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Translational Gastroenterology and... 2024Multiple pharmacological interventions and modalities are available for managing chronic idiopathic constipation (CIC), with variable efficacy. Vibrating capsule (VC) is...
BACKGROUND
Multiple pharmacological interventions and modalities are available for managing chronic idiopathic constipation (CIC), with variable efficacy. Vibrating capsule (VC) is a device that has shown variable results in alleviating constipation by tactile stimulation of the colonic wall and inducing peristalsis. This meta-analysis is to investigate the efficacy and safety of this modality.
METHODS
Comprehensive literature search was performed through June 14th, 2023, on databases including Embase, PubMed/MEDLINE, Cochrane Central, Web of Science, Global Index Medicus, and Google Scholar. Core concepts of VC, constipation, and bowel movement were searched. The DerSimonian-Laird method and random effects model were utilized. We calculated odds ratio (OR) and mean difference (MD) for proportional and continuous variables, respectively, with 95% confidence interval (CI) and a P value of <0.05 considered statistically significant.
RESULTS
The search strategy yielded 117 articles. Four studies with 705 total patients were finalized comparing VC to placebo/sham treatment. The pooled complete spontaneous bowel movement (CSBM), defined as bowel movement without use of laxatives within the last 48 hours with sense of complete evacuation did not achieve statistical improvement with VC (MD =0.153; 95% CI: -0.218 to 0.523; P=0.422). However, spontaneous bowel movement (SBM), defined as bowel movement without use of laxatives within the last 48 hours, showed statistical improvement with VC (MD =0.159; 95% CI: 0.095 to 0.223; P<0.001). VC didn't show an increase in pooled adverse events (OR =1.431; 95% CI: 0.702 to 2.916; P=0.324).
CONCLUSIONS
The systematic review and meta-analysis suggest that VC is safe and efficacious in some outcomes, however, larger randomized controlled trials (RCTs) and real-world data are needed to establish this.
PubMed: 38317751
DOI: 10.21037/tgh-23-64 -
Radiology Case Reports Apr 2024A 74-year-old man presented to the emergency department with the chief complaint of abdominal pain. A computed tomography scan showed paralytic ileus. An ileostomy tube...
A 74-year-old man presented to the emergency department with the chief complaint of abdominal pain. A computed tomography scan showed paralytic ileus. An ileostomy tube was placed, but the symptoms of bowel obstruction did not improve. Two days after admission, the patient's renal function deteriorated. Transabdominal ultrasound (TUS) showed linear high-intensity echoes consistent with a fibrotic band and microbubbles suggestive of circulatory disturbance in the dilated intestinal tract. Subsequent contrast-enhanced ultrasound revealed circulatory disturbance of the small bowel wall. Emergency surgery was performed under the diagnosis of strangulated ileus. Intraoperative examination revealed that the terminal ileum was strangulated by a fibrotic band from the retroperitoneum, which was confirmed by TUS. The fibrotic band was resected, the strangulation was released, and ileocecal resection was performed. Postoperatively, intestinal peristalsis was rapidly restored. TUS was able to depict the fibrotic band, which could not be detected by a computed tomography scan, allowing the patient to undergo immediate surgical treatment. We herein report this case of strangulated bowel obstruction in which TUS and contrast-enhanced ultrasound were useful in preoperative assessment of the patient's condition.
PubMed: 38312751
DOI: 10.1016/j.radcr.2024.01.012 -
Langenbeck's Archives of Surgery Feb 2024Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data...
PURPOSE
Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure.
METHODS
We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier's perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy.
RESULTS
Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred.
CONCLUSION
Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.
Topics: Female; Humans; Middle Aged; Feasibility Studies; Laparoscopy; Neoplasm Recurrence, Local; Rectal Prolapse; Rectum; Recurrence; Surgical Mesh; Treatment Outcome; Aged
PubMed: 38305915
DOI: 10.1007/s00423-024-03227-w -
BMC Microbiology Feb 2024Pediatric chronic intestinal pseudo-obstruction (PIPO) is a rare disease characterized by symptoms and radiological signs suggestive of intestinal obstruction, in the...
