|
1
|
Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29:1685-1707. [PMID: 37077514 PMCID: PMC10107216 DOI: 10.3748/wjg.v29.i11.1685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
Collapse
Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Rocco Ranaldo
- Department of Internal Medicine, “Mazzolani-Vandini” Hospital, Digestive Endoscopy, Ferrara 744011, Italy
| | - Antonella Contaldo
- Gastroenterology Unit, National Institute of Gastroenterology “S de Bellis” Research Hospital, Bari 70013, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, Foggia 71122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| |
Collapse
|
|
2
|
Oh HK, Sung TS, Ryoo SB, Park KJ. Regional Differences in Intestinal Contractile Responses to Radial Stretch in the Human Lower Gastrointestinal Tract. J Neurogastroenterol Motil 2023; 29:113-121. [PMID: 36437512 PMCID: PMC9837542 DOI: 10.5056/jnm21236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 07/01/2022] [Accepted: 08/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background/Aims Radial stretch evokes an increase or decrease in contractions in the lower gastrointestinal tract via mechanosensory enteric neurons that project into the muscle layers. We aim to elucidate the differences in stretch reflexes according to their location in the human colon. Methods We used healthy intestinal smooth muscle tissue excised during elective colon cancer surgery. Conventional intracellular recordings from colonic muscle cells and tension recordings of colonic segments were performed. Radial stretch was evoked through balloon catheter inflation. Changes in the membrane potential and frequency, amplitude, and area under the curve of muscle contractions were recorded before and after the radial stretch at proximal and distal segment sites. Results In intracellular circular muscle recordings, hyperpolarization was noted at the distal site of sigmoid colonic segments after radial stretch, in contrast to depolarization at all other sites. In tension recordings at proximal ascending or sigmoid colonic segment sites, contractile activation was observed with statistically significant increases in the frequency, amplitude, and area under the curve after radial stretch. Distal sites of ascending and sigmoid colonic segments showed increase and decrease in contraction, respectively. Conclusion Radial stretch in the human colon (in vitro) evokes excitatory activity at both proximal and distal sites of the ascending colon and at the proximal site of the sigmoid colon, whereas it elicits inhibitory activity at the distal site of the sigmoid colon.
Collapse
Affiliation(s)
- Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Tae Sik Sung
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea,Correspondence: Kyu Joo Park, MD, PhD, Department of Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Korea, Tel: +82-2-2072-2901, Fax: +82-2-766-3975, E-mail:
| |
Collapse
|
|
3
|
Jones BS, Keightley LJ, Harris JO, Wiklendt L, Spencer NJ, Dinning PG. Identification of neurogenic intestinal motility patterns in silver perch (Bidyanus bidyanus) that persist over wide temperature ranges. Neurogastroenterol Motil 2021; 33:e14037. [PMID: 33340207 DOI: 10.1111/nmo.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fish are increasingly being utilized as a model species for genetic manipulation studies related to gastrointestinal (GI) motility. Our aim was to identify whether patterns of GI motility in fish and the mechanisms underlying their generation are similar to those recorded from mammals (including humans). METHODS The entire intestine was removed from euthanized adult Silver Perch (n = 11) and lesioned at the midway point to obtain two equal lengths. Proximal and distal segments were studied separately in organ baths with oxygenated Krebs solution, maintained at either 15°C (n = 5) or 25°C (n = 6). Motility was analyzed during rest, after oral infusion of Krebs solution, and after application of hexamethonium (100 µM) and tetrodotoxin (TTX) (0.6 µM). KEY RESULTS Antegrade and retrograde propagating contractions (PC) were recorded in all preparations. In the proximal intestine, at 15 and 25°C, retrograde PCs occurred at 2.7 [1.7-4.5] and 3.1 [1.6-6.5] times the frequency of antegrade PCs, respectively. Colder temperatures did not inhibit PC frequency. Hexamethonium did not inhibit PC, and however, TTX abolished all contractile activity. CONCLUSIONS AND INFERENCES Both neurogenic antegrade and retrograde propagating contractions occur throughout the intestine of Silver Perch. However, unlike the mammalian colon, these motor patterns do not require enteric nicotinic transmission and they are not inhibited by cold temperatures (15°C). Therefore, while the GI motility patterns in Silver Perch resemble those recorded from the colon of mammals, there may be differences in the mechanisms that underlying their generation.
