Passive elastic wall properties in isolated guinea pig small intestine

Mechanical experimentation of the gastrointestinal tract: a systematic review

The gastrointestinal (GI) organs of the human body are responsible for transporting and extracting nutrients from food and drink, as well as excreting solid waste. Biomechanical experimentation of the GI organs provides insight into the mechanisms involved in their normal physiological functions, as well as understanding of how diseases can cause disruption to these. Additionally, experimental findings form the basis of all finite element (FE) modelling of these organs, which have a wide array of applications within medicine and engineering. This systematic review summarises the experimental studies that are currently in the literature (n = 247) and outlines the areas in which experimentation is lacking, highlighting what is still required in order to more fully understand the mechanical behaviour of the GI organs. These include (i) more human data, allowing for more accurate modelling for applications within medicine, (ii) an increase in time-dependent studies, and (iii) more sophisticated in vivo testing methods which allow for both the layer- and direction-dependent characterisation of the GI organs. The findings of this review can also be used to identify experimental data for the readers' own constitutive or FE modelling as the experimental studies have been grouped in terms of organ (oesophagus, stomach, small intestine, large intestine or rectum), test condition (ex vivo or in vivo), number of directions studied (isotropic or anisotropic), species family (human, porcine, feline etc.), tissue condition (intact wall or layer-dependent) and the type of test performed (biaxial tension, inflation-extension, distension (pressure-diameter), etc.). Furthermore, the studies that investigated the time-dependent (viscoelastic) behaviour of the tissues have been presented.

Biomechanical properties of abdominal organs under tension with special reference to increasing strain rate

Currently, abdominal finite element models overlook the organs such as gallbladder, bladder, and intestines, which instead are modeled as a simple bag that is not included in the analysis. Further characterization of the material properties is required for researchers to include these organs into models. This study characterized the mechanical properties of human and porcine gallbladder, bladder, and intestines using uniaxial tension loading from the rates of 25%/s to 500%/s. Small differences were observed between human and porcine gallbladder elastic modulus, failure stress, and failure strain. Strain rate was determined to be a significant factor for predicting porcine gallbladder elastic modulus and failure stress which were found to be 9.03 MPa and 1.83 MPa at 500%/s. Human bladder was observed to be slightly stiffer with a slightly lower failure stress than porcine specimens. Both hosts, however, demonstrated a strain rate dependency with the elastic modulus and failure stress increasing as the rate increased with the highest elastic modulus (2.16 MPa) and failure stress (0.65 MPa) occurring at 500%/s. Both human and porcine intestines were observed to be affected by the strain rate. Failure stress was found to be 1.6 MPa and 1.42 MPa at 500%/s for the human and porcine intestines respectively. For all properties found to be strain rate dependent, a numerical model was created to quantify the impact. These results will enable researchers to create more detailed finite element models that include the gallbladder, bladder, and intestines.

Diabetes-induced mechanophysiological changes in the small intestine and colon

The disorders of gastrointestinal (GI) tract including intestine and colon are common in the patients with diabetes mellitus (DM). DM induced intestinal and colonic structural and biomechanical remodeling in animals and humans. The remodeling is closely related to motor-sensory abnormalities of the intestine and colon which are associated with the symptoms frequently encountered in patients with DM such as diarrhea and constipation. In this review, firstly we review DM-induced histomorphological and biomechanical remodeling of intestine and colon. Secondly we review motor-sensory dysfunction and how they relate to intestinal and colonic abnormalities. Finally the clinical consequences of DM-induced changes in the intestine and colon including diarrhea, constipation, gut microbiota change and colon cancer are discussed. The final goal is to increase the understanding of DM-induced changes in the gut and the subsequent clinical consequences in order to provide the clinicians with a better understanding of the GI disorders in diabetic patients and facilitates treatments tailored to these patients.

