1
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Giddings HL, McNeill J, Rahman B, Meagher AP, Gett R, Lord RV. Effectiveness of an Oral Gastrografin Regimen for Complete Distal Intestinal Obstruction Syndrome. ANNALS OF SURGERY OPEN 2023; 4:e279. [PMID: 37601469 PMCID: PMC10431405 DOI: 10.1097/as9.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/12/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To assess the effectiveness of oral Gastrografin treatment and outcomes in adult patients with complete distal intestinal obstruction syndrome (cDIOS). Background DIOS is an important gastrointestinal complication of cystic fibrosis (CF). Conservative treatment options for cDIOS are largely empirical, and the optimal management remains unclear. Surgery should be reserved for patients who have failed nonoperative treatment or have immediate indications for surgery. Methods A retrospective single-institution cohort study was undertaken of adults with CF who had undergone lung transplantation and were admitted with an episode of cDIOS between 2004 and 2020. The outcomes of treatment in a high-volume CF transplant center with routine oral Gastrografin-based therapy were assessed. Results Forty-seven episodes of cDIOS were recorded in 29 (23.3%) of 124 patients who had undergone lung transplantation for CF, and mean age at cDIOS was 30.3 years (SD ±11.2). Mean follow-up post cDIOS was 75.6 months (SD ±45.5). Twelve patients had >1 cDIOS episode. One episode occurred during recovery after transplantation, and 5 patients were readmitted within 30 days posttransplant with cDIOS. A history of previous abdominal surgery was associated with the development of cDIOS (P < 0.001). Oral Gastrografin therapy was used in 95.7% of the episodes, at varying doses. Three patients (7.0%) were resistant to oral Gastrografin treatment, requiring laparotomy. There were no deaths due to DIOS. Conclusions Oral Gastrografin is effective and safe for the treatment of cDIOS, with low treatment failure rates. It should be considered as a first-line treatment option for patients with CF presenting with complete distal intestinal obstruction.
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Affiliation(s)
- Hugh L Giddings
- From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia
- Department of Surgery, School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Jared McNeill
- From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia
| | - Bayzidur Rahman
- Department of Epidemiology and Biostatistics, School of Medicine, University of Notre Dame Australia, Sydney, Australia
- The Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Alan P Meagher
- From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia
- Department of Surgery, School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Rohan Gett
- From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia
- Department of Surgery, School of Medicine, UNSW Australia, Sydney, Australia
| | - Reginald V Lord
- From the Department of General Surgery, St Vincent's Hospital, Sydney, Australia
- Department of Surgery, School of Medicine, University of Notre Dame Australia, Sydney, Australia
- St. Vincent's Centre for Applied Medical Research, Sydney, Australia
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2
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Tan X, Kini A, Römermann D, Seidler U. The NHE3 Inhibitor Tenapanor Prevents Intestinal Obstructions in CFTR-Deleted Mice. Int J Mol Sci 2022; 23:ijms23179993. [PMID: 36077390 PMCID: PMC9456459 DOI: 10.3390/ijms23179993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Mutations in the CFTR chloride channel result in intestinal obstructive episodes in cystic fibrosis (CF) patients and in CF animal models. In this study, we explored the possibility of reducing the frequency of obstructive episodes in cftr−/− mice through the oral application of a gut-selective NHE3 inhibitor tenapanor and searched for the underlying mechanisms involved. Sex- and age-matched cftr+/+ and cftr−/− mice were orally gavaged twice daily with 30 mg kg−1 tenapanor or vehicle for a period of 21 days. Body weight and stool water content was assessed daily and gastrointestinal transit time (GTT) once weekly. The mice were sacrificed when an intestinal obstruction was suspected or after 21 days, and stool and tissues were collected for further analysis. Twenty-one day tenapanor application resulted in a significant increase in stool water content and stool alkalinity and a significant decrease in GTT in cftr+/+ and cftr−/− mice. Tenapanor significantly reduced obstructive episodes to 8% compared to 46% in vehicle-treated cftr−/− mice and prevented mucosal inflammation. A decrease in cryptal hyperproliferation, mucus accumulation, and mucosal mast cell number was also observed in tenapanor- compared to vehicle-treated, unobstructed cftr−/− mice. Overall, oral tenapanor application prevented obstructive episodes in CFTR-deficient mice and was safe in cftr+/+ and cftr−/− mice. These results suggest that tenapanor may be a safe and affordable adjunctive therapy in cystic fibrosis patients to alleviate constipation and prevent recurrent DIOS.
