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.

Effects of a Patient Educational Video Program on Bowel Preparation Prior to Colonoscopy

PURPOSE: The purpose of this study was to evaluate the effects of an educational video program on bowel preparation for a colonoscopy. METHODS: The study used a non-equivalent control group and non-synchronized design as a quasi-experimental research involving 101 participants undergoing bowel preparation for a colonoscopy (experimental group 51, control group 50 subjects) at W. university hospital, from Aug. 7 to Oct. 31, 2013. The control group received verbal education with an explanatory note while the experimental group received education using a video program. To measure knowledge of diet restrictions and compliance with ingesting bowel preparation solutions, a questionnaire, based on The Korean Society of Gastrointestinal Endoscopy's Guide (2003), developed by Sam-Sook You, was used after revisions and supplementation was done. To measure bowel cleanness, the 'Aronchick Bowel Preparation Scale' was adopted. Data were analyzed using the SPSS WIN 12.0 program. RESULTS: A higher proportion of the experimental group showed a positive change in knowledge level on diet restrictions (U=1011.50, p=.035) and ingestion of bowel preparation solutions (U=980.50, p=.019), a higher level of compliance with diet restrictions (U=638.50, p<.001), ingesting bowel preparation solutions (U=668.00, p<.001) and the level of bowel cleanness (chi2=17.00, p<.001) than the control group. CONCLUSION: The results of this study indicate that a video educational program for patients having a colonoscopy can improve knowledge, level of compliance with diet restrictions, ingestion of bowel preparation solutions, and bowel cleanness. Therefore video educational program should be used with this patient group.

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.

Tissue quantification of neutral and acid mucins in the mucosa of the colon with and without fecal stream in rats / Quantificação tecidual de mucinas neutras e ácidas na mucosa do cólon com e sem trânsito intestinal em ratos

PURPOSE: To quantify the intensity of the expression of neutral and acids mucins in mucosa of the colon with and without fecal stream and to correlate this with the duration of fecal transit diversion. METHODS: Thirty male Wistar rats were subjected to fecal transit deviation in the left colon by a proximal colostomy and a distal mucous fistula. The animals were divided into three experimental groups, according to whether sacrificing would be performed six, 12 or 18 weeks after surgery. The expression of neutral and acid mucins was evaluated using the histochemical techniques of Periodic Acid Schiff and Alcian Blue, respectively. The tissue mucins expression was quantified by computer-assisted image analysis software (NIS-Elements) in the segments with and without fecal stream. Student's paired t test was used to compare the quantities of mucins in colon with or without fecal stream and variance between the experimental groups by ANOVA and Newman-Keuls post-test, establishing level of signification of 5 percent (p<0.05). RESULTS: There were significant decreased quantities of acid and neutral mucins in the colon without transit, compared with the colon with fecal stream, independent of the duration of exclusion. There was increased expression of neutral mucins in the colon with fecal stream after 12 and 18 weeks of exclusion. There was no increase in the expression of acid mucins in the colon with transit as the duration of fecal transit exclusion progressed. There was increased production of acid mucins in the animals submitted to diversion of the fecal stream for 18 weeks, compared with those subjected to diversion for 6 and 12 weeks. In the colon without fecal stream, there was increased expression of neutral mucins after 12 and 18 weeks of exclusion. CONCLUSIONS: Deviation of the fecal stream decreased the expression of acid and neutral mucins in the segments without fecal transit, compared with segments with transit. Regardless of ...