Collapse
Affiliation(s)
- Bradley S Jones
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Lauren J Keightley
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - James O Harris
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Lukasz Wiklendt
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Nick J Spencer
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Phil G Dinning
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia.,Department of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia
| |
Collapse
|
|
4
|
Parsons SP, Huizinga JD. Nitric Oxide Is Essential for Generating the Minute Rhythm Contraction Pattern in the Small Intestine, Likely via ICC-DMP. Front Neurosci 2021; 14:592664. [PMID: 33488345 PMCID: PMC7817771 DOI: 10.3389/fnins.2020.592664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022] Open
Abstract
Nitrergic nerves have been proposed to play a critical role in the orchestration of peristaltic activities throughout the gastrointestinal tract. In the present study, we investigated the role of nitric oxide, using spatiotemporal mapping, in peristaltic activity of the whole ex vivo mouse intestine. We identified a propulsive motor pattern in the form of propagating myogenic contractions, that are clustered by the enteric nervous system into a minute rhythm that is dependent on nitric oxide. The cluster formation was abolished by TTX, lidocaine and nitric oxide synthesis inhibition, whereas the myogenic contractions, occurring at the ICC-MP initiated slow wave frequency, remained undisturbed. Cluster formation, inhibited by block of nitric oxide synthesis, was fully restored in a highly regular rhythmic fashion by a constant level of nitric oxide generated by sodium nitroprusside; but the action of sodium nitroprusside was inhibited by lidocaine indicating that it was relying on neural activity, but not rhythmic nitrergic nerve activity. Hence, distention-induced activity of cholinergic nerves and/or a co-factor within nitrergic nerves such as ATP is also a requirement for the minute rhythm. Cluster formation was dependent on distention but was not evoked by a distention reflex. Block of gap junction conductance by carbenoxolone, dose dependently inhibited, and eventually abolished clusters and contraction waves, likely associated, not with inhibition of nitrergic innervation, but by abolishing ICC network synchronization. An intriguing feature of the clusters was the presence of bands of rhythmic inhibitions at 4-8 cycles/min; these inhibitory patches occurred in the presence of tetrodotoxin or lidocaine and hence were not dependent on nitrergic nerves. We propose that the minute rhythm is generated by nitric oxide-induced rhythmic depolarization of the musculature via ICC-DMP.
Collapse
Affiliation(s)
- Sean P. Parsons
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jan D. Huizinga
- Department of Medicine and School of Biomedical Engineering, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
|
5
|
Spencer NJ, Travis L, Wiklendt L, Hibberd TJ, Costa M, Dinning P, Hu H. Diversity of neurogenic smooth muscle electrical rhythmicity in mouse proximal colon. Am J Physiol Gastrointest Liver Physiol 2020; 318:G244-G253. [PMID: 31790272 DOI: 10.1152/ajpgi.00317.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The mechanisms underlying electrical rhythmicity in smooth muscle of the proximal colon are incompletely understood. Our aim was to identify patterns of electrical rhythmicity in smooth muscle of the proximal region of isolated whole mouse colon and characterize their mechanisms of origin. Two independent extracellular recording electrodes were used to record the patterns of electrical activity in smooth muscle of the proximal region of whole isolated mouse colon. Cross-correlation analysis was used to quantify spatial coordination of these electrical activities over increasing electrode separation distances. Four distinct neurogenic patterns of electrical rhythmicity were identified in smooth muscle of the proximal colon, three of which have not been identified and consisted of bursts of rhythmic action potentials at 1-2 Hz that were abolished by hexamethonium. These neurogenic patterns of electrical rhythmicity in smooth muscle were spatially and temporally synchronized over large separation distances (≥2 mm rosto-caudal axis). Myogenic slow waves could be recorded from the same preparations, but they showed poor spatial and temporal coordination over even short distances (≤1 mm rostro-caudal axis). It is not commonly thought that electrical rhythmicity in gastrointestinal smooth muscle is dependent upon the enteric nervous system. Here, we identified neurogenic patterns of electrical rhythmicity in smooth muscle of the proximal region of isolated mouse colon, which are dependent on synaptic transmission in the enteric nervous system. If the whole colon is studied in vitro, recordings can preserve novel neurogenic patterns of electrical rhythmicity in smooth muscle.NEW & NOTEWORTHY Previously, it has not often been thought that electrical rhythmicity in smooth muscle of the gastrointestinal tract is dependent upon the enteric nervous system. We identified patterns of electrical rhythmicity in smooth muscle of the mouse proximal colon that were abolished by hexamethonium and involved the temporal synchronization of smooth muscle membrane potential over large spatial fields. We reveal different patterns of electrical rhythmicity in colonic smooth muscle that are dependent on the ENS.
