Alterations of digestive motility after bariatric surgery.

Bariatric surgery can induce changes in digestive motility that are de novo or secondary to an improvement or aggravation of previous disorders due to obesity. Alterations of digestive motility are frequently part of the mechanism of action and a result of surgery. They are not rare and they are not always associated with an increase in weight loss but can lead to the negative consequences on quality of life, which are more or less reversible as a real surgical complication. Knowledge of these complications has become essential, especially in this period when bariatric surgery often concerns patients who have already undergone an operation. Thus, the changes in digestive motility after bariatric surgery and the complications that may result from them must be known and considered to adapt surgical techniques to each patient, both in the case of a first intervention and in the case of a reoperation, which is becoming more and more frequent. The objective of this review is to synthesize alterations of esophageal and gastro-intestinal motility secondary to bariatric surgical procedures.

Pathophysiology and management of opioid-induced constipation: European expert consensus statement.

Background: Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options. Objective: The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice. Methods: This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. Results: The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed. Conclusion: Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.

LAXATIVE EFFECT OF RHEUM UNDULATUM L. EXTRACT ON LOPERAMIDE INDUCED CONSTIPATION IN WISTAR RATS / Монголын эм зүй, эм судлал

Introduction: Constipation is highly prevalent, often chronic gastrointestinal disorder that affects adults. The treatment with classic drugs did not cut, in one hand with the inadequate relief of bloating and other symptoms, and with the luck of efficacy in relieving constipation. Therefore, the search for novel safe laxative drugs seems, inevitable. Rheum undulatum L. was traditionally used in constipation, thus we have attempted to evaluate the laxative effect of Rheum undulatum L. Purpose: The laxative effect of Rheum undulatum L. was evaluated against loperamide induced constipated rats. Methodology: Fifteen male normal rats were used in this study. Fifteen male constipated wistar albino rats weighing 180-250 g were also used for the study and randomized into three groups (n=5) in each of the experiments. Constipated control group rats oral administrated distilled water. Constipated rats (treatment groups) were treated with 4.1 mg/kg dose body weight /day of the preparation for one day and also Laxing a standard drug was used for the reference group. The fecal weight, the fecal humidity laxative activity were monitored in experimental rats.Results: Constipation was successfully induced in the rats by loperamide as seen in the elevated fecal properties compared to the control rats. The Rheum undulatum L. compounds preparation administered orally produced significant laxative activity and reduced loperamide induced constipation in dose dependent manner as seen in the increase of fecal output. The same doses of the Rheum undulatum L. compounds preparation produced a significant increase (P<0.05) fecal weight, the faeces humidity. The effect of the compounds preparation compares favourably well with Laxing, a standard laxative drug. Conclusion: The results of this study justify the use of Rheum undulatum L. compounds preparation as a laxative in traditional medicine. The produced significantly increase in fecal output of rats and the stimulation of gastrointestinal motility. Keywords: Laxative, gastro intestinal motility, loperamide, constipated

Laxative effect of Rheum undulatum L. Extract on loperamide induced constipation in wistar rats / Монголын эм зүй, эм судлал

Introduction@#Constipation is highly prevalent, often chronic gastrointestinal disorder that affects adults. The treatment with classic drugs did not cut, in one hand with the inadequate relief of bloating and other symptoms, and with the luck of efficacy in relieving constipation. Therefore, the search for novel safe laxative drugs seems, inevitable. Rheum undulatum L. was traditionally used in constipation, thus we have attempted to evaluate the laxative effect of Rheum undulatum L.@*Purpose@#The laxative effect of Rheum undulatum L. was evaluated against loperamide induced constipated rats.@*Methodology@#Fifteen male normal rats were used in this study. Fifteen male constipated wistar albino rats weighing 180-250 g were also used for the study and randomized into three groups (n=5) in each of the experiments. Constipated control group rats oral administrated distilled water. Constipated rats (treatment groups) were treated with 4.1 mg/kg dose body weight /day of the preparation for one day and also Laxing a standard drug was used for the reference group. The fecal weight, the fecal humidity laxative activity were monitored in experimental rats.@*Results@#Constipation was successfully induced in the rats by loperamide as seen in the elevated fecal properties compared to the control rats. The Rheum undulatum L. compounds preparation administered orally produced significant laxative activity and reduced loperamide induced constipation in dose dependent manner as seen in the increase of fecal output. The same doses of the Rheum undulatum L. compounds preparation produced a significant increase (P<0.05) fecal weight, the faeces humidity. The effect of the compounds preparation compares favourably well with Laxing, a standard laxative drug. @*Conclusion@#The results of this study justify the use of Rheum undulatum L. compounds preparation as a laxative in traditional medicine. The produced significantly increase in fecal output of rats and the stimulation of gastrointestinal motility.

Plasticity of Interstitial Cells of Cajal (ICC) and Intestinal Motility in Murine Small Bowel Obstruction / 체질인류학회지

Interstitial cells of Cajal (ICC) are the pacemakers in gastrointestinal slow wave, and also transduce signal inputs from the enteric nervous system to smooth muscle. The abnormal motility corresponded to a lack or decreasing of ICC and a disruption of electrical slow waves. So we developed partial obstruction model in murine small intestine, and found that ICC and electrical slow wave were absent or decreased oral to the occlusion site in previous study. In an additional series of experiments, we examined the ability of tissue regenerate the ICC phenotype and normal electrical slow waves after surgical treatment to relieve the mechanical obstruction, and the animals were allowed to recover for 1~2 months. Removal of the obstruction led to the normal gross appearance and the redevelopment of ICC and recovery of slow wave activity within 30 days. These data demonstrate the plasticity of ICC networks in response to partial obstruction, and suggest that adult tissue retain the ability to regenerate functional ICC. This model may be useful for estimating molecular factors responsible for the regulation of the ICC phenotype. More work is needed to find out the factors in ICC for the therapy of intestinal motility disorders.

Morphology of the c-Kit-Immunoreactive Interstitial Cells of Cajal (ICC) in the Mouse Intestine / 대한해부학회지

Interstitial cells of Cajal (ICC) are the pacemalkers in gastrointestinal muscles, and these cells also mediate or transduce inputs from the enteric nervoius system. Immunolabelling of interstitial cells of ICC in intestinal wall is recently developed by using specific marker, anti-c-kit antibody. Immunohistochemistry was done for c-Kit-positive ICC network in attempt to provide a morphological basis for the mechanism regulating gastro-intestinal movement. Cryosection and whole-mount preparations of mouse ileum and colon were immunolabelled using the anti-c-Kit. Immunolabelled specimens were observed under a confocal laser scanning microscopy. According to three dimensional reconstruction study, it was found that the c-Kit-positive cells were widely distributed in the intestinal wall: (1) circular muscle layer, (2) myenteric plexus, (3) deep muscular plexus in ileum, (4) submucosal plexus and longitudinal muscle layer in colon. The characteristic profiles of ICC containing c-Kit-positive cells provide a morphological basis upon the mechanism regulating gastro-intestinal motility.