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Affiliation(s)
| | | | | | - Ursula Seidler
- Correspondence: ; Tel.: +49-5115-329-427; Fax: +49-5115-328-428
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3
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Understanding Cystic Fibrosis Comorbidities and Their Impact on Nutritional Management. Nutrients 2022; 14:nu14051028. [PMID: 35268004 PMCID: PMC8912424 DOI: 10.3390/nu14051028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Cystic fibrosis (CF) is a chronic, multisystem disease with multiple comorbidities that can significantly affect nutrition and quality of life. Maintaining nutritional adequacy can be challenging in people with cystic fibrosis and has been directly associated with suboptimal clinical outcomes. Comorbidities of CF can result in significantly decreased nutritional intake and intestinal absorption, as well as increased metabolic demands. It is crucial to utilize a multidisciplinary team with expertise in CF to optimize growth and nutrition, where patients with CF and their loved ones are placed in the center of the care model. Additionally, with the advent of highly effective modulators (HEMs), CF providers have begun to identify previously unrecognized nutritional issues, such as obesity. Here, we will review and summarize commonly encountered comorbidities and their nutritional impact on this unique population.
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4
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Gilchrist FJ, Green J, Carroll W. Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Cochrane Database Syst Rev 2021; 12:CD012798. [PMID: 34936086 PMCID: PMC8693852 DOI: 10.1002/14651858.cd012798.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention. OBJECTIVES This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 09 September 2021. We also searched online trial registries. Date of last search: 12 October 2021. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE. MAIN RESULTS There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall certainty of the evidence was found to be very low. AUTHORS' CONCLUSIONS There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.
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Affiliation(s)
- Francis J Gilchrist
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Jessica Green
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Will Carroll
- Department of Paediatric Respiratory Medicine, University Hospitals of the North Midlands, Stoke-on-Trent, UK
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5
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Morales Morales CA, Gonzalez-Urquijo M, Morales Flores LF, Quevedo-Fernandez E, Guzmán Huerta EA, Virgilio Hernández-Torre MM. Proximal intestinal obstruction syndrome (PIOS) in a patient with cystic fibrosis: A case report. Ann Med Surg (Lond) 2020; 60:669-672. [PMID: 33312560 PMCID: PMC7721660 DOI: 10.1016/j.amsu.2020.11.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Distal Intestinal Obstruction Syndrome is a rare complication in patients with cystic fibrosis, which characterized by the accumulation of viscid fecal material, combined with sticky mucous secretions located in the distal ileum adhere to the intestinal wall, causing complete bowel obstruction. Presentation of case We report a case of a 45 years old patient with cystic fibrosis, who presented bowel obstruction secondary to accumulation of fecal material, combined with mucous secretions, in the mid-jejunum. A diagnostic laparoscopy was performed where a dilated jejunum was encountered with impaction of fecal content. Surgery was converted to open surgery, where a longitudinal enterotomy of 5 cm after the transition zone was created, evacuating manually the fecal material with mucous secretion. The patient evolved favorably, without complications. Discussion We present a case of a patient with cystic fibrosis presenting with bowel obstruction due to a proximal intestinal obstruction syndrome, which can be diagnosed with the DIOS definition, with the only distinction of a more proximal location in the gastrointestinal tract, such as the stomach, the duodenum, or the jejunum. Conclusion It is important for the clinician to know the existence of this syndrome at its different locations in the small bowel to treat accordingly. Proximal Intestinal Obstruction Syndrome is a rare complication in patients with cystic fibrosis. It is the accumulation of viscid feces with mucous secretions in the small bowel. It is important to know the existence of this syndrome to treat accordingly.