OBJETIVO: Quantificar a intensidade de expressão de mucinas neutras e ácidas na mucosa cólica provida e desprovida de trânsito intestinal relacionando-a ao tempo de exclusão fecal. MÉTODOS: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, 12 e 18 semanas após a cirurgia. A avaliação da expressão de mucinas neutras e ácidas na mucosa cólica foi realizada com as técnicas histoquímicas do Periódico Ácido de Schiff e Azul de Alcian, respectivamente. A quantificação da expressão tecidual das mucinas foi com auxílio de programa de análise de imagem assistida por computador (NIS-Elements) nos segmentos providos e desprovidos de trânsito fecal. Utilizou-se o teste t de Student pareado na comparação da expressão de mucinas nos segmentos com e sem trânsito e a variação na expressão entre os grupos experimentais pelo teste ANOVA e pós-teste de Newmann-Keuls, estabelecendo-se nível de significância de 5 por cento (p<0,05). RESULTADOS: Houve redução na quantidade de mucinas neutras e ácidas no cólon desprovido de trânsito quando comparado ao cólon provido de trânsito, independente do tempo de exclusão. Ocorreu aumento na expressão de mucinas neutras no cólon provido de trânsito intestinal após 12 e 18 semanas de exclusão. Não houve aumento na expressão de mucinas ácidas no cólon provido de trânsito com o progredir do tempo exclusão de trânsito fecal. Ocorreu aumento na produção de mucinas ácidas nos segmentos com exclusão de trânsito por 18 semanas quando comparados aos animais submetidos à exclusão por seis e 12 semanas. No cólon desprovido de trânsito ocorreu aumento na expressão de mucinas neutras após 12 e 18 semanas de exclusão. CONCLUSÕES: A derivação do trânsito fecal diminui a expressão de mucinas ácidas e neutras nos segmentos desprovidos de trânsito fecal ...

Lipoma de ciego / Cecum lipoma

Los lipomas del colon ocupan el tercer lugar en frecuencia de aparición de tumores benignos. Estos tumores están formados por tejido adiposo bien diferenciado con un estroma fibroso. La gran mayoría de estos lipomas son asintomáticos, algunos en raras ocasiones presentan complicaciones de urgencia. El fin de esta publicación es presentar un caso de enterorragia y dolor abdominal por un lipoma a nivel del ciego.

A spectral analysis of the myoelectric activity of the left colon in patients with schistosomiasis mansoni

The objective of the present study was to perform a spectral analysis of the electrical activity of the left colon of patients with hepatosplenic schistosomiasis. Thirty patients were studied, divided into 2 groups: group A was composed of 14 patients (9 males and 5 females) with hepatosplenic schistosomiasis and group B was composed of 16 female patients without schistosomiasis mansoni. Three pairs of electrodes were implanted in the left colon at the moment of the surgical treatment. The signals of the electric activity of the colon were captured after postoperative recovery from the ileus and fed into a computer by means of a DATAQ data collection system which identified and captured frequencies between 0.02 and 10 Hz. Data were recorded, stored and analyzed using the WINDAQ 200 software. For electrical analysis, the average voltage of the electrical wave in the three electrodes of all patients, expressed as millivolts (mV), was considered, together with the maximum and minimum values, the root mean square (RMS), the skewness, and the results of the fast Fourier transforms. The average RMS of the schistosomiasis mansoni patients was 284.007 mV. During a long period of contraction, the RMS increased in a statistically significant manner from 127.455 mV during a resting period to 748.959 mV in patients with schistosomiasis mansoni. We conclude that there were no statistically significant differences in RMS values between patients with schistosomiasis mansoni and patients without the disease during the rest period or during a long period of contraction.

Análise tensional e morfológica da anastomose colônica na colite induzida por ácido acético a 10 por cento, em ratos Wistar, tratados com extrato aquoso de aroeira-do-sertão a 10 por cento (Myracrodruon urundeuva fr. all.) / Tensional and morphologic analysis of the colonic anastomosis on 10 percent acetic acid induced colitis, in Wistar rats, treated with 10 percent aroeira-do-sertão (Myracrodruon urundeuva fr. all.) aqueous extract

