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Gunther RS, Farrell MB, Banks KP. Got the Munchies for an Egg Sandwich? The Effects of Cannabis on Bowel Motility and Beyond. J Nucl Med Technol 2024; 52:8-14. [PMID: 38443102 PMCID: PMC10924153 DOI: 10.2967/jnmt.123.266816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/11/2023] [Indexed: 03/07/2024] Open
Abstract
The use of medicinal cannabis has a long history dating back thousands of years. Recent discoveries have shed light on its mechanism of action with the identification of cannabinoid receptors and endocannabinoids, which make up the body's endocannabinoid system. Cannabinoid receptors, particularly the cannabinoid 1 and 2 receptors, play a crucial role in modulating the gut-brain axis and serve as potential therapeutic targets for gastrointestinal motility and inflammatory disorders. With increasing legalization of cannabis and a rising number of users, understanding the effects of cannabis on gut motility is essential for nuclear medicine providers. Although tetrahydrocannabinol, the principal psychoactive constituent of cannabis, may decrease gut motility in experimental settings, it appears to paradoxically improve symptoms in gastroparesis. Treatment effects are difficult to measure given the large number of variables that could significantly alter outcomes, such as cannabinoid type, potency, and route of intake. Another consideration is the highly personalized gut microbiome, which directly interacts with the endocannabinoid system. Further research is required to delineate these multifaceted, complex cannabinoid interactions. The goal of this article is to explore the knowns and unknowns of the impact of cannabis on the alimentary system.
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Affiliation(s)
- Rutger S Gunther
- Uniformed Services University of the Health Sciences, Bethesda, Maryland;
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; and
| | - Mary B Farrell
- Intersocietal Accreditation Commission, Ellicott City, Maryland
| | - Kevin P Banks
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; and
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Alshammari MT, Alyami AS, Wilkinson-Smith V, Spiller RC, Gowland P, Marciani L, Moran GW, Hoad CL. MRI tagging of colonic chyme mixing in healthy subjects: Inter-observer variability and reliability of the measurement with time. Neurogastroenterol Motil 2023; 35:e14610. [PMID: 37158374 DOI: 10.1111/nmo.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) tagging techniques have been applied to the GI tract to assess bowel contractions and content mixing. We aimed to evaluate the dependence of a tagging measurement (for assessing chyme mixing) on inter-observer variability in both the ascending colon (AC) and descending colon (DC) and to investigate the temporal variation and hence reliability of the colonic tagging technique by acquiring multiple measurements over time on healthy participants. METHODS Two independent datasets of healthy adults were used for the retrospective inter-observer variability (Study 1: 13 datasets and Study 2: 31 datasets), and ten participants were scanned for the prospective temporal variation study following a 1 L mannitol oral preparation. All colonic tagging data were acquired on 3 T MRI scanners. The mean and the standard deviation (SD) maps were generated pixel-by-pixel using custom-written software in MATLAB. The colonic regions of interest were defined using MIPAV software. Bland-Altman plots and scatter plots were used for the inter-observer variability. The mean and SD of all repeated measures for each subject were calculated along with a one-way ANOVA to test for variations with time. RESULTS Scatter plots and Bland-Altman plots showed a large range of data with low variation and small limits of agreements (<5% CoV). The intraclass correlation coefficient of inter-rater reliability was excellent and 0.97 or above for the AC and DC measurements for both datasets. The temporal variation study shows that there was no significant difference found between the multiple measures with time (p = 0.53, one-way repeated measures ANOVA test). CONCLUSIONS MRI tagging technique can provide an assessment of colonic chyme mixing. The inter-observer study data showed high inter-rater agreement. The temporal variation study showed some individual variations with time suggesting multiple measurements may be needed to increase accuracy.