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Affiliation(s)
| | - Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico.,Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
| | | | - Enrique Quevedo-Fernandez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico.,Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
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6
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Alattar Z, Thornley C, Behbahaninia M, Sisley A. Proximal small bowel obstruction in a patient with cystic fibrosis: a case report. Surg Case Rep 2019; 5:143. [PMID: 31520190 PMCID: PMC6744530 DOI: 10.1186/s40792-019-0701-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background As advancements are made in the management of cystic fibrosis (CF), survival of the CF patient into adulthood has increased, leading to the discovery of previously unknown CF complications. Though gastrointestinal complications of CF, such as distal intestinal obstruction syndrome, are common, this case demonstrates a variant presentation of small bowel obstruction in this population. Case presentation We describe a 42-year-old male with CF who presented with 2 days of worsening upper abdominal pain, emesis, and loss of bowel function. The patient had no history of any prior abdominal surgeries; however, imaging was concerning for high-grade mechanical small bowel obstruction possibly related to internal hernia. Given leukocytosis and diffusely tender abdomen found on further workup, the decision was made to proceed with diagnostic laparoscopy after a brief period of intravenous fluid resuscitation. Intraoperatively, the transition point was found in the mid-jejunum and was noted to be due to kinking of the bowel causing vascular congestion in the proximal portion. Surgical manipulation of the bowel was required for return of normal perfusion and patency. Conclusion Though the exact mechanism cannot be definitively delineated, we speculate that the increased viscosity and prolonged intestinal transit time, characteristic of CF, resulted in inspissated fecal content in the proximal small bowel, which then acted as a lead point for obstruction. Thus, though small bowel obstruction in patients with CF is often attributed to distal intestinal obstruction syndrome, a broader differential must be considered. Early surgical intervention may be necessary to prevent bowel ischemia and subsequent small bowel resection in a patient presenting with concerning clinical and image findings, as was seen in this patient.
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Affiliation(s)
- Zana Alattar
- College of Medicine, University of Arizona College of Medicine - Phoenix, 550 E. Van Buren Street Phoenix, Phoenix, AZ, 85004, USA.
| | - Caitlin Thornley
- Phoenix Integrated Surgical Residency, University of Arizona College of Medicine, 550 E. Van Buren Street Phoenix, Phoenix, AZ, 85004, USA
| | - Milad Behbahaninia
- Phoenix Integrated Surgical Residency, University of Arizona College of Medicine, 550 E. Van Buren Street Phoenix, Phoenix, AZ, 85004, USA
| | - Amy Sisley
- College of Medicine, University of Arizona College of Medicine - Phoenix, 550 E. Van Buren Street Phoenix, Phoenix, AZ, 85004, USA.,Phoenix Integrated Surgical Residency, University of Arizona College of Medicine, 550 E. Van Buren Street Phoenix, Phoenix, AZ, 85004, USA
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7
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Mavilia M. Distal intestinal obstructive syndrome (DIOS): a gastrointestinal complication of cystic fibrosis in adults. Clin J Gastroenterol 2019; 12:571-573. [PMID: 30963407 DOI: 10.1007/s12328-019-00979-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/01/2019] [Indexed: 11/24/2022]
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8
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Green J, Carroll W, Gilchrist FJ. Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Cochrane Database Syst Rev 2018; 8:CD012798. [PMID: 30075058 PMCID: PMC6513219 DOI: 10.1002/14651858.cd012798.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention. OBJECTIVES This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 24 July 2018.We also searched the following trials registries and other resources: ClinicalTrials.gov; International Standard Randomised Controlled Trial Number (ISRCTN) Registry; the WHO International Clinical Trials Registry; and Open Grey.Date of last searches: 10 June 2018. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE. MAIN RESULTS There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall quality of the evidence was found to be very low. AUTHORS' CONCLUSIONS There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.