Biomechanical remodelling of obstructed guinea pig jejunum

Data on morphological and biomechanical remodelling are needed to understand the mechanisms behind intestinal obstruction. The effect of partial obstruction on mechanical properties with reference to the zero-stress state and on the histomorphological properties of the guinea pig small intestine was determined in this study. Partial obstruction and sham operation were surgically created in mid-jejunum of guinea pigs. The animals survived 2, 4, 7, and 14 days. The age-matched guinea pigs that were not operated served as normal controls. The segment proximal to the obstruction site was used for histological analysis, no-load state and zero-stress state data, and distension test. The segment for distension was immersed in an organ bath and inflated to 10cm H(2)O. The outer diameter change during the inflation was monitored using a microscope with CCD camera. Circumferential stresses and strains were computed from the diameter, pressure and the zero-stress state data. The opening angle and absolute value of residual strain decreased (P<0.01 and P<0.001) whereas the wall thickness, wall cross-sectional area, and the wall stiffness increased after 7 days obstruction (P<0.05, P<0.01). Histologically, the muscle and submucosa layers, especially the circumferential muscle layer increased in thickness after obstruction. The opening angle and residual strain mainly depended on the thickness of the muscle layer whereas the wall stiffness mainly depended on the thickness of the submucosa layer. In conclusion, the histomorphological and biomechanical properties of small intestine (referenced for the first time to the zero-stress state) remodel proximal to the obstruction site in a time-dependent manner.

Biomechanical properties of the anterior urethra of the male rabbitA study using impedance planimetry

OBJECTIVE

To evaluate the anterior urethra of the male rabbit regarding its luminal cross-sectional area (CSA), CSA distensibility, circumferential tension-strain relation, histology and the collagen content of the tissue. material and methods: Nineteen rabbits were examined with impedance planimetry by distending the urethra at the passage from the spongious to the bulbous part and 1 cm proximally in the bulbous part. Four weeks later, eight rabbits underwent a second examination. After the measurements the urethras were processed for either histology or determination of collagen content. The urethras from six additional rabbits served as controls for histology and collagen content.

RESULTS

The CSA and the CSA distensibility were smaller at the distal than the proximal distension site. At both sites the CSA distensibility was high at low luminal pressure loads and decreased with increasing pressure. The circumferential tension-strain plot displayed an exponential relation, with a steeper slope distally than proximally. Repeated biomechanical investigation revealed a significantly increased CSA and a decreased slope of the circumferential tension-strain relation at both distension sites. The biomechanical investigation induced abrasion of the epithelium, extravasation of erythrocytes and separation of the collagen fibres, suggesting oedema of the luminal part of the wall. After 4 weeks the epithelium had changed from transitional to stratified, squamous and often keratinized epithelium and the collagen beneath the epithelium formed a dense network instead of wavy lines as seen in the control urethras. The collagen content was larger at the distal than the proximal distension site. No change in collagen content could be demonstrated between the urethras investigated once or twice with impedance planimetry.

CONCLUSIONS

The non-linear pressure-CSA, pressure-CSA distensibility and circumferential tension-strain relations found at both distension sites demonstrate that the urethra yields readily at low pressures, thus facilitating flow. At higher pressure loads, the tissue becomes less distensible, a property that protects it against over-distension and damage. Impedance planimetry cannot be used to study before-and-after phenomena as the biomechanical investigation changed both the histology and the biomechanical properties of the rabbit urethra.

Hyperelastic Model of Anisotropic Fiber Reinforcements within Intestinal Walls for Applications in Medical Robotics

The development of an anatomically realistic model of intestinal tissue is essential for the progress of several clinical applications of medical robotics. A hyperelastic theory of the layered structure of the intestine is proposed in this paper to reproduce its purely elastic passive response from the structural organization of its main constituents. The hyperelastic strain energy function is decoupled into an isotropic term, describing the ground biological matrix, and an anisotropic term, describing the single contributions of the directional fiber-reinforcements. The response of the muscular coat layer has been modeled as a stiffening effect due to two longitudinal and circular muscular reinforcements. The contribution of the submucosa has been described from a uniform distribution of fibrillar collagen in a cross-ply arrangement. An experimental procedure has been proposed in order to characterize the passive response of porcine intestinal samples from planar uniaxial traction and shear tests. The experimental data have been non-linearly fitted in the least square sense with the results of the theoretical predictions. The mechanical parameters have been fitted with high accuracy (Rmin =0.9329, RMSEmax =0.01167), demonstrating the ability of the model to reproduce the mechanical coupling due to the presence of multiple directional reinforcements. The fundamental mechanical role of collagen morphology in the passive biomechanical behavior of intestinal wall is demonstrated. These results may drive a better understanding of the key factors in growth and remodeling of healthy and diseased tissue, together with numerous applications in robotic endoscopy, minimally invasive surgery, and biomedical research.

