• Autonomic neuropathy
• Diabetic gastroenteropathy
• Exocrine pancreatic insufficiency
• Gallbladder dysfunction
• Gastrointestinal dysmotility
• Gastrointestinal symptoms
• Review
• Sensory gastrointestinal dysfunction

• Humans
• Gastrointestinal Diseases/physiopathology
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Gastrointestinal Diseases/epidemiology
• Gastroparesis/physiopathology
• Diabetic Neuropathies/physiopathology
• Diabetes Complications/physiopathology
• Gastric Emptying/physiology

• Cafeteria diet
• Ectonucleotidases
• Intestinal low-grade inflammation
• Obesity
• Purinergic receptors
• Type 2 diabetes

• Animals
• Diabetes Mellitus, Type 2/metabolism
• Diabetes Mellitus, Type 2/genetics
• Obesity/metabolism
• Obesity/genetics
• Mice
• Mice, Inbred C57BL
• Signal Transduction/physiology
• Inflammation/metabolism
• Male
• Receptors, Purinergic/metabolism
• Diabetes Mellitus, Experimental/metabolism
• Diabetes Mellitus, Experimental/genetics
• Diet, High-Fat/adverse effects
• Gene Expression

• 806361 CONAHCYT Scholarship

• anthranoid laxatives
• bisacodyl
• constipation
• diphenylmethane laxatives
• safety
• senna and sennosides
• stimulant laxatives

• Sanofi

• autonomic neuropathy
• constipation
• diarrhoea
• digestion
• gallstone disease
• gastroesophageal reflux
• gastrointestinal hormones
• gastrointestinal motility
• gastroparesis
• insulin resistance
• obesity

• Diabetes Mellitus/epidemiology
• Gastrointestinal Diseases/etiology
• Gastrointestinal Tract
• Glucose
• Hormones
• Humans
• Hypoglycemic Agents
• Lipids
• Quality of Life

• diabetes mellitus
• digestive complications
• liver disease

• diabetes mellitus
• digestive
• gastrointestinal tract
• signs and symptoms
• wireless motility capsule

• constipation
• diabetes mellitus
• gastroenteropathy
• motility
• transit
• wireless motility capsule

• Adult
• Capsule Endoscopy
• Case-Control Studies
• Constipation/diagnosis
• Constipation/physiopathology
• Cross-Sectional Studies
• Diabetes Complications/physiopathology
• Female
• Gastrointestinal Motility/physiology
• Gastrointestinal Transit/physiology
• Humans
• Male
• Middle Aged

• Helse Vest
• Norges Forskningsråd

• Tangshen Formula
• diabetes
• interstitial cells of Cajal
• intestinal epithelia
• macrophage
• tight junction

The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastrointestinal tract is a common finding in AD, but no commercially available method exists for direct verification of enteric dysfunction. Thus, assessing segmental enteric physiological function is recommended to aid diagnostics and guide treatment. Several established assessment methods exist, but disadvantages such as lack of standardization, exposure to radiation, advanced data interpretation, or high cost, limit their utility. Emerging methods, including high-resolution colonic manometry, 3D-transit, advanced imaging methods, analysis of gut biopsies, and microbiota, may all assist in the evaluation of gastroenteropathy related to AD. This review provides an overview of established and emerging assessment methods of physiological function within the gut and assessment methods of autonomic neuropathy outside the gut, especially in regards to clinical performance, strengths, and limitations for each method.

• Parkinson’s disease
• autonomic dysfunction
• breath test
• diabetes mellitus
• gastrointestinal
• imaging
• investigations
• manometry
• motility

• Blood Glucose
• Constipation/diagnosis
• Constipation/therapy
• Glycemic Control
• Humans

• diabetes mellitus
• enteropathy
• high resolution anorectal manometry
• neurological disorders

To examine the effect of combined exercise on colonic transit time (CTT) in admitted psychiatric patients.

Over a 6-mo period, consecutive in patients with mental illness were recruited from the Somang Hospital Psychiatry Unit. A combined exercise program that included 60 min per day of exercise 3 d per week for 12 wk was performed. Physical fitness and CTT of the patients were measured twice before and twice after the exercise program. CTT was measured using a multiple marker technique with a radio-opaque marker. Changes in the exercising patients’ CTT and weight-, cardiovascular- and fitness-related parameters were statistically assessed.