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Affiliation(s)
- Meshari T Alshammari
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Ali S Alyami
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Saudi Arabia
| | - Victoria Wilkinson-Smith
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Robin C Spiller
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Penny Gowland
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Luca Marciani
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Gordon W Moran
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Caroline L Hoad
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Nata N, Bunpeth W, Tasanavipas P, Varothai N, Supasyndh O, Satirapoj B. Effect of senna glycoside on serum potassium levels among patients on maintenance hemodialysis: A randomized controlled trial. Ther Apher Dial 2022; 26:908-914. [PMID: 38318690 DOI: 10.1111/1744-9987.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyperkalemia is common among end-stage renal disease (ESRD) patients, and consequently contributes to an increased risk of cardiac arrhythmia. Senna glycoside may decrease colonic transit time and potassium colonic reabsorption. METHODS Patients on hemodialysis were randomized to receive either oral senna glycoside (n = 37) or control (n = 36) for 8 weeks. The primary outcomes were predialysis serum potassium and prevalence of hyperkalemia. RESULTS At the end of the study, significantly reduced serum potassium concentrations were observed in the senna glycoside compared with the control (-0.32 [95%CI -0.43, -0.04] vs. -0.02 [95%CI -0.12, 0.05] mEq/L, p < 0.001, respectively). The prevalence of hyperkalemia during the study occurred at 13.8% in the control and 5.4% in the senna glycoside (p = 0.309). No serious adverse events were observed. CONCLUSION Among patients with ESRD on hemodialysis, senna glycoside significantly decreases serum potassium level. Senna glycoside is a safe and possibly effective alternative treatment for hyperkalemia in ESRD.
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Affiliation(s)
- Naowanit Nata
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Wasin Bunpeth
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pamila Tasanavipas
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Narittaya Varothai
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Bancha Satirapoj
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Kang HY, Kim Y, You AH, Kim YJ, Kim MK. A randomized controlled trial of the effect of ramosetron on postoperative restoration of bowel motility after gynecologic laparoscopic surgery. Int J Gynaecol Obstet 2021; 158:172-178. [PMID: 34614204 DOI: 10.1002/ijgo.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the effect of ramosetron after gynecological laparoscopic surgery on the recovery of bowel function. METHODS A prospective randomized controlled trial conducted at Kyung Hee University hospital, South Korea, from August 2016 to September 2017. Patients were randomized to receive either 10 mg dexamethasone before induction of anesthesia (control group C), followed by intravenous administration of patient-controlled analgesia (IV-PCA) or 2 ml normal saline before induction of anesthesia and 0.6 mg ramosetron (study group R) administered with IV-PCA. RESULTS A total of 88 patients were enrolled. Times to first flatus (group C 23.98 ± 6.31 vs. group R 27.14 ± 9.56 h; P = 0.148) and first defecation (group C 36.16 ± 16.04 vs. group R 43.41 ± 20.01 h; P = 0.138) showed no statistically significant differences. No significant differences were observed in the frequency of postoperative nausea and vomiting (PONV) and demand for additional analgesics. Multiple linear regression for analysis of factors affecting time to first flatus revealed no significant results. CONCLUSION Ramosetron did not delay bowel movement recovery after gynecologic laparoscopic surgery and was as effective as dexamethasone in regulating PONV. Ramosetron can be used with IV-PCA without concerns about delay in recovery of bowel function. ClinicalTrials.gov registration number: NCT02849483.
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Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Youngsoon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Yeon Jin Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
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5
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Ishimaru K, Akita S, Matsuda S, Yukumi S, Morimoto M, Kikuchi C, Matsui S, Tanigawa K, Kuwabara J, Matsumoto H, Kikuchi S, Yoshida M, Koga S, Watanabe Y. The screening program, incidence, and treatment for tumors in patients with severe motor and intellectual disabilities. J NIPPON MED SCH 2021; 89:212-214. [PMID: 34526464 DOI: 10.1272/jnms.jnms.2022_89-217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, aging in patients with severe motor and intellectual disabilities (SMID) has been causing serious problems. There have been few reports about treatment for tumors in patients with SMID. METHODS The treatments performed for tumors of 12 SMID patients were examined. RESULTS Blood tests and ultrasonography were useful in screening. With regard to treatment, the surgery for SMID patients was performed in the same manner as in healthy cases, and the results were generally satisfactory, without major complications. Typically, the patients were diagnosed in advanced stages; many metachronous double cancers were observed. CONCLUSIONS We reported a tumor therapy to the patients with SMID. Our therapy provides satisfactory results for patients with SMID and their families. Further studies are required to clarify the clinical significance of the screening test and the tumor operative method for the patients with SMID.