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Affiliation(s)
- Jessica Green
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Will Carroll
- University Hospitals of the North MidlandsDepartment of Paediatric Respiratory MedicineNewcastle RoadStoke‐on‐TrentUKST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University HospitalAcademic Department of Child HealthNewcastle RoadStoke‐on‐TrentUKST4 6QG
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9
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Incomplete Distal Intestinal Obstruction Syndrome Complicated by Oligosymptomatic Intussusception. ACG Case Rep J 2018; 5:e53. [PMID: 30038925 PMCID: PMC6053545 DOI: 10.14309/crj.2018.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022] Open
Abstract
Distal intestinal obstruction syndrome (DIOS) is a relatively common intestinal complication in cystic fibrosis (CF), and it can eventually lead to intussusception, a less frequent complication in CF. Intussusception is classically associated with gastrointestinal symptoms that overlap those of DIOS. We describe a young woman with oligosymptomatic intussusception diagnosed after resolution of DIOS symptoms.
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10
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Vargas MG, Miguel-Sardaneta ML, Rosas-Téllez M, Pereira-Reyes D, Justo-Janeiro JM. Neonatal Intestinal Obstruction Syndrome. Pediatr Ann 2018; 47:e220-e225. [PMID: 29750290 DOI: 10.3928/19382359-20180425-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neonatal intestinal obstruction is caused by an anatomical abnormality that produces bowel movement failure. Intestinal obstruction presents with three classic clinical signs: vomiting, abdominal distention, and failure to pass meconium. Intestinal obstruction is one of the most common causes for admitting a pediatric patient to the pediatric surgery unit in his or her first weeks of postnatal life. Congenital obstruction of the digestive tract in neonates is a common problem, with the most frequent cause being anorectal malformations (41%), followed by esophageal obstruction (24%), and duodenal obstruction (20%). [Pediatr Ann. 2018;47(5):e220-e225.].
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11
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Abstract
Cystic fibrosis is one of the most common inheritable traits in Caucasians. Meconium ileus and its potential complications are the most likely reasons that these patients will need surgical care. Surgical intervention is usually needed in the neonatal period but may also be required later in life. This article discusses the various ways cystic fibrosis can affect the gastrointestinal tract. Both the operative and nonoperative management of complicated and uncomplicated meconium ileus are discussed in the neonatal period as well as long-term issues, such as distal intestinal obstructive syndrome, fibrosing colonopathy, and rectal prolapse, all of which may be seen in older children and adults.
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Affiliation(s)
- John H.T. Waldhausen
- Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Morgan Richards
- Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
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12
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Green J, Gilchrist FJ, Carroll W. Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jessica Green
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Francis J Gilchrist
- Royal Stoke University Hospital; Academic Department of Child Health; Newcastle Road Stoke-on-Trent UK ST4 6QG
| | - Will Carroll
- University Hospitals of the North Midlands; Department of Paediatric Respiratory Medicine; Newcastle Road Stoke-on-Trent UK ST4 6QG
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13
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Question 8: How should distal intestinal obstruction syndrome [DIOS] be managed? Paediatr Respir Rev 2017; 21:68-71. [PMID: 27425011 DOI: 10.1016/j.prrv.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/23/2022]
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14
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Oz HS. Multiorgan chronic inflammatory hepatobiliary pancreatic murine model deficient in tumor necrosis factor receptors 1 and 2. World J Gastroenterol 2016; 22:4988-4998. [PMID: 27275091 PMCID: PMC4886374 DOI: 10.3748/wjg.v22.i21.4988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To provoke persistent/chronic multiorgan inflammatory response and to contribute to stones formation followed by fibrosis in hepatobiliary and pancreatic tissues.