After the 12-wk combined exercise intervention, decreased intestinal transit time was observed in all CTTs of the exercise group, including the right CTT (exercise: 15.6 ± 15.2 vs 9.2 ± 11.9, control: 13.1 ± 10.4 vs 10.9 ± 18.7), left CTT (exercise: 19.7 ± 23.5 vs 10.4 ± 13.2, control: 19.2 ± 19.0 vs 16.9 ± 19.8), recto-sigmoid CTT (exercise: 14.3 ± 16.7 vs 6.7 ± 7.9, control: 15.0 ± 14.4 vs 19.3 ± 30.3), and total colonic transit time (TCTT) (exercise: 50.2 ± 38.1 vs 27.1 ± 28.0, control: 47.4 ± 34.6 vs 47.3 ± 47.3). After the 12-wk combined exercise period, TCTT was significantly shortened in the exercise group compared with that in the control group. In addition to eating habits, water intake, and fiber intake, the increased physical activity level as a result of the 12-wk combined exercise program reduced the CTT.

The CTT of the psychiatric patients was reduced due to increased physical activity via a 12-wk combined exercise program.

• Combined exercise
• Constipation
• Colonic transit time
• Radio-opaque marker
• Psychiatry unit patient

• Bowel preparation
• bowel resection
• chronic constipation
• chronic kidney disease
• colorectal resection
• diabetes mellitus
• liver cirrhosis
• low-fiber diet
• quality of colonoscopy
• split-dose

• bowel habits
• colonoscopy
• constipation
• infrequent bowel movement
• poor bowel preparation

• Academic Medical Centers
• Age Factors
• Cathartics/administration & dosage
• Colonoscopy
• Constipation
• Defecation
• Female
• Habits
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Quality Improvement
• Republic of Korea
• Retrospective Studies
• Risk Factors
• Sex Factors
• Surveys and Questionnaires

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

• Diabetes
• Intestine
• Colon
• Biomechanics
• Motor-sensory
• Gut microbiota
• Symptoms

Aim. This study investigated the effect and mechanism of the Chinese herbal medicine Tangshen Formula (TSF) on GI structure remodeling in the rat model of diabetes. Methods. Type 2 diabetic rats were used. Wet weight per unit length, layer thicknesses, levels of collagens I and III, nuclear factor kappa B (NF-κB), interferon-γ (IFN-γ), interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1), and Smad2/3 expression in the rat colon were measured. Results. Compared with the control group animals, wet weight and layer thicknesses of the colon increased, and expressions of collagens I and III, NF-κB, IFN-γ, IL-6, TGF-β1, and Smad2/3 increased significantly in the diabetic animals. TSF inhibited increase in colonic wet weight and layer thicknesses, downregulated expressions of collagens I and III in the mucosal layer, and downregulated expressions of NF-κB, IFN-γ, IL-6, TGF-β1, and Smad2/3 in the colon wall. Furthermore, level of expression of NF-κB was associated with those of TGF-β1 and Smad2/3. Expression of TGF-β1 was associated with the most histomorphometric parameters including colonic weight, mucosal and muscle thicknesses, and levels of collagens I and III in mucosal layer. Conclusion. TSF appears to attenuate colonic structure remodeling in type 2 diabetic rats through inhibiting the overactivated pathway of NF-κB, thus reducing expressions of TGF-β1.

Physical activity is associated with a reduced risk of colorectal cancer. We examined the colon transit time (CTT) according to the total energy expenditure (TEE) in psychiatry unit patients. The study participants included 67 adults, with a mean age of 49.8 years. The participants used an accelerometer for 7 days to measure their 1-week TEE. They took a capsule containing 20 radio-opaque markers for 3 days. On the 4th day and 7th day, a supine abdominal radiography was performed. According to the TEE of all study participants, the upper 30%, middle 30%, and lower 40% were classified into groups according to high (H), moderate (M), and low (L) physical activity. The mean total CTT was 52.0 hours. The segmental CTT for the right, left, and recto-sigmoid colon were 15.3 hours, 19.2 hours, and 17.4 hours. Total CTT in the H group was significantly shorter than that in the L group (p = .010). A comparison of the segmental CTT between the L, M, and H groups showed that the right CTT (p = .010) of the H group was significantly shorter than that of the M group. The left CTT of the M group (p = .028) and H group (p = .004) was significantly shorter than that of the L group. The recto-sigmoid CTT (p = .016) of the M group was significantly shorter than that of the L group. The study showed that moderate and high TEE was assisted with reduced CTT.