Collapse
Affiliation(s)
- Nick J Spencer
- Visceral Neurophysiology Laboratory, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - Lee Travis
- Visceral Neurophysiology Laboratory, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - Lukasz Wiklendt
- Department of Gastroenterology, Flinders Medical Center, Bedford Park, South Australia, Australia
| | - Timothy J Hibberd
- Visceral Neurophysiology Laboratory, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - Marcello Costa
- Visceral Neurophysiology Laboratory, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - Phil Dinning
- Department of Gastroenterology, Flinders Medical Center, Bedford Park, South Australia, Australia
| | - Hongzhen Hu
- Department of Anesthesiology, Center for the Study of Itch, Washington University, St. Louis, Missouri
| |
Collapse
|
|
6
|
Beck K, Voussen B, Reigl A, Vincent AD, Parsons SP, Huizinga JD, Friebe A. Cell-specific effects of nitric oxide on the efficiency and frequency of long distance contractions in murine colon. Neurogastroenterol Motil 2019; 31:e13589. [PMID: 30947401 DOI: 10.1111/nmo.13589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nitric oxide (NO) mediates inhibitory neurotransmission and is a critical component of neuronal programs that generate propulsive contractions. NO acts via its receptor NO-sensitive guanylyl cyclase (NO-GC) which is expressed in smooth muscle cells (SMC) and interstitial cells of Cajal (ICC). Organ bath studies with colonic rings from NO-GC knockout mice (GCKO) have indicated NO-GC to modulate spontaneous contractions. The cell-specific effects of NO-GC on the dominant pan-colonic propulsive contraction, the long distance contractions (LDCs), of whole colon preparations have not yet been described. METHODS Contractions of whole colon preparations from wild type (WT), global, and cell-specific GCKO were recorded. After transformation into spatiotemporal maps, motility patterns were analyzed. Simultaneous perfusion of the colon enabled the correlation of outflow with LDCs to analyze contraction efficiency. KEY RESULTS Deletion of NO-GC in both ICC and SMC (ie, in GCKO and SMC/ICC-GCKO) caused loss of typical LDC activity and instead generated high-frequency LDC-like contractions with inefficient propulsive activity. Frequency was also increased in WT, SMC-GCKO, and ICC-GCKO colon in the presence of L-NAME to block neuronal NO synthase. LDC efficiency was dependent on NO-GC in SMC as it was reduced in GCKO, SMC-GCKO, and ICC/SMC-GCKO colon; LDC efficiency was decreased in all genotypes in the presence of L-NAME. CONCLUSIONS AND INFERENCES NO/cGMP signaling is critical for normal peristaltic movements; as NO-GC in both SMC and ICC is essential, both cell types appear to work in synchrony. The efficiency of contractions to expel fluid is particularly influenced by NO-GC in SMC.
