Abnormal Bowel Motility Research Articles

Treatment of small intestinal bacterial overgrowth: Conventional antibiotic therapy and alternative therapy - probiotics and low FODMAP diet

Introduction and purpose of the study: Small intestinal bacterial overgrowth syndrome (SIBO) is a syndrome characterized by an increased number of bacteria in the small intestine. The condition causes many non-specific symptoms such as diarrhea, abdominal pain and bloating. The purpose of this study is to review the current knowledge regarding treatment options for SIBO. 
 Methodology: A literature review was conducted based on PubMed, GoogleScholar databases and American College of Gastroenterology (ACG) guidelines.
 Current knowledge: SIBO is a heterogeneous syndrome. Symptoms of bacterial overgrowth include bloating, abdominal pain and abnormal bowel motility. In more severe cases, patients may experience malabsorption leading to weight loss and malnutrition. SIBO can occur in healthy individuals, but very often accompanies other conditions. The primary test for diagnosis is non-invasive lactulose or glucose breath tests. For treatment, the antibiotic rifaximin is preferred. It exhibits a broad spectrum of activity and a low toxicity profile. Treatment may also include diet therapy and the use of probiotics.
 Summary: SIBO continues to be both a diagnostic and therapeutic problem. Effective treatment includes not only elimination of the bacteria but also treatment of predisposing conditions. Conclusions of the study show a positive effect of rifaximin on the reduction of SIBO symptoms and improvement of patients' quality of life. The use of certain probiotics has a proven effect. According to the currently available literature, the effectiveness of the low-FODMAP diet in SIBO is hypothetical and further studies are needed to unequivocally confirm its efficacy.

Therapeutic Effect of Amitriptyline in Patients Suffering from Irritable Bowel Syndrome

Patients suffering from irritable bowel syndrome (IBS) form a part of the most frequent visitors in GP and gastroenterologist. Pathophysiology of irritable bowel syndrome consists of abnormal bowel motility including the pathological gastro-colic reflex with an abnormal character of stool consistency

Fecal Microbiota Transplantation for the Critically Ill Patient.

The gut microbiome has been implicated in a diversity of diseases, such as irritable bowel syndrome, inflammatory bowel disease, hepatic steatosis, metabolic syndrome, obesity, and anxiety. Current research also suggests the presence of a bidirectional relationship between the composition of the gut microbiome and critical illness. In the critical care setting, multiple factors (eg, use of antibiotics, aberrant nutrition, bloodstream infections, bowel ischemia, and abnormal bowel motility) strongly contribute to intestinal dysbiosis. Conversely, early studies have associated intestinal dysbiosis with worse clinical outcomes in the intensive care unit (ICU), such as infection, organ failure, and mortality. The possibility of intestinal dysbiosis influencing these clinical outcomes has prompted the question of whether microbiome manipulation strategies, such as fecal microbiota transplantation (FMT), may have a role in the management of critical illness. After a literature search of FMT used in the ICU for indications other than Clostridium difficile infections, we found 4 case reports that describe the use of FMT in 5 critically ill patients with systemic inflammatory responses and no clear source of infection. This review discusses the relationship between the gut microbiome and critical illness, early data on the use of FMT in critical care, and safety considerations of FMT in the critically ill and immunocompromised populations.

Systemic Scleroderma and Colonic Volvulus

Introduction: Patients with scleroderma may have significant gastrointestinal symptoms due to intestinal dysmotility and pseudo-obstruction. Abnormal bowel motility is a risk factor for volvulus, a lifethreatening condition with a similar presentation as pseudo-obstruction. The literature shows the rare occurrence of colonic volvulus in scleroderma. The aims of this study were to examine the occurrence of colonic volvulus in scleroderma and its associated clinical features. Methods: Patients with documented ICD-9 or ICD-10 codes for both scleroderma and colonic volvulus were identified from the electronic and archived medical records using institutional software between July 1950 and January 2017. Records eligible were limited to patients between the ages of 18 and 99 at time of diagnosis. This data was combined with similar patients from the medical literature using PubMed. Results: From our database, 8 patients were identified with concomitant scleroderma and colonic volvulus. In combination with the 8 cases from the literature, a total of 16 patients were analyzed. The mean age at diagnosis of volvulus was 54.3 (SD +/-15.5) and the mean disease duration from onset of scleroderma diagnosis to colonic volvulus was 16.1 years (SD +/-12.3). There were 11 females and 5 males, with most having limited disease versus diffuse (81.3% vs. 18.7%, respectively). The most frequent associated disease was universally Raynaud's phenomenon (n=16), followed by interstitial lung disease (n=6). As for chronic GI symptoms, half the patients had documented gastroesophageal reflux disease (GERD), and 37.5% had chronic constipation. The most common site for initial volvulus was sigmoid (50%), followed by cecum (25%), and the majority required surgery for successful final treatment of volvulus (81.3%). While half the patients had a good outcome, 37.5% had poor outcomes including 2 deaths. Conclusion: While scleroderma with colonic volvulus is a rare occurrence, it is critical to consider this diagnosis in scleroderma patients presenting with symptoms of pseudo-obstruction because it is lifethreatening and requires surgery. The misdiagnosis of pseudo-obstruction in a patient with colonic volvulus can be catastrophic.