• diabetes
• physical activity
• colon cancer

• Aged
• Causality
• Colonic Neoplasms/epidemiology
• Comorbidity
• Diabetes Complications/epidemiology
• Diabetes Mellitus, Type 2/epidemiology
• Exercise
• Female
• Follow-Up Studies
• Health Behavior
• Health Status
• Humans
• Male
• Middle Aged
• National Institutes of Health (U.S.)
• Odds Ratio
• Risk Assessment
• United States/epidemiology

• ZIA CP010196 Intramural NIH HHS

• Constipation
• Diabetes
• Diagnosis
• Diarrhea
• Fecal incontinence
• Gastrointestinal enteropathy
• Management

The negative effect of diabetes mellitus (DM) on the colonoscopy preparation has been previously established. Metabolic syndrome has been shown to increase risk for malignancy and possibly for premalignant lesions. This study aimed to investigate the impact of DM control on colonoscopy outcomes including bowel preparation and adenoma detection rate (ADR).

We included patients with DM who underwent colonoscopy in our hospital and had a documented glycated hemoglobin (HbA1C) within 3 months. Patients were categorized into three groups based on their HbA1C level. The clinical and endoscopic data were collected and analyzed.

Our cohort included 352 DM patients. The mean age was 63.5 years. When patients were analyzed based on HBA1C, bowel preparation was poor in 46.7% of patients with good glycemic control, 52.1% of patients with fair control and 50% of patients with poor control. ADR was 24.3% in patients with good glycemic control, 20.2% in patients with fair glycemic control and 27.1% in patients with poor glycemic control. There was no statistically significant difference in the quality of preparation or adenoma detection amongst the groups.

The degree of glycemic control did not impact the quality of bowel preparation or ADR.

• Adenoma detection rate
• bowel preparation
• colonoscopy
• diabetes mellitus
• glycosylated hemoglobin

Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR).

Prospectively collected data on 433 patients undergoing laparoscopic or laparoscopic-assisted colon surgery at a single institution were retrospectively reviewed from March 2004 to February 2009. Patients were divided into groups undergoing RC (n = 175) and LAR (n = 258). These groups were evaluated by use of analgesia: epidural analgesia, “patient-controlled analgesia” alone, and a combination of both. Demographic and perioperative outcomes were compared.

Epidural analgesia was associated with a faster return of bowel function, by 1 day (P < .001), in patients who underwent LAR but not in the RC group. Delayed return of bowel function was associated with increased operative time in the LAR group (P = .05), patients with diabetes who underwent RC (P = .037), and patients after RC with combined analgesia (P = .011). Mean visual analogue scale pain scores were significantly lower with epidural analgesia compared with patient-controlled analgesia in both LAR and RC groups (P < .001).

Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia.

• Epidural analgesia
• Laparoscopic colectomy
• Low anterior resection
• Pain scores
• Patient-controlled analgesia

• arterial hypertension
• enantiomers
• gestational diabetes mellitus
• metoprolol
• parturients
• pharmacokinetics

• Diabetes mellitus
• Dysfunction
• Enteric nerves
• Gut microbiota
• Interstitial cells of Cajal
• Small and large bowel

• Animals
• Colon/physiopathology
• Diabetes Complications
• Diabetes Mellitus/physiopathology
• Enteric Nervous System
• Gastrointestinal Motility
• Humans
• Intestine, Small/physiopathology

Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (≤5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers in gastroparetics (r = -0.49). Numbers of contractions increased from the 1^st to 4^th colon transit quartile in controls and diabetics with normal emptying (P≤0.04), but not gastroparetics. Numbers of contractions in the 3^rd and 4^th quartiles were reduced in gastroparetics vs. healthy controls (P≤0.05) and in the 4^th quartile vs. diabetics with normal emptying (P = 0.02). Numbers of contractions were greatest in the final 15 minutes of transit, but were reduced in gastroparetics vs. healthy controls and diabetics with normal emptying (P≤0.005). On multivariate analyses, differences in numbers of contractions were not explained by demographic or clinical variables. In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments. These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

• Adult
• Capsule Endoscopy/methods
• Female
• Gastrointestinal Transit/physiology
• Gastroparesis/diagnosis
• Humans
• Male
• Middle Aged
• Muscle Contraction/physiology

• P30 DK034933 NIDDK NIH HHS

AIM: To investigate the incidence and risk factors for constipation in patients with acute myocardial infarction (AMI).