OBJETIVO: Verificar, do ponto de vista tensional e morfológico, o efeito do extrato aquoso de aroeira-do-sertão a 10 por cento na anastomose colônica, na vigência de colite induzida por ácido acético a 10 por cento, em ratos Wistar. MÉTODOS: Foram utilizados 48 ratos da linhagem Wistar, distribuídos em dois grupos. Todos os animais foram submetidos à indução da colite por solução aquosa de ácido acético a 10 por cento. Vinte e quatro horas após, os animais foram submetidos à laparotomia, colotomia transversa total e anastomose término-terminal com fio de polipropileno 5-0. Grupo A (veículo), animais tratados com veículo à base de carboximetilcelulose. Grupo B (aroeira), animais tratados com extrato aquoso de aroeira a 10 por cento. Ambos tratamentos foram sob a forma de enema. Os grupos A e B foram distribuídos em subgrupos A3, A7, A14 e A21; B3, B7, B14 e B21, respectivamente, conforme a data prevista para a eutanásia (3, 7, 14 e 21 dias). Nas respectivas datas, os animais foram relaparotomizados, o segmento colônico contendo a anastomose foi ressecado, submetido ao teste de pressão e em seguida à análise histológica. Para o estudo morfológico, as lâminas foram coradas com hematoxilina-eosina e avaliou-se a condição de cicatrização baseado numa tabela de escores que variava de 0 a 16. Quanto maior o escore melhor o grau de cicatrização. RESULTADOS: Na avaliação do estudo morfológico, que quantifica a evolução e o grau de cicatrização, como resultado final do processo cicatricial, o grupo aroeira foi superior ao grupo veículo (p<0,05) no vigésimo primeiro dia, mostrando maior rapidez na reparação tecidual que se dá por regeneração e não por fibrose. Com relação ao teste de tensão, houve diferença estatisticamente significante no dia 3, com predominância do grupo aroeira sobre o grupo veículo (p<0,05). CONCLUSÃO: O extrato aquoso de aroeira-do-sertão a 10 por cento, tem atividade cicatrizante na anastomose colônica na vigência de colite induzida por ácido acético a 10 por cento. Melhora a resistência à tensão na zona da anastomose colônica no 3° dia.

study of age associated changes in the mouse colon

The aim of the present work was to demonstrate any age associated changes in the colon. Forty mice were used in this study with different ages. The mice were divided into four groups aged 1, 2, 12 and 24 months. Light microscopic [LM] and scanning electron microscopic [SEM] examination as well as statistical analysis of the results were done. It was found that in old aged mice [12 and 24 months], there was an apparent decrease in the number of goblet cells and a marked increase in the amount of collagenous fibres compared to the young aged mice [1 and 2 months]. Statistical analysis showed a significant increase in the outer diameter and length of the crypts in old aged mice. In addition, a significant decrease in the nerve cell number of Auerbach' s plexus was also recorded. Using SEM many black spots as well as epithelial denuded areas were also observed in old mice. It was concluded that the observed decrease in goblet cells number, number of neurons and in muscle wall thickness with an increase in deposition of collagen fibres in old-aged mice probably contribute to colon dysfunctions in elderly

Dietary fiber intake, stool frequency and colonic transit time in chronic functional constipation in children

The objective of the present study was to evaluate associations between fiber intake, colonic transit time and stool frequency. Thirty-eight patients aged 4 to 14 years were submitted to alimentary evaluation and to measurement of colonic transit time. The median fiber intake of the total sample was age + 10.3 g/day. Only 18.4 percent of the subjects presented a daily dietary fiber intake below the levels recommended by the American Health Foundation. In this group, the median left colonic transit time was shorter than in the group with higher dietary fiber intake (11 vs 17 h, P = 0.067). The correlation between stool frequency and colonic transit time was negative and weak for left colon (r = -0.3, P = 0.04), and negative and moderate for rectosigmoid and total colon (r = -0.5, P<0.001 and r = -0.5, P<0.001, respectively). The stool frequency was lower in the group with slow transit time (0.8 vs 2.3 per week, P = 0.014). In conclusion, most patients with chronic functional constipation had adequate dietary fiber intake. The negative correlation between stool frequency and colonic transit time increased progressively from proximal segments to distal segments of the colon. Patients with normal and prolonged colonic transit time differ in terms of stool frequency

Towards a better oral rehydration fluid.

Improvements in characteristics of solutions used for oral rehydration therapy, to provide significant reductions in amount and duration of diarrhea, are expected to contribute to wider use of these fluids. Recent studies suggest that these may come about from reducing the osmolality of the solution, and by providing short chain fatty acids for better fluid absorption from the colon. This article briefly reviews the physiology of intestinal and colonic absorption in diarrhea, and indicates the further studies that are needed to translate the above advances into universal practice for the treatment of diarrhea.