METHODS: Tumor necrosis factor receptors 1 and 2 (TNFR1/R2) deficient mice reared in-house were given dibutyltin dichloride (DBTC) twice within 10 d by oral gavage delivery. Sham control animals received vehicle treatment and naïve animals remained untreated throughout the study. Animals were monitored daily for symptoms of pain and discomfort. The abdominal and hindpaw hypersensitivity were assessed with von Frey microfilaments. Exploratory behaviors were recorded at the baseline, after initiation of treatment, and before study termination. Histopathological changes were examined postmortem in tissues. Collagen accumulation and fibrosis were confirmed with Sirius Red staining.
RESULTS: Animals lost weight after oral administration of DBTC and developed persistent inflammatory abdominal and hindpaw hypersensitivity compared to sham-treated controls (P < 0.0001). These pain related secondary mechanical hypersensitivity responses increased more than 2-fold in DBTC-treated animals. The drastically diminished rearing and grooming rates persisted after DBTC administration throughout the study. Gross as well as micropathology at one month confirmed that animals treated with DBTC developed chronic hepatobiliary injuries evidenced with activation of stellate cells, multifocal necrosis, fatty degeneration of hepatocytes, periportal infiltration of inflammatory cells, and prominent biliary ductal dilation. The severity of hepatitis was scored 3.7 ± 0.2 (severe) in DBTC-treated animals vs score 0 (normal) in sham-treated animals. Fibrotic thickening was extensive around portal ducts, in hepatic parenchyma as well as in lobular pancreatic structures and confirmed with Sirius Red histopathology. In addition, pancreatic microarchitecture was presented with distortion of islets, and parenchyma, infiltration of inflammatory cells, degeneration, vacuolization, and necrosis of acinar cells and distention of pancreatic ducts. Extent of pancreatic damage and pancreatitis were scored 3.6 ± 0.4 (severe) for DBTC-treated in contrast to score 0 (normal) in sham-treated animals. The gall bladder became expanded with ductal distention, and occasional bile stones were detected along with microscopic hepatic lesions. DBTC-treated animals developed splenic hypertrophy with increased weight and length (P < 0.01) along with thymic atrophy (P < 0.001). Finally, colitic lesions and colitis were prominent in DBTC-treated animals and scored 3.4 ± 0.3 (moderately severe) vs 0 (normal) for the sham-treated animals.
CONCLUSION: This is the first report of chronic inflammatory multiorgan hepatobiliary pancreatitis, along with fibrosis and calculi formation induced reliably utilizing oral DBTC administration in TNFR1/R2 deficient mice.
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MESH Headings
- Abdominal Pain/chemically induced
- Abdominal Pain/genetics
- Abdominal Pain/metabolism
- Animals
- Behavior, Animal
- Bile Ducts/metabolism
- Bile Ducts/pathology
- Chemical and Drug Induced Liver Injury/etiology
- Chemical and Drug Induced Liver Injury/genetics
- Chemical and Drug Induced Liver Injury/metabolism
- Chemical and Drug Induced Liver Injury/psychology
- Cholangitis/chemically induced
- Cholangitis/genetics
- Cholangitis/metabolism
- Cholangitis/psychology
- Colitis/chemically induced
- Colitis/genetics
- Colitis/metabolism
- Exploratory Behavior
- Genetic Predisposition to Disease
- Grooming
- Hepatic Stellate Cells/metabolism
- Hepatic Stellate Cells/pathology
- Hyperalgesia/chemically induced
- Hyperalgesia/genetics
- Hyperalgesia/metabolism
- Lithiasis/chemically induced
- Lithiasis/genetics
- Lithiasis/metabolism
- Lithiasis/psychology
- Liver/metabolism
- Liver/pathology
- Liver Cirrhosis, Experimental/chemically induced
- Liver Cirrhosis, Experimental/genetics
- Liver Cirrhosis, Experimental/metabolism
- Liver Cirrhosis, Experimental/psychology
- Mice, Knockout
- Organotin Compounds
- Pain Perception
- Pancreas/metabolism
- Pancreas/pathology
- Pancreatic Stellate Cells/metabolism
- Pancreatic Stellate Cells/pathology
- Pancreatitis/genetics
- Pancreatitis/metabolism
- Pancreatitis/psychology
- Phenotype
- Receptors, Tumor Necrosis Factor, Type I/deficiency
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type II/deficiency