Allergy in Children with Functional Constipation and Irritable Bowel Syndrome

Context: Functional constipation (FC) and irritable bowel syndrome (IBS) represent very common pediatric functional gastrointestinal disorders (FGIDs). Controversial results have suggested a potential role of food allergy as a trigger of functional bowel symptoms. Evidence Acquisition: This review summarizes the literature regarding the role of allergic diseases in children with FC and IBS and discusses the hypothesis of the pathogenesis of constipation due to cow’s milk protein allergy (CMPA). We searched systematic reviews, guidelines, or original data in PubMed, MEDLINE, and the Cochrane central register of controlled trials. Results: The pathogenesis of FGIDs remains elusive and is likely multifactorial. Among these factors, adverse reactions to food may play a pathogenic role. Some features, such as abnormal bowel motility, visceral hypersensitivity, and changes in mucus composition caused by inflammation of the gastrointestinal wall, have been found both in IBS or FC and in food allergy. Since 1978, an increasing number of reports have suggested a relationship between CMPA and FC. Two randomized controlled studies conducted in children showed that CMPA may induce chronic FC; one study indicated that fermentable oligosaccharide, disaccharide, and monosaccharide polyols (FODMAP) foods may play a role in triggering IBS. Conclusions: Food allergy in children with chronic constipation should be identified using an oral food challenge after being on a diet free of cow’s milk. A diet low in FODMAPs might also be recommended for children with IBS. This approach could be suggested for children with chronic FC and IBS, especially when they do not respond to standard treatment. However, it should also be considered that a minority of patients with FC or IBS could respond to an elimination diet. Further studies are needed to understand the complex pathogenic mechanisms of FGIDs; they also might be helpful to recognize markers for identifying children with IBS and FC caused by foods and to improve their management.

Profile of rifaximin and its potential in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain and abnormal bowel patterns. Alteration in gut flora, visceral hypersensitivity, and abnormal bowel motility are among numerous factors in the complex pathophysiology of IBS. Antibiotics have been used adjunctively to treat IBS for many years but are associated with various systemic side effects. Rifaximin is a nonabsorbable, broad-spectrum antimicrobial that inhibits bacterial RNA synthesis by binding the β-subunit of microbial RNA polymerase. It targets the gastrointestinal tract and works by reducing the quantity of gas-producing bacteria and altering the predominant species of bacteria present. In vivo animal studies suggest additional beneficial mechanisms of rifaximin, including reducing mucosal inflammation and visceral hypersensitivity. Clinical studies have demonstrated that rifaximin improves symptoms associated with IBS, such as bloating, flatulence, stool consistency, and abdominal pain, and has a side-effect profile similar to placebo. Although additional investigation into optimal dosing, treatment duration, and potential resistance is required, rifaximin presents as a safe and beneficial addition to the current management options for IBS.