METHODS: The study had a retrospective design, and 334 AMI patients were included. The incidence and risk factors for constipation were analyzed in these patients.

RESULTS: The incidence of constipation was 32.6% in the overall AMI patient population, 61.5% in those who did not use laxatives, 21.9% in those who received milk fructose, and 24.8% in those who received rhubarb soda. The use of laxatives was a protective factor for constipation during the hospitalization period (OR = 0.544, P < 0.05), while combined diabetes (OR = 1.813, P < 0.05) and the improper timing of laxative use were risk factors (OR = 0.589, P < 0.05).

CONCLUSION: The incidence of constipation in AMI patients is high, and there are many influencing factors. Preventive measures should be taken to reduce the occurrence of constipation in hospitalized AMI patients.

• Acute myocardial infarction
• Constipation
• Incidence
• Dangerous factors

• Area Under Curve
• Computer Simulation
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/drug therapy
• Diabetes Mellitus, Type 2/metabolism
• Humans
• Hypoglycemic Agents/blood
• Hypoglycemic Agents/pharmacokinetics
• Kidney/metabolism
• Liver/metabolism
• Male
• Models, Biological
• Monte Carlo Method

• Constipation/etiology
• Constipation/physiopathology
• Constipation/therapy
• Diabetes Mellitus
• Diabetic Neuropathies/complications
• Diabetic Neuropathies/physiopathology
• Diabetic Neuropathies/therapy
• Diarrhea/etiology
• Diarrhea/physiopathology
• Diarrhea/therapy
• Electric Stimulation Therapy
• Enteric Nervous System/physiopathology
• Esophageal Motility Disorders/etiology
• Esophageal Motility Disorders/physiopathology
• Esophageal Motility Disorders/therapy
• Gastrointestinal Agents/therapeutic use
• Gastroparesis/etiology
• Gastroparesis/physiopathology
• Gastroparesis/therapy
• Humans
• Mesenchymal Stem Cell Transplantation

• Accelerometer
• Adult
• Colon transit time
• Physical activity
• Radio-opaque marker

AIM: To investigate the effects of a ghrelin receptor agonist GHRP-6 on delayed gastrointestinal transit in alloxan-induced diabetic mice.

METHODS: A diabetic mouse model was established by intraperitoneal injection with alloxan. Mice were randomized into two main groups: normal mice and diabetic mice treated with GHRP-6 at doses of 0, 20, 50, 100 and 200 μg/kg ip. Gastric emptying (GE), intestinal transit (IT), and colonic transit (CT) were studied in mice after they had a phenol red meal following injection of GHRP-6. Based on the most effective GHRP-6 dosage, atropine was given at 1 mg/kg for 15 min before the GHRP-6 injection for each measurement. The mice in each group were sacrificed 20 min later and the percentages of GE, IT, and CT were calculated.

RESULTS: Percentages of GE, IT, and CT were significantly decreased in diabetic mice as compared to control mice. In the diabetic mice, GHRP-6 improved both GE and IT, but not CT. The most effective dose of GHRP-6 was 200 μg/kg and atropine blocked the prokinetic effects of GHRP-6 on GE and IT.

CONCLUSION: GHRP-6 accelerates delayed GE and IT, but has no effect on CT in diabetic mice. GHRP-6 may exert its prokinetic effects via the cholinergic pathway in the enteric nervous system, and therefore, has therapeutic potential for diabetic patients with delayed upper gastrointestinal transit.

• GHRP-6
• Diabetes mellitus
• Gastric emptying
• Intestinal transit
• Colonic transit

AIM: To investigate the effects of ghrelin on delayed gastrointestinal transit in alloxan-induced diabetic mice.

METHODS: A diabetic mouse model was established by intraperitoneal injection with alloxan. Mice were randomized into two main groups: normal mice group and diabetic mice group treated with ghrelin at doses of 0, 20, 50, 100 and 200 &mgr;g/kg ip. Gastric emptying (GE), intestinal transit (IT), and colonic transit (CT) were studied in mice after they had a phenol red meal following injection of ghrelin. Based on the most effective ghrelin dosage, atropine was given at 1 mg/kg 15 min before the ghrelin injection for each measurement. The mice in each group were sacrificed 20 min later and their stomachs, intestines, and colons were harvested immediately. The amount of phenol red was measured. Percentages of GE, IT, and CT were calculated.