Time-dependent viscoelastic properties along rat small intestine

AIM: To measure the time-dependent (viscoelastic) behavior in the change of the small intestinal opening angle and to test how well the behavior could be described by the Kelvin model for a standard linear solid.

METHODS: Segments from the duodenum, jejunum, and ileum were harvested from 10 female Wistar rats and the luminal diameter, wall thickness, and opening angle over time (θ(t)) were measured from rings cut from these segments.

RESULTS: Morphometric variations were found along the small intestine with an increase in luminal area and a decrease in wall thickness from the duodenum to the ileum. The opening angle obtained after 60 min was highest in the duodenum (220.8±12.9°) and decreased along the length of the intestine to 143.9±8.9° in the jejunum and 151.4±9.4° in the ileum. The change of opening angle as a function of time, fitted well to the Kelvin model using the equation θ(t)/θo = [1-ηexp (-λt)] after the ring was cut. The computed creep rate λ did not differ between the segments. Compared to constant calculated from pig aorta and coronary artery, it showed that α agreed well (within 5%), η was three times larger than that for vascular tissue, and λ ranged ±40% from the value of the pig coronary artery and was a third of the value of pig aorta.

CONCLUSION: The change of opening angle over time for all the small intestine segments fits well to the standard linear spring-dashpot model. This viscoelastic constant of the rat small intestine is fairly homogenous along its length. The data obtained from this study add to a base set of biomechanical data on the small intestine and provide a reference state for comparison to other tissues, diseased intestinal tissue or intestinal tissue exposed to drugs or chemicals.

Biomechanical and morphometric intestinal remodelling during experimental diabetes in rats

AIMS/HYPOTHESIS

Morphometric and passive biomechanical properties were studied in the duodenum, jejunum and ileum in 10 non-diabetic and 40 streptozotocin-induced diabetic rats.

METHODS

The diabetic rats were divided into groups living 4 days, 1, 2, and 4 weeks after diabetes was induced ( n=10 for each groups). The mechanical test was done as a ramp distension experiment. The intestinal diameter and length were obtained from digitised images of the intestinal segments at pre-selected pressures and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data and from the zero-stress state geometry.

RESULTS

The blood glucose concentration increased four- to fivefold in the diabetic rats. Streptozotocin-induced diabetes generated pronounced increase in the weight per centimetre length, wall thickness and wall cross-sectional area in all intestinal segments during diabetes ( p<0.05). Histological analysis showed that the thickness of the intestinal layers was increased in all segments during diabetes ( p<0.05). In the duodenum the opening angle did not change in the first 2 weeks and decreased after 4 weeks ( p<0.05). In the jejunum and ileum the opening angle increased after 1 week in the diabetic group. The residual strain showed the same pattern as the opening angle. Furthermore, it was found that the circumferential and longitudinal stiffness of the intestinal wall increased with the duration of diabetes ( p<0.05 and p<0.01).

CONCLUSION/INTERPRETATION

Morphological and biomechanical remodelling of the small intestine occurred during the development of diabetes.

The effect of epidermal growth factor on the incremental Young's moduli in the rat small intestine