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Affiliation(s)
- Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shunji Matsuda
- Department of Pediatrics, National Hospital Organization Ehime Hospital
| | - Shungo Yukumi
- Department of Surgery, National Hospital Organization Ehime Hospital
| | | | - Chiya Kikuchi
- Department of Pediatrics, National Hospital Organization Ehime Hospital
| | - Sayuri Matsui
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kazufumi Tanigawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Hironori Matsumoto
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Yuji Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
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Abstract
Circadian rhythms ensure that physiological processes occur at the most biologically meaningful time. The circadian timing in the gastrointestinal tract involves interlocking transcriptional and translational feedback loops that culminate in the rhythmic expression and activity of a set of clock genes and related hormones. The suprachiasmatic nucleus and peripheral core molecular clocks oscillate every 24 hours and are responsible for the periodic activity of various segments and transit along the gastrointestinal tract. Environmental cues may alter or reset these rhythms to align them with new circumstances. Colonic motility also follows a circadian rhythm with reduced nocturnal activity. Healthy humans have normal bowel motility during the day, frequently following awakening or following a meal, with minimal activity during the night. Maladjusted circadian rhythms in the bowel have been linked to digestive pathologies, including constipation and irritable bowel syndrome. Our advanced knowledge of the link between the circadian clock and gastrointestinal physiology provides potential therapeutic approaches for the treatment of gastrointestinal diseases. This review seeks to establish evidence for the correlation between circadian rhythm, bowel movements and digestive health, and examine the implications of disrupted circadian rhythms on gut physiology.
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Affiliation(s)
- Henri Duboc
- AP-HP Hospital Louis Mourier, Colombes
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMRS 1149, Université de Paris, Paris
| | - Benoit Coffin
- AP-HP Hospital Louis Mourier, Colombes
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMRS 1149, Université de Paris, Paris
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Han JP, Lee JH, Lee GS, Koo OJ, Yeom SC. Positive Correlation between nNOS and Stress-Activated Bowel Motility Is Confirmed by In Vivo HiBiT System. Cells 2021; 10:1028. [PMID: 33925396 PMCID: PMC8145384 DOI: 10.3390/cells10051028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Neuronal nitric oxide synthase (nNOS) has various roles as a neurotransmitter. However, studies to date have produced insufficient data to fully support the correlation between nNOS and bowel motility. This study aimed to investigate the correlation between nNOS expression and gastrointestinal (GI) tract motility using a stress-induced neonatal maternal separation (NMS) mouse model. In this study, we generated a genetically modified mouse with the HiBiT sequence knock-in into the nNOS gene using CRISPR/Cas9 for analyzing accurate nNOS expression. nNOS expression was measured in the stomach, small intestine, large intestine, adrenal gland, and hypothalamus tissues after establishing the NMS model. The NMS model exhibited a significant increase in nNOS expression in large intestine, adrenal gland, and hypothalamus. Moreover, a significant positive correlation was observed between whole gastrointestinal transit time and the expression level of nNOS. We reasoned that NMS induced chronic stress and consequent nNOS activation in the hypothalamic-pituitary-adrenal (HPA) axis, and led to an excessive increase in intestinal motility in the lower GI tract. These results demonstrated that HiBiT is a sensitive and valuable tool for analyzing in vivo gene activation, and nNOS could be a biomarker of the HPA axis-linked lower intestinal tract dysfunction.