RESULTS: Percentages of GE, IT, and CT were significantly decreased in diabetic mice as compared to control mice (22.9 ± 1.4 vs 28.1 ± 1.3, 33.5 ± 1.2 vs 43.2 ± 1.9, 29.5 ± 1.9 vs 36.3 ± 1.6, P < 0.05). In the diabetic mice, ghrelin improved both GE and IT, but not CT. The most effective dose of ghrelin was 100 &mgr;g/kg and atropine blocked the prokinetic effects of ghrelin on GE and IT.

CONCLUSION: Ghrelin accelerates delayed GE and IT but has no effect on CT in diabetic mice. Ghrelin may exert its prokinetic effects via the cholinergic pathway in the enteric nervous system, and therefore has therapeutic potential for diabetic patients with delayed upper gastrointestinal transit.

• Ghrelin
• Diabetes mellitus
• Gastric emptying
• Intestinal transit
• Colonic transit

• Animals
• Diabetes Complications/etiology
• Diabetes Complications/pathology
• Gastrointestinal Motility
• Humans
• Intestinal Diseases/etiology
• Intestinal Diseases/pathology
• Muscle, Smooth/pathology

AIM: To investigate the effect of heme oxygenase (HO) interference on the colonic dysfunction in rats with diabetes mellitus (DM).

METHODS: DM model was established by intraperitoneal injection of streptozotocin (STZ) in Sprague and Dawley rats. Six weeks later, the diabetic rats were validated to be suffered with gastrointestinal dysfunction using charcoal (Indian ink) propulsion experiment. Then the rest rats were randomly divided into 4 groups, named group A (normal control), B (diabetic rats without interference), C (diabetic rats administrated with Hemin, the inducer of HO) and D [diabetic rats administrated with zinc protoporphyrin Ⅸ (ZnPP Ⅸ), the inhibitor of HO]. The weight and blood glucose of the rats were tested. Three more weeks later, the motilities of the strips isolated from the proximal and distal colon were recorded. The level of HO in the colon was also detected by immunohistochemistry and Western blot.

RESULTS: The model of diabetic rats suffered with gastrointestinal dysfunction was successfully duplicated. Administration of Hemin or ZnPP Ⅸ had no effect on the weight or blood glucose of diabetic rats (P > 0.05). There was no significant difference in HO-2 expression of the distal colon between the diabetic rats with or/and without interference (P > 0.05). But in comparison with the controls, HO-2 expression of the proximal colon in group B, C or D was significantly declined (Western blot: 1.20 ± 0.09, 1.08 ± 0.11, 1.10 ± 0.08 vs 1.66 ± 0.14, P < 0.05). The colonic expression of HO-1 was not significantly different between group A and B (Western blot: proximal 0.22 ± 0.02 vs 0.22 ± 0.03; distal 0.23 ± 0.03 vs 0.23 ± 0.03; both P > 0.05), but HO-1 expression was markedly higher in group C (proximal 0.66 ± 0.09; distal 0.47 ± 0.07) than that in the former two groups (P < 0.05); the expression of HO-1 was hardly found in group D. In comparison with those in group B, the gastrointestinal propulsion rate (54.4% ± 2.9% vs 63.0% ± 1.2%, P < 0.05), spontaneous contraction frequencies, amplitudes, and reaction to acetylcholine of colonic smooth muscles were dramatically declined in group C (P < 0.05), while those (gastrointestinal propulsion rate: 72.5% ± 2.6% vs 63.0% ± 1.2%, P < 0.05) in group D were markedly improved (all P < 0.05).

CONCLUSION: HO interference has no effect on the body weight or blood glucose of diabetic rats. The induction of HO-1 may aggravate the decline of colonic motility in diabetic rats, while HO-1 blockage may improve the declined colonic motility.

• Heme oxygenase
• Colonic dysfunction
• Diabetes mellitus
• Hemin
• Zinc protoporphyrin Ⅸ

• Animals
• Diet
• Digestive System Physiological Phenomena
• Dogs
• Edible Grain
• Fatty Acids, Volatile/metabolism
• Female
• Gastric Emptying
• Gastrointestinal Motility
• Hydrogen-Ion Concentration
• Lactates/metabolism
• Male
• Meat