Collapse
Affiliation(s)
- Katharina Beck
- Physiologisches Institut, Universität Würzburg, Würzburg, Germany
| | - Barbara Voussen
- Physiologisches Institut, Universität Würzburg, Würzburg, Germany
| | - Amelie Reigl
- Physiologisches Institut, Universität Würzburg, Würzburg, Germany
| | - Alexander D Vincent
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sean P Parsons
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jan D Huizinga
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andreas Friebe
- Physiologisches Institut, Universität Würzburg, Würzburg, Germany
| |
Collapse
|
|
7
|
Wang YB, Ling J, Zhang WZ, Li G, Qiu W, Zheng JH, Zhao XH. Effect of bisacodyl on rats with slow transit constipation. ACTA ACUST UNITED AC 2018; 51:e7372. [PMID: 29846410 PMCID: PMC5995042 DOI: 10.1590/1414-431x20187372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
The effect of bisacodyl on the treatment of rats with slow transit constipation
(STC) was studied. Forty-five female Wister rats were divided into control
group, STC group, and STC bisacodyl group. The immunohistochemical method was
used to determine interstitial cells of Cajal (ICC) and the expression of c-Kit
protein. Body mass and the number of defecations were significantly decreased in
the STC group compared with the control group on the 100th day after
diphenoxylate administration, while dry weight of feces was significantly
increased and the intestinal transit time was prolonged. There were significant
differences in the number of defecations, dry weight of feces, and intestinal
transit time among the three groups. The number of defecations was higher, dry
weight of feces was lower, and intestinal transit time was shorter in the STC
bisacodyl group compared to the STC group. In addition, ICC basement membrane
dissolution occurred in the colon wall of the STC group. The connection between
ICC and surrounding cells was destroyed, and the nucleus shrunken to different
degrees. Moreover, c-Kit expression in the STC group was significantly lower
than the control group. The connection between ICC and surrounding cells in the
STC bisacodyl group was significantly stronger than the STC group, and the
number of ICC and the expression of c-Kit were increased. Bisacodyl could reduce
the severity of STC in rats by increasing the number of ICC and the expression
of c-Kit.
Collapse
Affiliation(s)
- Yong-Bing Wang
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jie Ling
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wen-Zhong Zhang
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Gang Li
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wei Qiu
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun-Hua Zheng
- Pudong New Area People's Hospital, Department of General Surgery, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xiao-Hui Zhao
- Clinical Medical School, Shanghai University of Medicine & Health Sciences, Shanghai, China
| |
Collapse
|
|
8
|
Mandolesi D, Frazzoni L, Bazzoli F, Fuccio L. The management of 'hard-to-prepare' colonoscopy patients. Expert Rev Gastroenterol Hepatol 2017; 11:731-740. [PMID: 28594580 DOI: 10.1080/17474124.2017.1338947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Effective bowel cleansing is crucial for high quality colonoscopy. A notable portion of patients still present with low quality bowel preparation prior to their colonoscopy, compromising the overall quality of their colonoscopy. Areas covered: This review focuses on the main strategies that can improve the cleansing quality with a special interest on those clinical conditions that have been associated with a poor bowel preparation quality, such as patients with chronic constipation, history of bowel resection, liver cirrhosis, diabetes mellitus and chronic kidney disease. The review provides a practical and evidence-based approach to help clinicians in the management of 'hard-to-prepare' patients. Expert commentary: In the past few years, the quality of colonoscopy has become a hot topic and bowel cleansing is a crucial part of it; however, the approach to patients with an increased risk of poor bowel preparation quality is still not always supported by high-quality evidence, since most of these patients are routinely excluded from the clinical studies. Trials focused on this subgroup of patients are recommended to provide tailored bowel preparation regimens and guarantee high-quality procedures.