Motility mapping as evaluation tool for bowel motility: Initial results on the development of an automated color‐coding algorithm in cine MRI

To develop and implement an automated algorithm for visualizing and quantifying bowel motility using cine magnetic resonance imaging (MRI). Four healthy volunteers as well as eight patients with suspected or diagnosed inflammatory bowel disease (IBD) underwent MR examinations on a 1.5T scanner. Coronal T2-weighted cine MR images were acquired in healthy volunteers without and with intravenous (i.v.) administration of butylscopolamine. In patients with IBD, cine MRI sequences were collected prior to standard bowel MRI. Bowel motility was assessed using an optical flow algorithm. The resulting motion vector magnitudes were presented as bowel motility maps. Motility changes after i.v. administration of butylscopolamine were measured in healthy volunteers. Inflamed bowel segments in patients were correlated with motility map findings. The acquisition of bowel motility maps was feasible in all subjects examined. In healthy volunteers butylscopolamine led to quantitatively measurable decrease in bowel motility (mean decrease of 59%; P = 0.171). In patients with IBD, visualization of bowel movement by color-coded motility mapping allowed for the detection of segments with abnormal bowel motility. Inflamed bowel segments could be identified by exhibiting a decreased motility. Our method is a feasible and promising approach for the assessment of bowel motility disorders.

S1341 Classification and Treatment of Irritable Bowel Syndrome (IBS) Based on Colonoscopy Abnormal Bowel Motility Type and Abnormal Bowel Morphology Type

S1341 Classification and Treatment of Irritable Bowel Syndrome (IBS) Based on Colonoscopy Abnormal Bowel Motility Type and Abnormal Bowel Morphology Type

S1342 Effect of Proton Pump Inhibitors on the Results of Glucose Breath Test

IBS is characterized by symptom relief upon defecation, aggravation by psychological strain, and absence of organic abnormalities, however, there is no mention of “involvement of stress” in the Rome III. Thus, there may be cases that fulfill the diagnostic criteria in which stress is not involved. We previously reported a sedative-risk-free colonoscopy insertion technique, namely, the “COLLAPSE-SUBMERGENCE METHOD” (Dig Endosc19:43-47, 2007) and showed that, after suppression of the bowel motility of healthy subjects with an antispasmodic, the persistent abnormal bowel motility of IBS, peristalsis (almost all cases of IBS-D), and segment-type motility (some cases of IBS-C) was observed in response to the psychological stress of the “colonoscopy” (NGM2009). The present study was designed to evaluate the bowel motility and morphology of each subtype of IBS by colonoscopy, and assess its pathophysiology, and then propose a novel therapeutic strategy. Methods. Colonoscopy was performed under premedication with an antispasmodic agent alone in 146 patients with IBS (74 males, 72 females), and the bowel motility pattern, the timepoint of bowel motility cessation, and the bowel morphology were evaluated. Separately, a barium enema series was performed for assessment of the bowel outline. Patients were interviewed to determine their symptoms. According to the abnormality of bowel motility or abnormal morphology, the patients were treated and the results of the therapy were evaluated. Results. After administration of the antispasmodic, peristalsis that persisted for 8 min or more was observed in 67% (male IBS-D) and 78% (female -D), and segmental type motility was observed in 48%(m -C) and 10%(f -C) and 14%(m -M) and 0%(f -M). Abnormal bowel morphology was observed in 28% (m -D) and 44% (f -D), in 58% (m -C) and 92% (f -C), and in 100% (both sexes -M). Stress preceding symptoms was reported by 62%(m -D) and 67% (f -D), 39%(m -C) and 5%(f -C), 9%(m -M) and 4%(f -M). Tandospirone was useful in the patients with Ab-Mot., whereas a low dose of a laxative and exercise were useful in the Ab-Mor. group. Conclusions. Abnormal motility was common in male patients with IBS-D and -C, and many of them experienced stress during the colonoscopy. Abnormal bowel morphology was observed in many of the female patients with IBS-C and all of the male patients with IBS-M, and scarcely any of these patients reported experiencing preceding stress. The pathophysiology in the abnormal motility type and the abnormal morphology type of IBS differ from each other, which may be responsible for the gender differences in the pathophysiology types and in the response to conventional therapy.

Functional Foods: Salient Features and Clinical Applications

The term "functional food" refers to foods or ingredients of foods providing an additional physiological benefit beyond their basic nutritional needs. Health benefits are best obtained through a varied diet containing fruits, vegetables, grains, legumes and seeds. However, fortified foods and dietary supplements have been marketed and food industry have made functional food one of their current leading trends. Recently, the number of functional foods that have a potential benefit on health has hugely grown and scientific evidence is supporting the role of functional foods in prevention and treatment of several diseases. Cancer, diabetes, heart disease and hypertension are the most important diseases that can be treated or prevented by functional foods; other diseases are osteoporosis, abnormal bowel motility, and arthritis. It has been estimated that 80% of cancer in USA have a nutrition/diet component suggesting a great impact of functional food and foods components on incidence and treatment of cancer. Numerous factors complicate the evaluation of scientific evidence such as the complexity of food substance, effect on food, metabolic changes associated to dietary changes, the lack of biological markers of disease development. This paper reviews the scientific evidence supporting this area regarding only those foods and ingredients in which a clear experimental and clinical evidence exists for their chemopreventive and therapeutic effects.

