Comparison of colonic transit time between patients with constipation-predominant irritable bowel syndrome and functional constipation.

Background/Aim Functional constipation (FC) and constipation-predominant IBS (C-IBS) are two main subtypes of constipation. Using radio-opaque markers is an easy and cost effective method to measure colonic transit time (CTT). We designed this study to compare the CTT between these two groups of constipated patients. Methods Patients with chronic constipation of no organic etiology were classified as having FC or C-IBS according to the Rome II criteria. All patients ingested 10 radio opaque markers daily for six days. A plain abdominal X-ray was taken on the seventh day. To calculate the total and segmental colonic transit time in hours, number of markers in right and left colonic and rectosigmoid area were counted and multiplied by 2.4. The mean total and segmental colonic transit time were compared between the two groups. Results A total of 100 patients (50 FC and 50 C-IBS) were enrolled. The mean (SD) total CTT was not significantly different between FC patients (52.2 [35.5] h) and C-IBS patients (41.2 [31.6] h; p = 0.10). The mean rectosigmoid transit time was significantly slower in FC patients (19.9 [15.5] h) compared to C-IBS patients (11.9 [10.6] h; p = 0.003). Conclusion Rectosigmoid transit time in FC patients is slower than in C-IBS patients.

Calcitonin Gene-related Peptide Immunoreactivity in the Muscle Layer of Small Intestine; Its Action on Interstitial Cell / 체질인류학회지

In addition to the central and the peripheral nervous system, calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) has been identified throughout the enteric nervous system. Several functions of the CGRP in gastrointestinal (G-I) tract has been identified, but the effect of CGRP on G-I motility is unclear. The distribution of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) in the murine small bowel were studied by using immunohistochemistry, also analyzed functionally by using electrophysiological method. Immunohistochemical studies demonstrated that CGRP-LI is localized in both nerve fibers and myenteric ganglion cells in the whole-mount preparation of murine small intestine. Double labelling with CGRP and c-kit investigated by confocal microscope was shown that CGRP-LI enteric nerve fiber surrounded the c-kit positive interstitial cells of Cajal (ICC). Electrophysiological finding revealed that treatment of CGRP inhibited electrical activity on culture ICC. Our results suggest a CGRP innervation of murine small bowel ICC. The released CGRP from enteric nerve terminals may induce relaxation of small bowel through the inhibition of ICC.

Comparison of Recovery of Bowel Motility after Laparoscopic-assisted and Open Surgery for Right Colon Cancer: A Study of Gastric Emptying by Using Sitz-marker(TM) and Changes of Intraperitoneal Temperature

PURPOSE: Early recovery of gastrointestinal motility is one of the main advantages of laparoscopic intestinal surgery. However, the reasons for this advantage are still not well known. To compare recovery of bowel motility after laparoscopic-assisted and open surgery for right colon cancer, we analyzed early clinical results, including both the gastric emptying time by using a Sitz-marker(TM) and the intraperitoneal temperature. METHODS: From January 1996 to December 1999, 80 curative right hemicolectomies, which were divided into a laparoscopic-assisted surgery group (LS) with 36 patients and an open surgery group (OS) with 44 patients, were prospectively, but not randomly, studied for recovery of bowel motility. Clinical results, such as the pain score, the time to gas passage, the time to resumption of meals the hospital stay and the gastric emptying time obtained by using a Sitz-markers(TM), were evaluated. At the beginning and the end of the operation, the intraperitoneal temperature was checked at three different points. RESULTS: In the LS and OS groups, the first flatus passed at the 3.0 and the 3.67 postoperative day (POD) and oral intake resumed at the 3.9 and the 5.2 POD, respectively (P0.05), 1.7 and 4.2 at the 3rd POD (P<0.05) and 0 and 1.1 at the 4th POD (P<0.05), respectively. No difference in intraperitoneal temperature was noted. CONCLUSIONS: We found earlier recovery of bowel function after laparoscopic surgery than after open surgery, but could not identify any relationship between bowel function and the possible parameter of intraperitoneal temperature.

The Effect of Morphine on Pain and Bowel Function after Colonic Surgery:Epidural Bupivacaine-morphine Versus Intravenous Patient-controlled Analgesia with Morphine / 대한마취과학회지

BACKGROUND:Gastrointestinal paralysis after abdominal surgery has long troubled both patients and surgeons. Gastrointestinal side effects still constitute a major drawback in the acute use of opioids. Choice of postoperative analgesia may affect the rate of recovery of gastrointestinal function. The purpose of the present study was to investigate the influence of intravenous and epidural morphine on recovery of bowel function and pain by measuring intestinal motility and the visual analogue scale after colon surgery. METHODS: Twenty patients undergoing colon surgery used postoperative pain contol. Patients were allocated to receive either IV PCA (patient-controlled analgesia) with morphine or CEA (continuous epidural analgesia) with 0.1% bupivacaine-0.04% morphine. Patients were assessed for pain with a visual analogue scale, and for side effects at 1, 6, 12, 24, 48 hours postoperatively. Arterial blood samples for the measurement of blood gas and plasma concentration of morphine were taken. The time to first postoperative passage of flatus and feces, length of nasogastric therapy, time to liquid, soft and solid food intake, daily and total morphine requirement and length of hospital stay were recorded. RESULTS: There were no significant differences in bowel movement outcome except in length of nasogastric therapy, but the CEA group had significantly lower pain scores and required fewer days of nasogastric therapy when compared with the IV PCA group. CONCLUSIONS: These observations indicate that IV PCA with morphine and CEA can be used to relieve postoperative pain without prolonging the recovery of bowel movements, but CEA with bupivacaine and morphine constitutes an effective means of analgesia.

The Effects of Combined Epidural-General Anesthesia and Postoperative Epidural Analgesia on Recovery of Bowel Function and Complications in Colon Surgery / 대한마취과학회지

BACKGROUND: The combination of epidural opioids and local anesthetics provides synergistic analgesia and appears to provide superior analgesia with activity. But the effects of both drugs on bowel motility are oppositional. The object of this study is to evaluate the effect of combined epidural-general anesthesia and postoperative epidural analgesia on the recovery of bowel function and on complications in colon surgery. METHODS: 84 patients were allocated to three groups. 29 patients received intraoperative epidural- general anesthesia and continuous epidural analgesia with local anesthetic-opioid for 48 hours postoperatively (Group I). Group II (n = 25) and Group III (n = 30) received intraoperative general anesthesia alone with postoperative epidural analgesia with an intramuscular injection of analgesics, respectively. We compared the pain score and side effects of these analgesic methods, recovery of bowel movements, postoperative complications and postoperative hospital stay among groups. RESULTS: Groups I and II showed better analgesic effects at rest and upon coughing when compared with Group III (P<0.05). There were no significant differences in the incidences of nausea and vomiting, pruritus, motor blockade and the recovery time of bowel movement and postoperative hospital stay among groups. The incidences of ileus/wound complication and dysrhythmia were not different, but the incidence of pulmonary complication in group I (0%) was significantly lower than in group II (12%) and III (20%) (P<0.05). CONCLUSIONS: Combined epidural-general anesthesia and postoperative epidural analgesia results in decreases in the pain score and in the incidence of pulmonary complication. Moreover, epidural analgesia using local anesthetic and opioid does not affect side effects, recovery time of bowel motility, incidences of ileus/wound and dysrhythmia complications.