Collapse
Affiliation(s)
- Daniele Mandolesi
- a Gastroenterology Unit, Department of Medical and Surgical Sciences , University of Bologna, S.Orsola-Malpighi Hospital , Bologna , Italy
| | - Leonardo Frazzoni
- a Gastroenterology Unit, Department of Medical and Surgical Sciences , University of Bologna, S.Orsola-Malpighi Hospital , Bologna , Italy
| | - Franco Bazzoli
- a Gastroenterology Unit, Department of Medical and Surgical Sciences , University of Bologna, S.Orsola-Malpighi Hospital , Bologna , Italy
| | - Lorenzo Fuccio
- a Gastroenterology Unit, Department of Medical and Surgical Sciences , University of Bologna, S.Orsola-Malpighi Hospital , Bologna , Italy
| |
Collapse
|
|
9
|
Wei R, Parsons SP, Huizinga JD. Network properties of interstitial cells of Cajal affect intestinal pacemaker activity and motor patterns, according to a mathematical model of weakly coupled oscillators. Exp Physiol 2017; 102:329-346. [DOI: 10.1113/ep086077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Ruihan Wei
- McMaster University, Department of Medicine; Farncombe Family Digestive Health Research Institute; Hamilton ON Canada
| | - Sean P. Parsons
- McMaster University, Department of Medicine; Farncombe Family Digestive Health Research Institute; Hamilton ON Canada
| | - Jan D. Huizinga
- McMaster University, Department of Medicine; Farncombe Family Digestive Health Research Institute; Hamilton ON Canada
| |
Collapse
|
|
10
|
Chen JH, Yang Z, Yu Y, Huizinga JD. Haustral boundary contractions in the proximal 3-taeniated rabbit colon. Am J Physiol Gastrointest Liver Physiol 2016; 310:G181-92. [PMID: 26635318 DOI: 10.1152/ajpgi.00171.2015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023]
Abstract
The rabbit proximal colon is similar in structure to the human colon. Our objective was to study interactions of different rhythmic motor patterns focusing on haustral boundary contractions, which create the haustra, using spatiotemporal mapping of video recordings. Haustral boundary contractions were seen as highly rhythmic circumferential ring contractions that propagated slowly across the proximal colon, preferentially but not exclusively in the anal direction, at ∼0.5 cycles per minute; they were abolished by nerve conduction blockers. When multiple haustral boundary contractions propagated in the opposite direction, they annihilated each other upon encounter. Ripples, myogenic propagating ring contractions at ∼9 cycles per min, induced folding and unfolding of haustral muscle folds, creating an anarchic appearance of contractile activity, with different patterns in the three intertaenial regions. Two features of ripple activity were prominent: frequent changes in propagation direction and the occurrence of dislocations showing a frequency gradient with the highest intrinsic frequency in the distal colon. The haustral boundary contractions showed an on/off/on/off pattern at the ripple frequency, and the contraction amplitude at any point of the colon showed waxing and waning. The haustral boundary contractions are therefore shaped by interaction of two pacemaker activities hypothesized to occur through phase-amplitude coupling of pacemaker activities from interstitial cells of Cajal of the myenteric plexus and of the submuscular plexus. Video evidence shows the unique role haustral folds play in shaping contractile activity within the haustra. Muscarinic agents not only enhance the force of contraction, they can eliminate one and at the same time induce another neurally dependent motor pattern.
Collapse
Affiliation(s)
- Ji-Hong Chen
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei Province, China; and Farncombe Family Digestive Health Research Institute, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Zixian Yang
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei Province, China; and
| | - Yuanjie Yu
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei Province, China; and
| | - Jan D Huizinga
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei Province, China; and Farncombe Family Digestive Health Research Institute, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| |
Collapse
|
|
11
|
Vather R, O'Grady G, Arkwright JW, Rowbotham DS, Cheng LK, Dinning PG, Bissett IP. Restoration of normal colonic motor patterns and meal responses after distal colorectal resection. Br J Surg 2016; 103:451-61. [DOI: 10.1002/bjs.10074] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/30/2015] [Accepted: 11/05/2015] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Colorectal resections alter colonic motility, including disruption of control by neural or bioelectrical cell networks. The long-term impact of surgical resections and anastomoses on colonic motor patterns has, however, never been assessed accurately. Fibreoptic high-resolution colonic manometry was employed to define motility in patients who had undergone distal colorectal resection.
Methods
Recruited patients had undergone distal colorectal resections more than 12 months previously, and had normal bowel function. Manometry was performed in the distal colon (36 sensors; 1-cm intervals), with 2-h recordings taken before and after a meal, with comparison to controls. Analysis quantified all propagating events and frequencies (cyclical, short single, and long single motor patterns), including across anastomoses.
Results
Fifteen patients and 12 controls were recruited into the study. Coordinated propagating events directly traversed the healed anastomoses in nine of 12 patients with available data, including antegrade and retrograde cyclical, short single and long single patterns. Dominant frequencies in the distal colon were similar in patients and controls (2–3 cycles/min) (antegrade P = 0·482; retrograde P = 0·178). Compared with values before the meal, the mean(s.d.) number of dominant cyclical retrograde motor patterns increased in patients after the meal (2·1(2·7) versus 32·6(31·8) in 2 h respectively; P < 0·001), similar to controls (P = 0·178), although the extent of propagation was 41 per cent shorter in patients, by a mean of 3·4 cm (P = 0·003). Short and long single propagating motor patterns were comparable between groups in terms of frequency, velocity, extent and amplitude.
