Up-regulated cystic fibrosis transmembrane conductance regulator after anal stenosis in rats.

BACKGROUND: The pathophysiology of fecal incontinence from fecal impaction and rectal distension is poorly understood. We hypothesize that fecal impaction elicits up-regulation of cystic fibrosis transmembrane conductance regulator (CFTR), a cAMP-activated mucosal chloride channel. METHODS: The anus was ligated to produce 75% stenosis in rats. Controls received ligation without inducing stenosis. 24 to 48 hours after ligation the colon was removed. Mucosal short-circuit current was measured by Ussing chamber. Western blot analysis was used to detect CFTR expression in the colonic mucosa. Ligated rats failed to defecate, whereas control rats stooled normally. RESULTS: Ligated colons were markedly stool filled and dilated. Water content of feces was significantly increased to 66.5% ± 1.1% (P < .01, n = 12) 24 hours after ligation, vs controls (49.5 ± 5.2%, n = 12). Baseline short-circuit current was significantly increased in the distal (78.8 ± 7.4 µA/cm(2), n = 8, P < .01) and mid colon (24.5 ± 2.5 µA/cm(2), n = 8, P < .05) 24 hours after ligation, compared to control rats (12.5 ± 3.2 µA/cm2, n = 8). CFTR expression was significantly increased 24 hours after ligation in the mid and distal colon. CONCLUSION: We observe that fecal impaction from anal ligation induces early compensatory up-regulation of CFTR, altering function from net absorption to net secretion in the mid and distal colon.

Bacterial overgrowth and methane production in children with encopresis.

OBJECTIVES: To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis. STUDY DESIGN: Radiographic fecal impaction (FI) scores were assessed in children with secondary, retentive encopresis and compared with the breath test results. Breath tests with hypoosmotic lactulose solution were performed in both the study patients (n = 50) and gastrointestinal control subjects (n = 39) groups. RESULTS: The FI scores were significantly higher in the patients with encopresis who were methane producers (P < .01). SIBO was diagnosed in 21 of 50 (42%) patients with encopresis and 9 of 39 (23%) of control subjects (P = .06). Methane was produced in 56% of the patients with encopresis versus 23.1% of the control subjects in the gastrointestinal group (P < .01). Fasting methane level was elevated in 48% versus 10.3 %, respectively (P < .01). CONCLUSIONS: Children with FI and encopresis had a higher prevalence of SIBO, elevated basal methane levels, and higher methane production. Methane production was associated with more severe colonic impaction. Further study is needed to determine whether methane production is a primary or secondary factor in the pathogenesis of SIBO and encopresis.

The relationship between stool hardness and stool composition in breast- and formula-fed infants.

"Constipation" and "hard stools" are associated with formula feeding of both term and preterm infants and, in the latter, can lead to life-threatening complications. This study tested the hypothesis that stool hardness is related to excretion of fatty acid (FA) soaps in term infants, and in the extreme to milk bolus obstruction in premature infants. Stools (n = 44) were collected from 20 formula-fed and 10 breast-fed infants aged 6 weeks and were classified using visual charts for stool hardness on a 5-point scale (1, watery; 5, hard). Stools were analysed for nitrogen, minerals, and lipid, the latter divided between the soap and nonsoap fractions. We explored the relationship between stool hardness or solids content and stool constituents, relative to both wet and dry weight. Calcium and FA soaps were the dominant factors significantly related to stool solids and hardness score across the breast- and formula-fed groups. An 8% increase in stool dry weight FA soap content corresponded to a 1-point change in stool hardness score. Stools from formula-fed infants had a higher solids content and were classified as significantly harder than those from breast-fed infants (hardness scores, 4.0 +/- 0.5 versus 2.6 +/- 0.7, mean +/- SD) and on both a wet- and dry-weight basis contained severalfold higher levels of minerals and lipid and considerably less carbohydrate. Differences in lipids between formula- and breast-fed infants' stools were due almost entirely to FAs (mainly C16:0 and C18:0) excreted as soaps (27.7 +/- 7.5% compared to 3.1 +/- 4.1% of dry weight), suggesting the groups differed markedly in their handling of saturated FAs. An inspissated stool sample from a premature infant requiring surgical disempaction of an obstructed small intestine was found to be enriched in FA and calcium relative to the preterm formula. FA soaps, predominantly saturated, accounted for one third of the stool dry weight. These data support the hypothesis that calcium FA soaps are positively related to stool hardness; we speculate that this may, at least in part, explain the greater stool hardness in formula- versus breast-fed infants and milk bolus obstruction in preterm infants. This conclusion is consistent with the physical properties of calcium FA soaps.

Absorption of paracetamol from suppositories in geriatric patients with fecal accumulation in the rectum.

The bioavailability of paracetamol from suppositories was studied in 16 geriatric in-patients in stable clinical condition; 9 had significant amounts of feces in the rectum. Rectal accumulation of feces reduced the peak plasma paracetamol concentration by 32% (p = 0.05) and the AUC0-8h by 27% (p = 0.04). The peak concentration, however, appeared earlier among patients with rectal accumulation of feces. Compared to findings in 6 healthy young controls, geriatric patients had higher plasma concentrations of the main paracetamol metabolites.

[Coprolith-ileus of the small intestine]. / Kotstein-Ileus des Dünndarms

The case of a 71 year old man is reported, in which coproliths developed in the small intestines over a period of 13 years and which finally lead to a complete ileus. This condition is discussed in connection with other rare forms of ileus; specific clinical phenomena are pointed out, which might be helpful in establishing a correct diagnosis. Among the transient forms of ileus associated with food intake, which may cause the patient only slight discomfort, one should bear in mind a corpus alienum-ileus. Only operative therapy of ileus is promising success.