A modified radiographic method for estimating segmental colonic transit time in subjects with rapid gut transit.

In this study on Indian subjects, the single X-ray method was assessed for its reliability in measuring the transit of particulate matter through the colon, and if inaccurate a suitable and simple alternative was to be devised. Radio-opaque markers were serially followed in 20 normal male volunteers. This was done by three 12 hourly radiographs and by stool collection to determine the transit time through the colon and its segments. It was compared with similar parameters calculated from the same data using one radiograph and three combinations of two radiographs each. The mean +/- SD colonic transit time determined by using three X-rays was 18.0 +/- 6.6 h which agreed well with the mean mouth-to-anus transit time of 24.2 +/- 6.8 h (mean +/- SDdiff = -6.2 +/- 2.9). When two of the three X-rays were used in various combinations, the best results were obtained with the method including radiographs at 12 and 36 h. Parameters calculated from a single radiograph done 36 h after the ingestion of makers showed lesser agreement with the results of the three radiograph method. Therefore in subjects with rapid gut transit, the simplified method for estimating the colonic and segmental transit times using a single X-ray is inaccurate. Using two radiographs enhances the accuracy.

Estudio de la motilidad colónica (tránsito colónico con marcadores y test de expulsión de balón intrarrectal)

Objetivo: Evaluar, en población normal y con estreñimiento, las características de la motilidad colónica, por medio del estudio del tránsito colónico con marcadores (segmentos de catéter de Swan Ganz) y el Test de expulsión de Balón Intrarrectal. Método: Se llevó a cabo un estudio prospectivo observacional. Inicialmente estudiamos 51 voluntarios sanos, es decir más de tres deposiciones a la semana y sin síntomas gastrointestinales. Luego de recibir por una semana dieta con abundante fibra, tomarón por vía oral 20 segmentos de catéter de 6mm de longitud, distribuidos en 4 cápsulas. A las 48 y 72 horas se les realizó radiografías de abdomen simple. A 16 de estos pacientes se les realizó un test de expulsión de balón intrarrectal (Sonda de Nelaton más Pen Rose), distendiendolo con 50 c/c de SSN. Se contabilizó el tiempo de expulsión rectal en minutos, considerando anormal un tiempo mayor de 5 minutos. Dentro del grupo de los 51 pacientes sanos se establecieron parámetros de normalidad. Un segundo grupo de estudio de 51 pacientes con estreñmiento crónico (promedio de edad: 36, rango 17-56, 76 por ciento de mujeres) se dividio en dos, de acuerdo a sus características clínicas. Grupo 1- Estreñidos sin sindrome de intestino Irritable (25 pacientes, promedio de edad 34, rango: 18-56 años, 84 por ciento de mujeres). Grupo II- Estreñidos con sindrome de Intestino irritable (26 pacientes, promedio de edad:33, rango 17-55 años, 69 por ciento de mujeres): A estos grupos se les realizó las mismas pruebas que al grupo de los sanos. Resultados. El 94 por ciento de los pacientes sanos expulsaron el tota de los marcadores antes de las 72 horas (I.C 95 por ciento considerando un error del 9 por ciento. Los 51 pacientes sanos expulsaron la totalidad de los marcadores a las 72 horas. El test de expulsión de balón fue menor de 3.5 minutos en todos los voluntarios sanos...

Wheat bran -but not oat bran- enriched diets increase the mucosal height of the cecum and colon of newly weaned and aged rats

The effect of diets enriched with oat or wheat bran (prepared by the addition of 300 g of each fiber to 1000 g of the regular diet), given for 8 weeks, on the mucosal height of the colon and cecum was investigated. Newly weaned (21 days old) and aged (12 months old) male Wistar rats were used in this study. As compared to controls, diets enriched with wheat bran provoked a significant increase in the mucosal height, whereas oat bran did not cause any effect. In newly weaned rats (21 days old), wheat bran increased the mucosal height (mum) in the cecum by 20 per cent (mean + SEM for 8 rats; 169.1 + 5.2 and 202.9 + 8.0 for control and wheat bran, respectively) and in the colon (218.8 + 7.2 and 264.5 + 18.8 for control and wheat bran, respectively). A similar effect was observed in aged rats (12 months old), with an increase of 15 per cent in the mucosal height (mum) of the cecum (mean + SEM of 8 rats; 193.2 + 8.6 and 223.7 + 8.3 for control and wheat bran, respectively) and of 17 per cent in the colon (300.4 + 9.2 and 352.2 + 15.9 for control and wheat bran, respectively).