Conclusion
Motility patterns and meal responses are restored after distal colorectal resection in patients with normal bowel function. Coordinated propagation across healed anastomoses may indicate regeneration of underlying cellular networks.
Collapse
Affiliation(s)
- R Vather
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - G O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - J W Arkwright
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia
| | - D S Rowbotham
- Department of Gastroenterology and Hepatology, Auckland District Health Board, Auckland, New Zealand
| | - L K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - P G Dinning
- Department of Human Physiology, Flinders University, Adelaide, South Australia
- Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - I P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
|
12
|
Mañé N, Martínez-Cutillas M, Gallego D, Jimenez M. Enteric motor pattern generators involve both myogenic and neurogenic mechanisms in the human colon. Front Physiol 2015; 6:205. [PMID: 26257657 PMCID: PMC4508510 DOI: 10.3389/fphys.2015.00205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 01/10/2023] Open
Affiliation(s)
- Noemí Mañé
- Cell Biology, Physiology and Immunology, Universidad Autonoma de Barcelona Barcelona, Spain
| | | | - Diana Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Barcelona, Spain
| | - Marcel Jimenez
- Cell Biology, Physiology and Immunology, Universidad Autonoma de Barcelona Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Barcelona, Spain
| |
Collapse
|
|
13
|
Yu Y, Chen JH, Li H, Yang Z, Du X, Hong L, Liao H, Jiang L, Shi J, Zhao L, Tan S, Luo H, Huizinga JD. Involvement of 5-HT3 and 5-HT4 receptors in colonic motor patterns in rats. Neurogastroenterol Motil 2015; 27:914-28. [PMID: 25807879 DOI: 10.1111/nmo.12550] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Colonic migrating motor complexes in the rat constitute two distinct propulsive motor patterns, pan-colonic rhythmic long distance contractions (LDCs), and rhythmic propulsive motor complexes (RPMCs) occurring primarily in the mid/distal colon. Interstitial cells of Cajal govern their rhythmicity, but their occurrence is dependent on neural programs. Our aim was to investigate the involvement of 5-HT3 and 5-HT4 receptors in the generation and pharmacological control of the motor patterns. METHODS Effects of 5-HT-related drugs on colonic motor patterns were analyzed through spatio-temporal maps created from video recordings of whole organ motility. KEY RESULTS 5-HT3 antagonists abolished RPMCs and LDCs. 5-HT4 agonists inhibited LDCs; they promoted RPMCs, which was blocked by the 5-HT4 antagonist GR 125487. 5-HT and the 5-HT3 agonist m-CPBG strongly inhibited LDCs and RPMCs. CONCLUSIONS & INFERENCES The generation of LDCs involves ongoing 5-HT release acting on 5-HT3 and 5-HT4 receptors. The spontaneous generation of RPMCs involves ongoing 5-HT release acting on 5-HT3 but not 5-HT4 receptors. Prucalopride and mosapride promote RPMCs, an effect that is inhibited by the 5-HT4 receptor antagonist GR 125487. A 5-HT3 agonist does not promote RPMCs. Segmentation, including a pattern of sequential segmental activity not previously described, can occur without significant involvement of 5-HT3 and 5-HT4 receptors. 5-HT and a 5-HT3 agonist are strongly inhibitory indicating that 5-HT receptors are present in inhibitory pathways which are normally not involved in the generation of spontaneous or distention-induced motor patterns.