Biomechanical remodelling of the rat small intestine after treatment with epidermal growth factor (EGF) subcutaneously for 2 days (n=6), 4 days (n=6), 7 days (n=6), and 14 days (n=4) was studied. The incremental circumferential, longitudinal and cross moduli close to the in vivo state were computed from bi-axial test data (combined inflation and axial stretching) by a least square method. The moduli in the circumferential direction and the longitudinal direction differed in all groups, i.e. the mechanical properties were anisotropic in both normal and EGF-treated rats. Time-dependent variation existed for the Young's moduli in all directions during EGF treatment (P<0.05). The circumferential modulus decreased during the first 7 days of EGF treatment and it almost remodelled back to that of the control group after 14 days treatment. The incremental modulus in the circumferential direction ranged between 17.4 and 24.2 kPa. The modulus in the longitudinal direction ranged between 22.9 and 32.4 kPa. The longitudinal modulus after 4 days EGF treatment was significantly larger than that of control group (P<0.02). The cross modulus decreased during the first 4 days of EGF treatment thereafter it increased to a maximum at 7 days. The values for the cross moduli were between 4.7 and 6.6 kPa. In conclusion, the mechanical properties in the intestinal wall are anisotropic and remodel during treatment with EGF.

Morphology and stress-strain properties along the small intestine in the rat

The stress-strain relationship is determined by the inherent mechanical properties of the intestinal wall, the geometric configurations, the loading conditions and the zero-stress state of the segment. The purpose of this project was to provide morphometric and biomechanical data for rat duodenum, jejunum and ileum. The circumferential strains were referenced to the zero-stress state. Large morphometric variations were found along the small intestine with an increase in the outer circumferential length and luminal area and a decrease in wall thickness in distal direction. The serosal residual strain was tensile and decreased in distal direction (P < 0.05). The mucosal residual strain was compressive and the absolute value decreased in distal direction (P < 0.001). The stress-strain experiments showed that the duodenum was stiffest. All segments were stiffest in longitudinal direction (P < 0.05). In conclusion, axial variation in morphometric and biomechanical properties was found in the small intestine. The zero-stress state must be considered in future biomechanical studies in the gastrointestinal tract.

Sensory and biomechanical responses to ramp-controlled distension of the human duodenum

The aim of this study was to develop a new method for investigation of the relationship among the mechanical stimulus, the biomechanical properties, and the visceral perception evoked by volume/ramp-controlled distension in the human duodenum in vivo. An impedance planimetric probe for balloon distension was placed in the third part of the duodenum in seven healthy volunteers. Distension of the duodenum was done at infusion rates of 10, 25, and 50 ml/min. The pump was reversed when level 7 was reached on a visual analog scale ranging from 0 to 10. Distensions were done with and without the administration of the antimuscarinic drug butylscopolamine. The total circumferential tension (T(total)) and the passive circumferential tension (T(passive)) were determined from the distension tests without and with the administration of butylscopolamine, respectively. T(total) and T(passive) showed an exponential behavior as a function of strain (a measure of deformation). The active circumferential tension (T(active)) was computed as T(total)-T(passive) and showed a bell-shaped behavior as a function of strain. At low distension intensities, the intensity of sensation at 10 ml/min was significantly higher than that obtained at 25 and 50 ml/min. The coefficient of variation at the pain threshold for circumferential strain (average 4.34) was closer to zero compared with those for volume (8.72), pressure (31.22), and circumferential tension (31.55). This suggests that the mechanoreceptors in the gastrointestinal wall depend primarily on circumferential strain. The stimulus-response functions provided evidence for the existence of low- and high-threshold mechanoreceptors in the human duodenum. Furthermore, the data suggest that high-threshold receptors are nonadapting.

Remodelling of zero-stress state of small intestine in streptozotocin-induced diabetic rats. Effect of gliclazide

BACKGROUND

Biomechanical properties in terms of residual strains in diabetic small intestine have not been studied. Furthermore, no data have been reported on affect of gliclazide on gastrointestinal complications of diabetes.

AIMS

To determine remodelling of zero-stress state of small intestine in streptozotocin-induced diabetic rats and effect of gliclazide treatment.

MATERIALS

Morphological properties and residual strains were studied in duodenum, jejunum and ileum obtained from diabetic rats, gliclazide-treated diabetic rats and normal rats (n = 8 each group).

METHODS

Diabetes was induced by single intraperitoneal injection of 65 mg/kg streptozotocin. Gliclazide (10 mg kg(-1) day(-1) was injected directly into stomach lumen by intragastric gavage twice daily. Experimental period was 35 days. To approach no-load state; intestinal segments were surgically excised and cut transversely into short ring-shaped segments. Each ring was cut radially to obtain geometry of zero-stress state. Circumferential length, the wall thickness and opening angle were measured from digital images of each specimen and residual strains were computed.