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Affiliation(s)
- Jeong Pil Han
- Graduate School of International Agricultural Technology and Green, Institute of Green BioScience and Technology, Seoul National University, 1447 Pyeongchang-ro, Daewha, Pyeongchang 25354, Korea
| | - Jeong Hyeon Lee
- Graduate School of International Agricultural Technology and Green, Institute of Green BioScience and Technology, Seoul National University, 1447 Pyeongchang-ro, Daewha, Pyeongchang 25354, Korea
| | - Geon Seong Lee
- Graduate School of International Agricultural Technology and Green, Institute of Green BioScience and Technology, Seoul National University, 1447 Pyeongchang-ro, Daewha, Pyeongchang 25354, Korea
| | - Ok Jae Koo
- Toolgen Inc., Gasan Digital-ro, Geumcheon, Seoul 08594, Korea
| | - Su Cheong Yeom
- Graduate School of International Agricultural Technology and Green, Institute of Green BioScience and Technology, Seoul National University, 1447 Pyeongchang-ro, Daewha, Pyeongchang 25354, Korea
- WCU Biomodulation Major, Department of Agricultural Biotechnology, Seoul National University, 1 Gwanak-ro, Gwanank, Seoul 08826, Korea
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8
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Yuan H, Hu H, Chen R, Mu W, Wang L, Li Y, Chen Y, Ding X, Xi Y, Mao S, Jiang M, Chen J, He Y, Wang L, Dong Y, Tou J, Chen W. Premigratory neural crest stem cells generate enteric neurons populating the mouse colon and regulating peristalsis in tissue-engineered intestine. Stem Cells Transl Med 2021; 10:922-938. [PMID: 33481357 PMCID: PMC8133337 DOI: 10.1002/sctm.20-0469] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/26/2020] [Accepted: 01/03/2021] [Indexed: 12/13/2022] Open
Abstract
Hirschsprung's disease (HSCR) is a common congenital defect. It occurs when bowel colonization by neural crest‐derived enteric nervous system (ENS) precursors is incomplete during the first trimester of pregnancy. Several sources of candidate cells have been previously studied for their capacity to regenerate the ENS, including enteric neural crest stem cells (En‐NCSCs) derived from native intestine or those simulated from human pluripotent stem cells (hPSCs). However, it is not yet known whether the native NCSCs other than En‐NCSCs would have the potential of regenerating functional enteric neurons and producing neuron dependent motility under the intestinal environment. The present study was designed to determine whether premigratory NCSCs (pNCSCs), as a type of the nonenteric NCSCs, could form enteric neurons and mediate the motility. pNCSCs were firstly transplanted into the colon of adult mice, and were found to survive, migrate, differentiate into enteric neurons, and successfully integrate into the adult mouse colon. When the mixture of pNCSCs and human intestinal organoids was implanted into the subrenal capsule of nude mice and grown into the mature tissue‐engineered intestine (TEI), the pNCSCs‐derived neurons mediated neuron‐dependent peristalsis of TEI. These results show that the pNCSCs that were previously assumed to not be induced by intestinal environment or cues can innervate the intestine and establish neuron‐dependent motility. Future cell candidates for ENS regeneration may include nonenteric NCSCs.
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Affiliation(s)
- Huipu Yuan
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hui Hu
- Department of Laboratory Medicine, Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Rui Chen
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wenbo Mu
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Liangliang Wang
- Interdisciplinary Institutes of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, People's Republic of China
| | - Ying Li
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yuelei Chen
- Cell Bank/Stem Cell Bank, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Xiaoyan Ding
- Cell Bank/Stem Cell Bank, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Yongmei Xi
- Institute of Genetics and Department of Genetics, Division of Human Reproduction and Developmental Genetics of the Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - ShanShan Mao
- Department of Internal Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Mizu Jiang
- Department of Gastroenterology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jie Chen
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong He
- State Key Laboratory of Fluid Power and Mechatronic Systems School of Mechanical Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Lang Wang
- Interdisciplinary Institutes of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, People's Republic of China
| | - Yi Dong
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, School of Physical Education & Health Care, East China Normal University, Shanghai, People's Republic of China
| | - Jinfa Tou
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wei Chen
- Institute of Translational Medicine, and Children's Hospital Affiliated and Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China.,Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurobiology, Institute of Neuroscience, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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9
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Turkay Ü, Yavuz A, Hortu İ, Terzi H, Kale A. The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy. J OBSTET GYNAECOL 2019; 40:705-709. [PMID: 31609137 DOI: 10.1080/01443615.2019.1652891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We aimed to investigate the effects of chewing gum on bowel activity and postoperative pain in patients undergoing laparoscopic hysterectomy. Patients were randomised into two groups (n = 58, study; n = 51, control). In the study group, patients started chewing sugarless gum every 2 h for 15 min, beginning at the second postoperative hour. The control group did not chew gum, and they received standard postoperative care. Both groups were compared primarily in terms of the amount of time until the first bowel movement, the time of the first passage of flatus and the time of first defaecation. The amount of time until the first bowel movement, the time of the first passage of flatus and the time of the first defaecation were found to be significantly shorter in the chewing gum group (p < .001). The amount of postoperative analgesics that were needed and VAS scores at 6-hours and 24-hours postoperatively, were found to be lower in the study group than in the control group (p < .001). Chewing gum was found to have beneficial effects on bowel motility and postoperative pain in patients undergoing laparoscopic hysterectomy. This affordable and simple method could be recommended to patients after total laparoscopic hysterectomy.Impact statementWhat is already known on this subject? Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract.What do the results of this study add? The findings of previous randomised controlled studies have been inconsistent regarding the effect of chewing gum on postoperative bowel function following abdominal gynecological surgery. In this randomised prospective study, we found that chewing gum early in the postoperative period after total laparoscopic hysterectomy hastened time to bowel motility and flatus. To our knowledge this is the first study of the impact of chewing gum on bowel motility after total laparoscopic hysterectomy.What are the implications of these findings for clinical practice and/or further research? Chewing gum early in the postoperative period following laparoscopic hysterectomy hastens time to bowel motility and flatus. The use of chewing gum is a simple and cheap strategy for promoting the recovery of gastrointestinal functions.
