Does the Oral-Anal Transit Test Correlate with Colonic Manometry Findings in Children with Refractory Constipation? / 대한소아소화기영양학회지

PURPOSE: The Oral-anal Transit Test (OTT) is a simple method of obtaining information about colonic transit. We aim to assess the correlation of OTT with the neuromuscular integrity of the colon determined by colonic manometry (CM).METHODS: All patients who had OTT followed by CM were evaluated. Less than 6 of 24 markers remaining on OTT was considered normal. CM was performed per previously published guidelines. A normal CM was defined as at least one High Amplitude Propagating Contraction progressing from the most proximal sensor through the sigmoid colon.RESULTS: A total of 34 patients underwent both OTT and CM (44% male, age 4–18 years, mean 11.5 years, 97% functional constipation +/− soiling, Hirschsprung's Disease). Of normal and abnormal OTT patients, 85.7% (6/7) and 18.5% (5/27) respectively had normal CM. When all markers progressed to at least the sigmoid colon, this was 100% predictive against colonic inertia. Greater than 50% of patients with manometric isolated sigmoid dysfunction had markers proximal to the recto-sigmoid.CONCLUSION: OTT and CM are both valuable studies that assess different aspects of colonic function. OTT can be used as a screening test to rule out colonic inertia. However, the most proximal extent of remaining markers does not predict the anatomical extent of the manometric abnormality, particularly in isolated sigmoid dysfunction.

Changes of vasocative intestinal peptide neurons in the myenteric plexus of gastric antrum in rats with se-vere acute pancreatitis / 医学研究生学报

Objective Patients with severe acute pancreatitis ( SAP) always suffer decrease in gastrointestinal motility , even gastrointestinal failure.The article aimed to investigate the changes of vasoactive intestinal peptide (VIP) in the myenteric plexus of the gastric antrum in rats with severe acute pancreatitis ( SAP) complicated by gastrointestinal dysmotility . Methods Twenty Sprague Dawley rats were randomly allocated into two groups:control group and SAP group .Acute pancreatitis was induced by intraductal infu-sion of 5%sodium taurodeoxycholate .24 h after operation , records were made on pathological evaluation of pancreatic lesion , amylase, C-reactive protein ( CRP) , gastric emptying rate and the percentage of VIP neurons in the total neurons . Results Compared with the control group, the gastric emptying rate in the SAP group was significantly lower ([31.49 ±3.96]% vs [70.99 ±1.82]%).The score of pancreatic lesion, amylase, CRP and the percentage of VIP neurons was significantly higher ([14.63 ±1.06]score vs [1.60 ± 0.52]score, [2061.25 ±434.86]U/L vs [360.20 ±30.29]U/L, [140.10 ±17.07]μg/mL vs [35.71 ±6.43]μg/mL, [22.45 ± 4.10]%vs [10.72 ±1.92]%)(P<0.05). Conclusion Plas-ticity took place in VIP neurons in the myenteric plexus of gastric an-trum in rats with SAP complicated by gastrointestinal dysmotility , which was connected with neural mechanism underlying SAP compli-cated by gastrointestinal dysmotility .

Constipação intestinal / Constipation

A constipação intestinal acomete cerca de 20% da população mundial e constitui um dos sintomas mais frequentes de procura ao médico. É mais comum em mulheres e idosos e se encontra entre as doenças funcionais do intestino. Pode ser referida pelo paciente como fezes endurecidas, esforço excessivo no ato evacuatório, evacuações infrequentes ou sensação de evacuação incompleta. Subdivide-se em primária e secundária, tendo essa última causa bem definida, como doenças endócrinas e neurológicas ou uso inadvertido de substâncias obstipantes. É importante orientarmos nossos pacientes para a necessidade de uma dieta rica em fibras e de uma hidratação adequada. O manejo farmacológico pode incluir suplementação de fibras, laxativos osmóticos, emolientes e laxativos irritativos

Constipation occurs in about 20% of the world population and it is a common reason for seeking medical attention. It is more common in women and in the elderly and may be part of a generalized gastrointestinal dysmotility syndrome. Patients may define constipation as hard stools, excessive straining, infrequent stools, or a sense of incomplete evacuation. There are two main types of constipation - primary or secondary, the latter caused by systemic disorders such as endocrine disorders, neurologic dysfunction, or as a side effect of medications. Proper dietary fiber and fluid intake should be emphasized. Pharmacologic management of constipation may include fiber laxatives, osmotic laxatives, stool surfactants, or stimulant laxatives

Efficacy of erythromycin on the functional gastrointestinal dysmotility in neonates / 中国小儿急救医学

Objective To assess the efficacy of oral erythromycin on the functional gastrointestinal dysmotility in neonates.Methods In this double-blind,randomized,placebo controlled trial,90 neonates consecutively admitted to the neonatal intensive care unit of Shenzhen Children's Hospital from Jan 2009 to Dec 2011 were enrolled and randomly divided into low-dosage erythromycin group ( LE group,n =30 ),highdosage erythromycin group ( HE group,n =30 ) and control group ( n =30).Patients received either erythromycin ( 3 mg/kg or 10 mg/kg) or equivalent normal saline with oral or nasal feeding every 8 hours one time for 14 d.The time to achieve half,three-quarters,and full enteral nutrition,the time of parenteral nutrition,and hospital length of stay were compared among each group.Results The time to achieve half,three-quarters,and full enteral nutrition in HE group [ ( 3.0 ± 0.5 ) d,( 6.2 ± 0.7 ) d,( 8.2 ± 1.0 ) d ] and in LE group [(6.2±0.5) d,(8.3 ±0.6) d,(10.6 ±1.1) d] were shorter than that in control group [(8.1 ±0.4) d,( 13.5 ± 1.0) d,( 15.7 ± 1.2) d] ( P ＜ 0.05 ).The duration of parenteral nutrition [ ( 14.2 ± 1.4) d vs (9.3 ± 1.2) d vs (7.8 ± 1.1 ) d ] and hospital length of stay [ ( 13.0 ± 1.4 ) d vs ( 8.1 ± 0.8 ) d vs ( 6.8 ±0.7) d] were significantly prolonged in control group compared with LE and HE groups,and there were significant differences among the three groups ( P ＜ 0.05).The incidence of liver injury and septicemia during the treatment of erythromycin were similar between HE group and LE group,but it was significantly lower than control group.No serious adverse effect such as prolongation of QT intervals,dysrhythmia associated with erythromycin treatment was found.Conclusion Oral erythromycin can be considered as a treatment for neonates with functional gastrointestinal dysmotility who fail to establish adequate enteral nutrition,and highdosage oral erythromycin is more effective than low-dosage.