RESULTS

Blood glucose level of diabetic group (approximately 20 mmol/l) was consistently higher than that in normal group (approximately 4 mmol/l) after induction of diabetes (p < 0.001). Gliclazide lowered average blood glucose level to between 10 and 15 mmol/l (p < 0.001). Plasma insulin levels of both diabetic groups (average between 10 and 15 pmol/l) were significantly lower than those in normal group (average approximately 18 pmol/l, p < 0.05). Wet weight per unit length and wall thickness of duodenum, jejunum and ileum were significantly higher in Diabetes group than those in Normal group (p < 0.05). Opening angle and absolute value of residual strain were significantly smaller in duodenum and larger in jejunum and ileum in Diabetes group than in Normal group (p < 0.001). Gliclazide treatment partly restored these changes (p < 0.05).

CONCLUSIONS

Diabetes induced morphometric and biomechanical remodelling in intestine. Gliclazide partly restored these changes.

Sensory-motor responses to volume-controlled duodenal distension

Abstract Visceral perception and secondary peristalsis evoked by distension of the duodenum were studied in 10 healthy volunteers. An impedance planimetric probe for cross-sectional area (CSA) measurements inside a balloon and with three pressure channels was used. Balloon distensions were performed in the fed state with or without the administration of the antimuscarinic drug butylscopolamine. A modified questionnaire was used to assess the nonpainful and painful sensations. The total tension (T(total)) and the passive tension (T(passive)) were determined from the distensions without and with the administration of butylscopolamine, respectively. The active tension (T(active)) was T(total) - T(passive). The stepwise balloon distensions induced the first sensation at a volume of 33 +/- 3 mL. After administration of butylscopolamine the first sensation appeared at 42 +/- 1 mL. The perception score (PS) revealed an approximately linear increase as function of volume, CSA, pressure and tension after the first sensation. Butylscopolamine resulted in significant changes in PS score as function of volume, CSA and strain, but not as a function of pressure and tension. The frequency of the secondary peristalsis increased to the highest value (8.2 +/- 0.8 contractions min(-1)) at a volume of 21 mL. Butylscopolamine almost abolished the distension-evoked motility. T(total) and T(passive) increased nonlinearly as a function of volume, whereas T(active) increased up to a distension volume of 33 mL and then decreased at higher volumes. Hence, the conventional length-tension diagrams as known from studies of smooth muscle strips in vitro can be reproduced in the human duodenum in vivo. This new way of studying intestinal sensation and motility may prove to have both basic and clinical importance as both passive tissue structures and the sensorimotor function are tested.

Morphological properties and residual strain along the small intestine in rats

AIM: Residual stress and strain are important for gastrointestinal function and relate to the geometric configuration, the loading conditions and the zero-stress state of the gastrointestinal tract. The purpose of this project is to provide morphometric data and residual strains for the rat small intestine (n = 11).

METHODS: To approach the no-load state, the intestine was surgically excised, transferred to an organ bath and cut transversely into short ring-shaped segments. Each ring was cut radially for obtaining the zero-stress state. The residual stress can be characterised by an opening angle. The strain difference between the zero-stress state and the no-load state is called residual strain.

RESULTS: Large morphometric variations were found along the small intestine. The wall thickness was highest in the proximal duodenum and decreased in distal direction along the axis of the small intestine (P < 0.001). The circumferential length of the inner and outer surfaces decreased rapidly along the length of duodenum by 30%-50% (P < 0.001). The wall area and lumen area showed a similar pattern (P < 0.001). In zero-stress state the rings always opened up after making the cut. The experiments resulted in larger inner circumferential length and smaller outer circumferential length when compared to the no-load state. The wall thickness and wall area did not differ between the no-load and zero-stress state. The opening angle and tangent rotation angle increased along the length of the duodenum and had its highest value 30% down the intestine. Further down the intestine it decreased again (P < 0.001). The serosal residual strain was tensile with the highest value close to the ligament of Treitz (P < 0.001). The mucosal residual strain was compressive in all segments of the small intestine with average values between -0.25 and -0.4 and with the lowest values close to the ligament of Treitz (P < 0.001).

