dependent gene transcription during chronic partial obstruction of murine small intestine. Neurogastroenterol Motil 2008; 20:829-42. [PMID: 18557893 PMCID: PMC8320440 DOI: 10.1111/j.1365-2982.2008.01149.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intestinal obstructions lead to a variety of motility disorders. Small intestine smooth muscles undergo dramatic phenotypic changes in response to obstruction, but the underlying molecular mechanisms are unknown. Using RT-PCR, ChIP, Re-ChIP, and Western blots, we examined the effect of small bowel mechanical obstruction on smooth muscle gene expression. Obstruction caused a transient hyperplasia, followed by a prolonged hypertrophic response of small intestine smooth muscle cells. Smooth muscle myosin heavy chain (MHC), alpha-actin, and gamma-actin expression decreased initially, and then increased as hypertrophy developed. Myocardin expression decreased initially and then increased, while kruppel-like factors (KLF)4 and KLF5 expression increased initially, and then decreased. Serum response factor (SRF) expression decreased initially, and then recovered to sham-operated levels as hypertrophy developed. SRF binding to smooth muscle MHC and alpha-actin promoters decreased initially, but then increased above sham-operated levels as hypertrophy developed. Elk-1 binding to smooth muscle myosin heavy chain and alpha-actin promoters increased initially, and then decreased to sham-operated levels as hypertrophy developed. c-fos expression increased initially, which was associated with increased SRF/Elk-1 binding to the c-fos promoter. The Elk-1 phosphorylation inhibitor U-0126 inhibited the increase in c-fos expression. These findings indicate a dynamic response of small intestine smooth muscles to bowel obstruction involving switching between differentiated, proliferative, and hypertrophic phenotypes. These results suggest that changes in the expression and interactions between SRF, myocardin, Elk-1, and c-fos play key roles in the phenotypic switching of small intestine smooth muscles in response to mechanical obstruction.
Collapse
Affiliation(s)
- J Chen
- Department of Physiology and Cell Biology, Center of Biomedical Research Excellence, University of Nevada School of Medicine, Reno, NV 89557, USA
| | | | | | | |
Collapse
|
|
8
|
Yin J, Chen JD. Excitatory effects of synchronized intestinal electrical stimulation on small intestinal motility in dogs. Am J Physiol Gastrointest Liver Physiol 2007; 293:G1190-5. [PMID: 17916650 DOI: 10.1152/ajpgi.00092.2007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to investigate effects of synchronized intestinal electrical stimulation (SIES) on small intestinal motility in dogs. Seventeen dogs were equipped with a duodenal cannula for the measurement of small bowel motility using manometry; an additional cannula was equipped in six of the dogs with 1.5 m distal to the first one for the measurement of small intestinal transit. Two pairs of bipolar electrodes were implanted on the small intestinal serosa with an interval of 5 cm; glucagon was used to induce postprandial intestinal hypomotility. Eleven dogs were used for the assessment of the small intestinal contractions in both fasting and fed states. The other six dogs were used for the measurement of small intestinal transit. We found that 1) SIES induced small intestinal contractions during phase I of the migrating motor complex (MMC) (contractile index or CI: 5.2 +/- 0.6 vs. 10.3 +/- 0.7, P = 0.003); 2) in the fed state, SIES significantly improved glucagon-induced small intestinal postprandial hypomotility (CI: 3.4 +/- 0.5 vs. 6.0 +/- 0.3, P = 0.03); 3) SIES significantly accelerated small intestinal transit delayed by glucagon (70.4 +/- 3.1 vs. 44.5 +/- 3.1 min, P < 0.01); 4) there was a negative correlation between the CI and transit time (r = -0.427, P = 0.048); and 5) the excitatory effect of SIES was blocked by atropine. SIES may have a therapeutic potential for treating patients with small intestinal disorders.
Collapse
Affiliation(s)
- Jieyun Yin
- Div. of Gastroenterology, Univ. of Texas Medical Branch, , Rte. 0632, 1108 The Strand, Rm. 221, Galveston, TX 77555, USA
| | | |
Collapse
|
|
9
|
Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy. World J Gastroenterol 2006; 12:2459-63. [PMID: 16688845 PMCID: PMC4088090 DOI: 10.3748/wjg.v12.i15.2459] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma.
METHODS: Three hundred and sixteen patients submitted to operations associated with colorectostomy from January 2004 to September 2005 were randomized to two groups: In experimental group (n = 161), the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding; In control group (n = 155), the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastomotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis.
RESULTS: The median and average days to the first passage of flatus (3.0 ± 0.9 vs 3.6 ± 1.2, P < 0.001), the first passage of stool (4.1 ± 1.1 vs 4.8 ± 1.4 P < 0.001) and the length of postoperative stay (8.4 ± 3.4 vs 9.6 ± 5.0, P < 0.05) were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage (1.24% vs 2.58%), acute dilation of stomach (1.86% vs 0.06%) and wound complications (2.48% vs 1.94%) were similar in the groups, but fever (3.73% vs 9.68%, P < 0.05), pulmonary infection (0.62% vs 4.52%, P < 0.05) and pharyngolaryngitis (3.11% vs 23.23%, P < 0.001) were much more in the control group than in the experimental group.
CONCLUSION: The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.
Collapse
Affiliation(s)
- Tong Zhou
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
| | | | | | | | | | | |
Collapse
|