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Spleen/metabolism
- Spleen/pathology
- Weight Loss
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15
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Olszowiec-Chlebna M, Koniarek-Maniecka A, Stelmach W, Smejda K, Jerzyńska J, Majak P, Białas M, Stelmach I. Predictors of deterioration of lung function in Polish children with cystic fibrosis. Arch Med Sci 2016; 12:402-7. [PMID: 27186187 PMCID: PMC4848371 DOI: 10.5114/aoms.2016.59268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/21/2014] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Severity of lung disease varies in patients with the same CFTR genotype. It suggests that other factors affect the severity of cystic fibrosis (CF). The aim of the study was to identify risk factors that determine lung function decline in Polish cystic fibrosis children. MATERIAL AND METHODS The follow-up time was no less than 5 years of respiratory status observation based on the forced expiratory volume in 1 s value (FEV1). The socio-economic data, perinatal interview, presence of meconium ileus (MI), time of CF diagnosis, initiation of tobramycin inhalation solution (TIS), pancreatic function, sensitization to Aspergillus fumigatus, presence of impaired glucose tolerance (IGT) or diabetes mellitus, chronic bacterial colonization and number of exacerbations and hospitalizations were assessed. RESULTS The mean age of 61 included children was 13.3 ±7.6 years. Delta F508 homozygosity was detected in 45.9%, 44.3% were delta F508 heterozygous, and 9.8% had other genotypes. FEV1 decline was observed among 20% of patients; the rest of the patients presented stable values of FEV1 during at least 5 years of observation. The most significant predictors related to the decline of FEV1 were presentation of MI (p = 0.0344), IGT (p = 0.0227), number of exacerbations (p = 0.0288), and early Pseudomonas aeruginosa (PA) chronic colonization (p = 0.0165) followed by late TIS initiation after the first detection of PA (p=0.0071). Neither time of diagnosis nor type of CFTR mutation was statistically significant as a predictor of lung deterioration. CONCLUSIONS The presence of MI, IGT, chronic PA colonization, and number of exacerbations are risk factors for lung function deterioration.
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Affiliation(s)
| | - Agnieszka Koniarek-Maniecka
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Włodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Smejda
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Paweł Majak
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Monika Białas
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
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Fernández-Ibieta M, Ayuso-González L, Fernández-Córdoba M, Argumosa-Salazar Y, Gonzálvez-Piñera J. Treatment options of distal intestinal obstruction syndrome: And if the enemas fail? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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17
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What Is the Role of Nutrition Therapy in the Management of the Adult Cystic Fibrosis Patient? Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Fernández-Ibieta M, Ayuso-González L, Fernández-Córdoba MS, Argumosa-Salazar Y, Gonzálvez-Piñera J. [Treatment options of distal intestinal obstruction syndrome: And if the enemas fail?]. An Pediatr (Barc) 2015; 84:54-5. [PMID: 26122491 DOI: 10.1016/j.anpedi.2015.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 04/25/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023] Open
Affiliation(s)
- M Fernández-Ibieta
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - L Ayuso-González
- Servicio de Cirugía Pediátrica, Hospital Virgen del Camino, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M S Fernández-Córdoba
- Servicio de Cirugía Pediátrica, Hospital General Universitario de Albacete, Albacete, España
| | - Y Argumosa-Salazar
- Servicio de Cirugía Pediátrica, Hospital General Universitario de Albacete, Albacete, España
| | - J Gonzálvez-Piñera
- Servicio de Cirugía Pediátrica, Hospital General de Alicante, Alicante, España
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