Constipation in the Elderly

Constipation is a common concern in the elderly and accounts for significant expenditures on over-the-counter drugs. Although normal aging is not associated with abnormal bowel motility, pathologic and psychosocial conditions lead to increased symptoms in elderly patients. Careful clinical evaluation to eliminate serious conditions including colon neoplasia is important. Medical management with emphasis on fiber, bulk agents, fluid intake, and exercise, as well as appropriate use of laxatives is reviewed.

ASSOCIATION OF VISCERAL MYOPATHY WITH VESICOINTESTINAL FISSURE

Vesico-intestinal fissure (extrophy of the cloaca, OEIS complex) is a pattern of multiple malformations including extrophy of the bladder with epispadias, extrophy of the cecum with rudimentary colon and imperforate anus. Other commonly associated anomalies include omphalocele, intestinal duplication, meningomylocele and hydronephrosis. Current pathogenetic theories postulate fusion of genital tubercles caudal to the normal position leading to interruption of migration of the infra-umbilical mesoderm with secondary abdominal wall rupture. Patients with vesico-intestinal fissure have a poor prognosis. Abnormal bowel motility with malabsorption often contribute to death. Histopathologic observation of a visceral myopathy suggestive of an embryologic insult to smooth muscle development in a recent patient with a negative family history for familial visceral myopathy, prompted review of all cases of vesicointestinal fissure since 1966 at this institution. Results suggest abnormal morphogenesis of intestinal smooth muscle may be an important part of the pathogenetic sequence. This is consistent with an early insult to the lateral plate mesoderm from which arise the intra-embryonic splanchopleure and the intra-embryonic somatopleure. These structures form the smooth muscle of the GI tract and the ventral body wall, respectively. Intestinal biopsy and electrophysiologic motility studies may help to define the extent of such defects and contribute to the successful clinical management of these patients.

Intussusception in adults.

A review of 25 adult patients with intussusception is reported. Intussusception in adults constituted 16.6% of 150 intussusception cases observed during 1956-1985. The underlying pathologic processes were identified in 23 patients (92%). Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3) miscellaneous--Meckel diverticulum (one case, 4%); and (4) idiopathic (two cases, 8%). The tumor-related intussusceptions were caused by benign tumors in five and malignant tumors in eight patients. Postoperative intussusceptions were related to various factors including suture lines, ostomy closure sites, adhesions, long intestinal tubes, bypassed intestinal segments, submucosal edema, abnormal bowel motility, electrolyte imbalance, and chronic dilatation of the bowel. The sites of involvement of intussusception were jejunogastric (one), jejunojejunal (seven), ileoileal (four), ileocolic (10), and colocolic (three patients). Four patients had synchronous multiple (ileoileal and jejunojejunal), four had compound (ileoilealcolic), and two had recurrent intussusceptions. When an intussusception is encountered in adults, an underlying pathologic process usually can and should be determined for proper management.

Pathogenesis of urgency in defaecation in Crohn's disease.

In 39 patients with Crohn's disease with 20 suffering from urgency in defaecation, the degree of proctitis, anal basal and squeeze pressures and anal sphincter responses to passive rapid or slow rectal filling were not correlated to the presence or absence of urgency or its severity. However, there was a positive correlation between urgency and both defaecation frequency and looseness of stools as well as extent of disease, with invariable involvement of the small intestine in urgency patients. Disease confined to the colon was found only in non-urgency cases. It was proposed that extensive disease involving both the small and large intestine could elicit abnormal bowel motility, and lead to unusually rapid rectal filling, inevitably followed by rapid reflex relaxation of the anal sphincter, manifesting itself as urgency. This hypothesis would be consistent with the observation that operative removal of diseased bowel with ileorectal anastomosis may abolish urgency.