BACKGROUND
Pediatric chronic intestinal pseudo-obstruction (PIPO) is a rare disease characterized by symptoms and radiological signs suggestive of intestinal obstruction, in the absence of lumen-occluding lesions. It results from an extremely severe impairment of propulsive motility. The intestinal endocrine system (IES) jointly with the enteric nervous system (ENS) regulates secreto-motor functions via different hormones and bioactive messengers/neurotransmitters. The neurotransmitter 5-hydroxytryptamine (5-HT) (or serotonin) is linked to intestinal peristalsis and secretory reflexes. Gut microbiota and its interplay with ENS affect 5-HT synthesis, release, and the subsequent serotonin receptor activation. To date, the interplay between 5-HT and gut microbiota in PIPO remains largely unclear. This study aimed to assess correlations between mucosa associated microbiota (MAM), intestinal serotonin-related genes expression in PIPO. To this purpose, biopsies of the colon, ileum and duodenum have been collected from 7 PIPO patients, and 7 age-/sex-matched healthy controls. After DNA extraction, the MAM was assessed by next generation sequencing (NGS) of the V3-V4 region of the bacterial RNA 16 S, on an Illumina Miseq platform. The expression of genes implicated in serotoninergic pathway (TPH1, SLC6A4, 5-HTR3 and 5-HTR4) was established by qPCR, and correlations with MAM and clinical parameters of PIPO have been evaluated.
RESULTS
Our results revealed that PIPO patients exhibit a MAM with a different composition and with dysbiosis, i.e. with a lower biodiversity and fewer less connected species with a greater number of non-synergistic relationships, compared to controls. qPCR results revealed modifications in the expression of serotonin-related intestinal genes in PIPO patients, when compared to controls. Correlation analysis do not reveal any kind of connection.
CONCLUSIONS
For the first time, we report in PIPO patients a specific MAM associated to underlying pathology and an altered intestinal serotonin pathway. A possible dysfunction of the serotonin pathway, possibly related to or triggered by an altered microbiota, may contribute to dysmotility in PIPO patients. The results of our pilot study provide the basis for new biomarkers and innovative therapies targeting the microbiota or serotonin pathways in PIPO patients.
Topics: Humans; Child; Serotonin; Gastrointestinal Microbiome; Pilot Projects; Intestines; Intestinal Pseudo-Obstruction; Serotonin Plasma Membrane Transport Proteins
PubMed: 38302874
DOI: 10.1186/s12866-024-03200-z -
Annals of Ibadan Postgraduate Medicine Aug 2023Transvaginal intestinal evisceration is a rare surgical emergency that is associated with morbidity and mortality. Only a few cases of transvaginal evisceration have so...
INTRODUCTION
Transvaginal intestinal evisceration is a rare surgical emergency that is associated with morbidity and mortality. Only a few cases of transvaginal evisceration have so far been described. The predisposing risk factors associated with this clinical condition are multifactorial.
CASE PRESENTATION
We report a case of an 85-year-old female that presented with spontaneous small bowel evisceration through the vagina. The loops of the small bowel appeared edematous and thickened but there was demonstrable visible peristalsis. She had no previous laparotomy or vaginal surgery. An emergency laparotomy was performed, and the small bowel was reduced into the abdomen through the vaginal defect. Afterward, a total abdominal hysterectomy was performed with the closure of the vaginal vault. The postoperative period was uneventful.
CONCLUSION
The spontaneous evisceration of bowel loops can be successfully managed when patients with such cases present early and promptly managed. Prompt diagnosis and surgical management are crucial to prevent complications. If the eviscerated viscera are non-viable, resection and restoration of bowel continuity are imperative. Management should be individualized and multidisciplinary.
PubMed: 38298337
DOI: No ID Found -
Poultry Science Mar 2024The objective of this study was to evaluate combined effects of corn particle size and feed form on performance, carcass characteristics, nutrient digestibility, and...