Padrao mioelétrico do cólon esquerdo em portadores de esquistossomose manônica na forma hepatoesplênica / Standard myoeletric activity in patients with hepatosplenic mansonic schistosomiasis

O granuloma esquistossomótico determina lesSes anatomopatológicas a nível dos plexos mioentéricos e submucoso do trato gastrointestinal, secundárias a reaçSes imunológicas. Essas lesSes podem produzir alteraçSes da mortalidade intestinal. o objetivo deste estudo foi determinar o padrÝo da atividade mioelétrica do cólon esquerdo em pacientes esquistossomoticos. Eletrodos bipolares cobertos por Téflon (fio de marcapasso) foram implantados a nível de tênia anterior do cólon esquerdo, em número de três pares, distando cinco centímetros um do outro, estando o último eletrodo a vinte centímetros da reflexÝo peritoneal. Após a recuperaçÝo do íleo paralítico pós-operatório,iniciou-se o precesso de coleta de dados. Foi utilizado um sistema de aquisiçÝo de dados (DATA Q Série 200), que capta frequência entre 0,02 a 10Hz. Os sinais foram amplificados com um ganho de 1000 vezes, e armazenados em disquetes, utilizando-se um softwere de aquisiçÝo (WINDAQ 200), que roda em ambiente windows. As frequencias situadas abaixo de 0,3HZ sÝo selecionadas para a atividade elétrica de controle (AEC) e as frequencias entre 0,7 e 10 HZ selecionadas para a atividade elétrica de resposta(AER). Os resultados obtidos evidenciaram uma AEC com predomínio de baixa frequência. Conclui-se que os portadores de esuistossomose hepatoesplênica apresentam um percentual de AEC de baixa frequência de 97,1+- 3,4. Uma AER de curta duraçÝo com número de 96,6 +- 30,5 n/h e duraçÝo média de AER de 2,12 +- 0,55s. A AER de longa duraçÝo foi de 8,1 +- 8,5 n/h e duraçÝo média de AER 12,4 +- 2,3s

Manejo nutricional y dietético del paciente ostomizado / Nutritional and dietary management of the patient with colostomy

Antes de analizar la dieta y el manejo nutricional de los pacientes sometidos a yeyunostomías se revisan los principales aspectos de la fisiología intestinal, lo mismo que la fisiopatología de los intestinos delgado y grueso, haciendo especial énfasis en el llamado síndrome de intestino corto. Estas guías dietéticas y nutricionales deben observarse con cuidado si se quiere mejorar el estado general y la calidad de vida de los pacientes ostomizados.

A propósito da renovaçäo do epitélio intestinal: II. Fatores intraluminais, sistêmico, influências neurovasculares e adaptaçäo pós-operatório, no cólon / Renewal of colonic intestinal epithelium: II. Action of intraluminal, systemic, neurovascular factors and postoperative adaptation

Vários estudos têm sido realizados com o objetivo de melhor determinar os múltiplos mecanismos envolvidos no precesso de renovaçäo do epitélio intestinal. Alguns fatores säo conhecidamente participantes deste fenômeno. Entretanto, existem inúmeras pesquisas com resultados contraditórios sobre o assunto, especialmente no que se refere ao cólon. Os autores fazem uma análise comparativa da participaçäo dos principais fatores atuantes no processo da renovaçäo epitelial colônica, associando condiçöes fisiológicas e/ou patológicas. O objetivo é para tentar elucidar algumas dúvidas, entre as inúmeras existentes, para melhor compreensäo de certas entidades mórbidas que, de maneira contumaz, assentam-se no intestino grosso