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PubMed1984

Therapeutic possibilities in colonic motility disorders.

Colonic motility disorders can be treated by changing the diet, modifying the patient's daily behaviour, giving drugs to enhance or inhibit colonic contraction, or by performing surgery. Therapy in constipation mainly relies on the use of bulk-forming agents, in addition to a change in behaviour. Dietary fibre, particularly bran, appears to be effective in diverticular disease. Bowel atony is largely caused by increased sympathetic activity, and thus frequently responds to sympatholysis. In the irritable bowel syndrome, amelioration is achieved by taking bran and omitting badly tolerated food; antispasmodics and psychotherapy are also probably beneficial. Diarrhoea and incontinence may be treated by opioids, such as loperamide. Recent progress has been mainly in the understanding of the pathophysiology of these disorders, but rapid therapeutic advances are now taking place.

Colonic Diseases, Functional↗
PubMedDate not supplied

[Correlation between colonoscopy and histopathology of the colon in diverticular disease and the irritable colon syndrome].

In this study 29 patients were carriers of diverticular disease of the colons (DDC) and 29 patients with irritable bowel syndrome (IBS). The patients were diagnosed by means of a directed anamnesis standardized by the radiologic study of the colons. The methodology included, radiologic study of the colons, endoscopic examination of the colon (colonoscopy with biopsy) and anatomic pathologic examination of the fragments obtained in the endoscopy. It was tried, by means of colonoscopy with biopsy and anatomic pathological examination, to demonstrate, classify and relate, in agreement with pre-established criterion, the degree of intensity of the inflammatory process in the colic mucosa. According to the results we may conclude that: 1) colonoscopy in the studied inflammatory diseases is important for diagnosis, evaluation of the inflammatory process, identification of associated illness and material obtention for the anatomic pathological examination; 2) there is always a chronic inflammatory process, in variable degrees, of the colic mucosa in DDC and in IBS; 3) colonoscopy with biopsy and the anatomic pathological examination are adequate to diagnose with precision the degree of intensity of the chronic inflammatory process of the colic mucosa and the presence of associated disease in DDC and in IBS.

Adult↗
PubMed2000

Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people.

OBJECTIVES: To review the epidemiology, pathophysiology and mechanisms of irritable bowel syndrome (IBS), constipation, and diverticulosis, for the purpose of addressing these three common conditions in older adults (>65 years of age). DESIGN: Using a MEDLINE search, we identified original English language journal articles and reviews from 1965 to December 1998. We also selected articles published before 1965 or after 1998 that were cross-referenced or pertinent to the topics researched. RESULTS: The prevalence of constipation and diverticulosis is higher in older than in younger adults. Significant risk factors for constipation in older women are failure of the anorectal angle to open or excessive perineal descent, which represent disturbances of pelvic floor function and rectal evacuation. In contrast, the prevalence of IBS is no greater than in younger adults. Nevertheless, these syndromes impact on the patient's functional status and quality of life. The mechanisms resulting in these gastrointestinal syndromes are unclear. Uncoordinated colonic activity and colonic segmentation may lead to IBS and diverticulosis, respectively, and these pathophysiological findings suggest disorders of inhibitory control of neuromuscular function. The total number of neurons in the myenteric plexus is decreased, and collagen deposited in the distal colon is increased with aging in humans. Animal studies suggest that senescent colonic muscle responds less to excitatory factors in vitro, and neural injury in older animals may result from apoptosis, defects of mitochondrial metabolism, and inadequate levels or response to neurotrophins. Future investigations will reveal whether similar mechanisms underlie human disease. Currently, treatment is aimed at relief of symptoms of IBS or constipation or dealing with the complications of diverticulosis. CONCLUSIONS: Constipation, IBS, and diverticulosis are common problems of aging. There is a need for further systematic research of the basic mechanisms in neuromuscular dysfunction with aging, including the studies of physical characteristics of the colonic wall, pelvic floor function (particularly in women with excessive perineal descent), and neurohormonal control of motility and sensation. Insights on the pathophysiology and mechanisms of neural injury may lead to more specific treatments in the future, e.g., serotonergic agents and neurotrophins. Meanwhile, collaborations between primary care physicians, geriatricians, and gastroenterologists can optimize management of these three common conditions that significantly impact the quality of life of older adults.

Age Distribution↗
PubMed1995

[Neuroimmune interactions in the gastrointestinal tract].

The enteric nervous system and immune system are integrated systems that play an important role in the regulation of gastrointestinal functions. Recent studies suggest a bidirectional interaction between both systems. The relationship is based on the synthesis and release of neuropeptides from immune cells and the receptor-mediated alteration of nervous and immune functions by neurotransmitters and inflammatory mediators. The activity of the enteric nervous and immune system can be modulated by the central nervous system. These psycho-neuro-immuno-interactions are involved in gut inflammation, in functional bowel diseases and in the physiological control of gastrointestinal functions.

Animals↗
PubMed1990

[Study on function of aganglionic colon musculature of Hirschsprung's disease murine model].

This study examined the function in vitro of aganglionic colon musculature in mice with hereditary aganglionosis--a strain of animals used as a model of Hirschsprung's disease. Double sucrose gap recordings from the muscle strips of both normal and aganglionic colon showed bursts of spike potentials with muscle contraction. Intracellular recordings of the membrane potentials of the circular muscle cells of normal, aganglionic and oligo-ganglionic colon had no statistical difference. Microelectrode recordings from the circular muscle cells of normal siblings, in the presence of nifedipine, irregular ongoing fluctuations in membrane potential, which were abolished by tetrodotoxin and reduced by d-tubocurarine or apamin. The fluctuations were less effected by atropine. These observations suggest that there is ongoing inhibitory neural activity to the circular smooth muscle of normal colon. These ongoing fluctuations were not recorded from the cells of aganglionic and oligo-ganglionic colon of affected animals. Although transmural stimulation of the intrinsic nerves produced cholinergic excitatory and inhibitory junction potentials in normal colon, no junction potentials were evoked by transmural stimulation in aganglionic colon. It was concluded that the ongoing tonic inhibitory activity may contribute to the compliance of the normal mouse colon and lack of the compliance may affect functional intestinal obstruction of the aganglionic colon in Hirschsprung's disease.

Animals↗
PubMed1982

[Measurable parameters in the irritable bowel syndrome (author's transl)].

In patients suffering from the irritable bowel syndrome no morphological substrate for this disease can be found; thus quantitation of functional parameters might be desirable. In the colon these patients exhibit myoelectrical waves of increased frequency, e.g. 3 per minute, as well as an exaggerated retropulsion and a prolonged motor response after food intake, indicating an abnormal motility pattern. In the small gut transit is either accelerated, causing diarrhea, or slowed down, causing constipation; in addition, there is an increased retrograde movement of intestinal gas. The pain threshold is decreased in the small and large bowel; inflation of a balloon or insufflation of gas may reproduce the clinical symptoms of the patients. In the terminal ileum there is net fluid secretion instead of net absorption, as normal. Even the esophagus may be affected, since manometry has demonstrated disturbed peristalsis and a reduced pressure of the lower esophageal sphincter. Such quantification of intestinal function is not a substitute for careful clinical work-up. It has however contributed to a better understanding of the underlying functional disturbances in irritable bowel syndrome.

Colonic Diseases, Functional↗