CONCLUSION: Axial variation in morphometric properties and residual strains were found in the small intestine. Existence of large residual strains indicates that the zero-stress state must be considered in future biomechanical studies in the gastrointestinal tract.

Luminal cross-sectional area and tension-strain relation of the porcine bile duct

The bile duct is a distensible tube serving to transport bile from the liver and gallbladder to the duodenum. The purpose of this study was to characterize the luminal cross-sectional area (CSA) and tension-strain properties during distension of the normal isolated porcine common bile duct in vitro. An impedance planimetric system located inside a balloon was used. Eleven porcine bile ducts were examined in two locations, in the hepatic duct and in the common bile duct. The CSAs obtained in the common bile duct were significantly higher than those in the hepatic duct in the pressure range 0-8 kPa (P < 0.001). The circumferential wall tension (T)-strain (epsilon) relations for both locations fitted to the exponential equation T = a.eb. epsilon with determination coefficients of 0.97 +/- 0.01. The a and b constants were not statistically different between the two locations indicating that the elastic properties did not differ. In conclusion, the luminal CSAs were larger in the common bile duct when compared to the hepatic duct and the tension-strain relations did not differ between the two segments of the bile duct.

Morphometry and strain distribution in guinea pig duodenum with reference to the zero-stress state

The aim of the present study is to determine the distribution of residual circumferential strains along the duodenum in anesthetized guinea pigs. A silicone elastomer was allowed to harden in the duodenal lumen under a pressure of 0.7 kPa. The duodenum was excised with the cast and photographed. The zero-stress state was obtained by cutting rings of duodenum radially. The geometric configuration at the zero-stress state is of fundamental importance, because it is the basic state with respect to which the physical stresses and strains are defined. A basic piece of information is the way the tangent vector rotates from one end of the circumference to the other. In the duodenum at zero-stress state, the total rotation of the tangent from one tip to the other is -500 to -850 , with the lowest absolute value in the proximal duodenum. In other words, the duodenum usually turns itself inside out on changing from a loaded state to the zero-stress state. The serosal circumference, the duodenal wall thickness, and the ratio of wall thickness to mucosal circumference decreased in the distal direction. In the pressurized state, the serosal Cauchy strain was tensile and increased in the distal direction; the mucosal Cauchy strain was compressive in the proximal half of the duodenum and tensile in the distal half. The large circumferential residual strains must be taken into account in a study of physiological problems in which the stresses and strains are important, e.g., the bolus transport function.

Biomechanics of the gastrointestinal tract

As the function of the gastrointestinal tract is to a large degree mechanical, it has become increasingly popular to acquire distensibility data in motility research based on various parameters. Hence it is important to know on which geometrical and mechanical assumptions the various parameters are based. Currently, compliance and tone derived from pressure-volume curves are by far the most often used parameters. However, pressure-volume relations obtained in tubular organs must be carefully interpreted as they provide no direct measure of luminal cross-sectional area and other variables useful in plane stress and strain analysis. Thus, erroneous conclusions concerning tissue distensibility may be deduced. Other parameters, such as wall tension, stress and strain, give more useful information about mechanical behaviour. Distensibility data procure significance in fluid mechanics and in the study of tone, peristaltic reflexes, and mechanoreceptor kinematics. Such data are needed for the determination of the interaction between stimulus, electrical responses in neurons and the mechanical behaviour of the gut. Furthermore, from a clinical perspective, investigation of visco-elastic properties is important because GI diseases are associated with growth and remodelling. For example, prestenotic dilatation, increased collagen synthesis, dysmotility and altered distensibility are common features of obstructive diseases. The purpose of this review is to discuss the physiological and clinical importance of acquiring biomechanical data, distensibility parameters and interpretation of these results and their associated errors. We will also discuss some aspects of the relationship between morphology, growth and biomechanics. Finally, we will outline a number of techniques to study the mechanical properties of the GI tract.