Evaluation of particle size and feed form on performance, carcass characteristics, nutrient digestibility, and gastrointestinal tract development of broilers at 39 d of age.
The objective of this study was to evaluate combined effects of corn particle size and feed form on performance, carcass characteristics, nutrient digestibility, and gastrointestinal tract development of broilers from 1 to 39 d of age. A total of 1,800 days old, male Cobb 500 broilers were randomly assigned to 9 dietary treatments with 8 replicate pens (25 birds/pen). The experiment consisted of a factorial arrangement of 3 corn particle sizes (750, 1,150, and 1,550 μm) and 3 feed forms (mash, 3- and 4-mm pellets) provided from 1 to 39 d. Titanium dioxide (TiO) was added as an indigestible marker (0.5%) during the finisher phase (27-39 d) to determine nutrient digestibility. Feed intake (FI), body weight (BW), and feed conversion ratio (FCR) were determined at 17, 27, and 39 d of age, with FCR adjusted for mortality. On d 40, 10 birds/pen were randomly selected and processed for meat yield determination. Data were analyzed as a 3×3 factorial (particle size x feed form) arrangement of treatments. Broilers fed 3- and 4-mm pellets had increased (P < 0.05) BW, FI, and lower FCR than broilers fed mash diets at 39 d of age. At 39 d of age, broilers fed diets with 750 µm corn particle size had heavier (P < 0.05) BW and increased FI than broilers fed diets with corn particle sizes of 1,150 and 1,550 µm. At 39 d of age FCR was unaffected by corn particle size. Heavier (P < 0.05) carcass and breast weights were observed for broilers fed 3-mm pellets. Broilers fed diets with corn particle size of 750 µm had heavier (P < 0.05) carcass and breast weight than broilers fed diets with 1,550 µm. Digestibility of nutrients was higher (P < 0.05) in pelleted diets, particularly when corn particle size was increased from 750 to 1,550 µm. Breast myopathies such as wooden breast (WB) and spaghetti meat (SM), were greater (P < 0.05) in broilers fed 3-mm pellets compared to mash diets. In conclusion, broilers fed 3- and 4-mm pelleted diets had greater nutrient digestibility and improved broiler performance compared to broilers fed mash diets.
Topics: Animals; Male; Chickens; Particle Size; Nutrients; Eating; Zea mays; Gastrointestinal Tract
PubMed: 38290341
DOI: 10.1016/j.psj.2024.103437 -
The Korean Journal of Gastroenterology... Jan 2024Achalasia is an esophageal motility disorder characterized by loss of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter. Patients with...
Achalasia is an esophageal motility disorder characterized by loss of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter. Patients with achalasia often complain of persistent symptoms for several years before diagnosis. On the other hand, achalasia diagnosed as a sudden esophageal food impaction is uncommon, and no report has been issued on the diagnosis and successful treatment of achalasia in a 95-year-old patient. We report a case of achalasia diagnosed by high-resolution esophageal manometry and timed barium esophagography after food material removal by endoscopy in a 95-year-old woman who visited the hospital due to sudden esophageal food impaction and was successfully treated by endoscopic balloon dilatation.
Topics: Aged, 80 and over; Female; Humans; Esophageal Achalasia; Nonagenarians; Esophageal Motility Disorders; Hospitals; Peristalsis
PubMed: 38268165
DOI: 10.4166/kjg.2023.112 -
Heliyon Dec 2023Present work describes the peristaltic flow of Sisko nanomaterial with bioconvection and gyrotactic microorganisms. Slip conditions are incorporated through elastic...
Present work describes the peristaltic flow of Sisko nanomaterial with bioconvection and gyrotactic microorganisms. Slip conditions are incorporated through elastic channel walls. Additionally, we considered the aspects of thermal radiation and viscous dissipation. Further ohmic heating features are also present in the thermal field. Buongiorno's nanofluid model comprising thermophoresis and Brownian movement is taken. The lubrication approach is utilized for the simplification of the problem. Being highly coupled and nonlinear, the resulting system of equations must be solved numerically using the NDSolve technique and bvp4c via Matlab. Velocity, concentration, thermal field and motile microorganisms. are addressed graphically.