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Affiliation(s)
- Ünal Turkay
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - Arzu Yavuz
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - İsmet Hortu
- Department of Obstetrics & Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ahmet Kale
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
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10
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Abstract
Chronic intestinal pseudo-obstruction (CIP) is defined by either continuous or intermittent symptoms of bowel obstruction in the absence of fixed lumen excluding lesion. CIP includes a heterogeneous group of disorders which result either from diseases affecting the enteric neurons and smooth muscle lining or those involving the autonomic innervation of the bowel. Symptoms associated with CIP are nonspecific, which can sometimes contribute to the delay in recognizing the condition and making the correct diagnosis. The diagnostic workup should include imaging and manometry studies and, occasionally, full-thickness bowel biopsies for histopathological examination may be required. Multidisciplinary team approach for the management of these patients is recommended, and the team members should include a gastroenterologist, surgeon, chronic pain specialist, clinical nutritionist, and a psychologist. The treatment goals should include optimizing the nutritional status and preventing or delaying the development of intestinal failure. The majority of the patients require enteral or parenteral nutrition support, and chronic pain is a common and distressing symptom. Small bowel transplantation may be required if patients develop liver complications due to parenteral nutrition, have difficult central line access, or have poor quality of life and worsening pain despite aggressive medical management.
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Affiliation(s)
- Khalil El-Chammas
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Manu R Sood
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Pediatric Gastroenterology, Children's hospital of Wisconsin, Milwaukee, Wisconsin
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11
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van der Paardt MP, Sprengers AMJ, Zijta FM, Lamerichs R, Nederveen AJ, Stoker J. Noninvasive automated motion assessment of intestinal motility by continuously tagged MR imaging. J Magn Reson Imaging 2013; 39:9-16. [PMID: 23553805 DOI: 10.1002/jmri.24094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/05/2013] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate continuously tagged 3 Tesla MRI for monitoring glucagon-induced bowel motility changes in healthy volunteers. MATERIALS AND METHODS After standardized oral bowel preparation, 10 healthy volunteers underwent a free-breathing, continuously tagged three-dimensional (3D) dynamic fast-field-echo (FFE), at a 3.36 Hz sampling frequency. One milligram of glucagon was administered intravenously during data acquisition. Each dataset was divided into four temporal sets of 2 min (period 1 to 4). Taglines were tracked automatically using a scale spaced based algorithm. Assessment of global spectral resolution was performed for three frequency intervals: 0.008-0.300 Hz (motility), 0.300-0.400 Hz (breathing motion), and 0.400-0.533 Hz (higher order motion). Additional analyses were performed at fine spectral resolution in frequency bands of 0.033 Hz. Glucagon-induced motility changes were investigated by means of a motility index (spectral power normalized to the maximal spectral power per-volunteer), resulting in a range of 0 to 1 (no motion to maximal motion). Statistical comparison was done for period 1 and 4 (Wilcoxon-signed rank test). RESULTS After glucagon administration, a significant decrease in the motility index was found for the low- (0.008-0.300 Hz) (P < 0.0001) and high-frequency interval (0.400-0.533 Hz) (P < 0.0001). Around breathing motion frequencies, no decrease in motility index was detected. CONCLUSION Free-breathing, continuously tagged MR imaging is a noninvasive method for automated bowel motility assessment and allows for detection of drug-induced changes.
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Affiliation(s)
- Marije P van der Paardt
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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