Collapse
Affiliation(s)
- Y Yu
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - J-H Chen
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - H Li
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Z Yang
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - X Du
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - L Hong
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - H Liao
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - L Jiang
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - J Shi
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - L Zhao
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - S Tan
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - H Luo
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - J D Huizinga
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| |
Collapse
|
|
14
|
Huizinga JD, Parsons SP, Chen JH, Pawelka A, Pistilli M, Li C, Yu Y, Ye P, Liu Q, Tong M, Zhu YF, Wei D. Motor patterns of the small intestine explained by phase-amplitude coupling of two pacemaker activities: the critical importance of propagation velocity. Am J Physiol Cell Physiol 2015; 309:C403-14. [PMID: 26135802 DOI: 10.1152/ajpcell.00414.2014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/26/2015] [Indexed: 12/23/2022]
Abstract
Phase-amplitude coupling of two pacemaker activities of the small intestine, the omnipresent slow wave activity generated by interstitial cells of Cajal of the myenteric plexus (ICC-MP) and the stimulus-dependent rhythmic transient depolarizations generated by ICC of the deep muscular plexus (ICC-DMP), was recently hypothesized to underlie the orchestration of the segmentation motor pattern. The aim of the present study was to increase our understanding of phase-amplitude coupling through modeling. In particular the importance of propagation velocity of the ICC-DMP component was investigated. The outcome of the modeling was compared with motor patterns recorded from the rat or mouse intestine from which propagation velocities within the different patterns were measured. The results show that the classical segmentation motor pattern occurs when the ICC-DMP component has a low propagation velocity (<0.05 cm/s). When the ICC-DMP component has a propagation velocity in the same order of magnitude as that of the slow wave activity (∼1 cm/s), cluster type propulsive activity occurs which is in fact the dominant propulsive activity of the intestine. Hence, the only difference between the generation of propagating cluster contractions and the Cannon-type segmentation motor pattern is the propagation velocity of the low-frequency component, the rhythmic transient depolarizations originating from the ICC-DMP. Importantly, the proposed mechanism explains why both motor patterns have distinct rhythmic waxing and waning of the amplitude of contractions. The hypothesis is brought forward that the velocity is modulated by neural regulation of gap junction conductance within the ICC-DMP network.
Collapse
Affiliation(s)
- Jan D Huizinga
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Sean P Parsons
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and
| | - Ji-Hong Chen
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Andrew Pawelka
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and
| | - Marc Pistilli
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and
| | - Chunpei Li
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Yuanjie Yu
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Pengfei Ye
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Qing Liu
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Mengting Tong
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| | - Yong Fang Zhu
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada; and
| | - Defei Wei
- Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan University Institute of Digestive and Liver Diseases, Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, China
| |
Collapse
|
|
15
|
Pawelka AJ, Huizinga JD. Induction of rhythmic transient depolarizations associated with waxing and waning of slow wave activity in intestinal smooth muscle. Am J Physiol Gastrointest Liver Physiol 2015; 308:G427-33. [PMID: 25540235 DOI: 10.1152/ajpgi.00409.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cannon described in 1902 the segmentation motor activity of the small intestine (Canon WB. J Med Res 7: 72-75, 1902). This motor pattern can arise when low-frequency transient depolarizations are evoked in the interstitial cells of Cajal associated with the deep muscular plexus (ICC-DMP) network, which then affect the omnipresent slow wave activity: changing its regular amplitude into a waxing and waning pattern. The objective of the present study was to investigate physiological stimuli that could induce the low-frequency component. Intracellular recordings were obtained from circular muscle with or without attached mucosa. Decanoic acid (1 mM) and butyric acid (10 mM) both evoked low-frequency transient depolarizations but through different mechanisms. Decanoic acid-induced waxing and waning was initiated by purely myogenic means when perfused onto exposed circular muscle. Butyric acid required the intact mucosa and uninhibited neural activity to elicit the low-frequency response. Evidence is provided that the transient rhythmic depolarizations occur in the absence of interstitial cells of Cajal associated with the myenteric plexus (ICC-MP). Onset of the slow transient depolarizations was stimulated by addition of N(ω)-nitro-l-arginine (l-NNA; 100 μM); thus the low-frequency component seems to be under chronic inhibition by nitric oxide. Excitatory tachykinergic stimulation induced the low-frequency component since substance P (0.5 μM) evoked it in the presence of neural blockade. In summary, interplay between two networks of myogenic pacemakers, neural activity, and nutrient factors such as fatty acids plays a role in the generation of the rhythmic low-frequency component that is essential for the development of the checkered segmentation motor pattern.
Collapse
Affiliation(s)
- Andrew J Pawelka
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan D Huizinga
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|