PubMed: 38213593
DOI: 10.1016/j.heliyon.2023.e22505 -
Scientific Reports Jan 2024The main objective of this study was to investigate the potential probiotic properties of Lacticaseibacillus rhamnosus VHProbi®M15 (M15). This study examined the...
The main objective of this study was to investigate the potential probiotic properties of Lacticaseibacillus rhamnosus VHProbi®M15 (M15). This study examined the effects of M15 on sucralfate-induced constipation in a mouse model. The BALB/c mice were randomly divided into four groups: the normal group (NOR) was without any treatment, while the constipation (CON), phenolphthalein (PHE), and probiotic (PRO) treatment groups were fed with sucralfate until the appearance of constipation symptoms. Afterward, the NOR and CON groups were given 1 ml saline orally every day until the end of the experiment; the PHE and PRO groups were given phenolphthalein or M15 suspension in 1 ml orally, respectively. Compared with the CON group, the fecal water content and intestinal peristalsis improved in the PRO group. Here, intake of M15 effectively attenuated sucralfate-induced constipation, recuperated colonic epithelial integrity, and increased serum levels of gastrointestinal excitatory neurotransmitters (motilin, gastrin, substance P). Analysis of the intestinal microbiota of mice by 16S rRNA metagenomic revealed an increase in the relative abundance of Bacteroides and a decrease in Sclerotinia, Verrucosa and Proteus in the PRO group. Compared with the CON group, the constipation-induced intestinal microecological changes were partially recovered in the PHE and PRO groups. These results demonstrate that M15 enhanced gastrointestinal transit and alleviated in mice with sucralfate-induced constipation.
Topics: Mice; Animals; Lacticaseibacillus rhamnosus; Sucralfate; RNA, Ribosomal, 16S; Constipation; Probiotics; Phenolphthaleins; Substance P; Galanin
PubMed: 38212429
DOI: 10.1038/s41598-024-51497-7 -
Scientific Reports Jan 2024Patients with Parkinson's disease (PD) have gastrointestinal motility disorders, which are common non-motor symptoms. However, the reasons for these motility disorders...
Patients with Parkinson's disease (PD) have gastrointestinal motility disorders, which are common non-motor symptoms. However, the reasons for these motility disorders remain unclear. Increased alpha-synuclein (α-syn) is considered an important factor in peristalsis dysfunction in colonic smooth muscles in patients with PD. In this study, the morphological changes and association between serping1 and α-syn were investigated in the colon of the 1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine-induced chronic PD model. Increased serping1 and α-syn were noted in the colon of the PD model, and decreased serping1 also induced a decrease in α-syn in C2C12 cells. Serping1 is a major regulator of physiological processes in the kallikrein-kinin system, controlling processes including inflammation and vasodilation. The kinin system also comprises bradykinin and bradykinin receptor 1. The factors related to the kallikrein-kinin system, bradykinin, and bradykinin receptor 1 were regulated by serping1 in C2C12 cells. The expression levels of bradykinin and bradykinin receptor 1, modulated by serping1 also increased in the colon of the PD model. These results suggest that the regulation of increased serping1 could alleviate Lewy-type α-synucleinopathy, a characteristic of PD. Furthermore, this study could have a positive effect on the early stages of PD progression because of the perception that α-syn in colonic tissues is present prior to the development of PD motor symptoms.
Topics: Animals; Humans; Mice; 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine; alpha-Synuclein; Bradykinin; Complement C1 Inhibitor Protein; Disease Models, Animal; Gastrointestinal Diseases; Mice, Inbred C57BL; Parkinson Disease; Receptors, Bradykinin
PubMed: 38212417
DOI: 10.1038/s41598-024-51770-9