Bowel Motility Research Articles

The effect of probiotics on ıntestinal motility in an experimental short bowel model.

PurposeTo investigate the effect of probiotics on spontaneous contractions of smooth muscle isolated from jejunum and ileum of rat model.MethodsFour rat groups were created (n=8, in each) including control (Group 1), control+probiotic (Group 2), short bowel (Group 3), and short bowel+probiotic (Group 4). Groups 1 and 2 underwent sham operation, Groups 3 and 4 underwent massive bowel resection. Bifidobacterium Lactis was administered in Groups 2 and 4 daily (P.O.) for three weeks. On postoperative week 3, rats were sacrificed, and jejunum and ileum smooth muscle were isolated for organ bath. Muscle contraction changes were analyzed before and after addition of antagonists.ResultsShort bowel group exhibited increased amplitude and frequency of spontaneous contractions. The addition of probiotics significantly decreased enhanced amplitude and frequency of bowel contraction in short bowel group and returned to control values. L-NNA increased amplitude and frequency of contractions in all groups. While indomethacin and nimesulide increased the amplitude in all groups, the frequency was only increased in jejunum. Hexamethonium and tetrodotoxin did not change the contraction characteristics in all groups.ConclusionWe suggest that early use of probiotics may significantly regulate bowel motility, and accordingly improve absorption of nutrients in short bowel syndrome.

Effect of Sham Feeding on Postoperative Clinical Outcomes among Patients Undergoing Elective Abdominal and Gynecological Surgeries

Sham feeding has been demonstrated to be one of the methods to increase bowel motility. Gum chewing, as an alternative to sham feeding, provides the benefits of gastrointestinal stimulation without the complications associated with feeding. Aim: to evaluate the effect of sham feeding on postoperative clinical outcomes among patients undergoing elective abdominal and gynecological surgeries. Subjects: A purposive sample including 150 patients who were admitted to the general surgical and gynecological unit for undergoing elective open abdominal surgeries such as cholecystectomy, appendectomy, hysterectomy, myomectomy. Were divided randomly into two equal groups 75 patients in each Study group (I): practice post-operative sham feeding in addition to the usual routine hospital care such as early mobilization and Control group (II): Follow the usual routine hospital care such as early mobilization only. Setting: The study was conducted at the general surgical and gynecological unit of Menoufia University Hospital. Instruments: Three instruments were utilized, I: A structured Interviewing Questionnaire, II: Postoperative Patient's Outcomes Questionnaire and III: Visual Analogue Scale (VAS). Results: Significant statistical differences existed between both groups regarding the time of resumption of gastrointestinal functions, postoperative ileus symptoms, and incidence of nausea, vomiting, pain and length of hospital stay. Conclusion: Patients who practiced chewing gum as alternative for sham feeding experience earlier return of bowel motility in terms of bowel sounds, first flatus and feeling of hunger than those patients who did not practice chewing gum. Furthermore, there was a significant reduction in pain and length of hospital stay among patients who were practice chewing gum than those who were not. Recommendations: the study recommended that: Sham feeding in a form of gum chewing should be added in the protocol of postoperative nursing care and conducting further studies for evaluating the effect of sham feeding on postoperative ileus among patients undergoing abdominal and gynecological surgeries using a larger sample and different geographical areas.

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI.

BackgroundContinuously tagged MRI during free breathing can assess bowel motility at frequencies as low as the slow wave, motility pattern range. This study aimed to evaluate noninvasive gastrointestinal‐tagged MRI for small bowel motility assessment and to observe the physiological response to a 300‐kcal meal challenge in healthy, overnight‐fasted volunteers.MethodsAfter overnight fasting, 16 healthy subjects (7 women, mean age 25.5, range 19‐37 years) underwent a free breathing, tagged MRI scan to capture small bowel motility. Each subject underwent a (a) baseline motility scan, (b) food challenge, (c) postchallenge scan, and (d) second postchallenge scan (after 20 minutes). Motility was quantified using a frequency analysis technique for measuring the spectral power of the strain, referred to as motility score. Motility score was assessed in 20 frequency intervals between 1 and 20 contractions per minute (cpm), and the data were analyzed with linear mixed‐effect models.Key ResultThe stimulation protocol demonstrated an immediate, food‐induced, motility response in the low‐frequency range (2‐10 cpm), which is consistent with the stomach and small bowel frequency range (3‐12 cpm).Conclusions and InferencesThis study shows that this MRI tagging technique is able to quantify the fasted‐to‐fed response to a 300‐kcal meal challenge within the specific small bowel motility frequency range in healthy subjects. The food provocation MRI protocol provides a tool to explore the gut's response to a stimulus in specific motility frequency ranges in patients with gastrointestinal dysmotility and functional disorders.

Efficacy of Early Mobilization on Bowel Motility For Children after Abdominal Surgery

Early mobilization may exert a mechanical stimulation of intestinal function. Generally it is believed that early mobilization aids in the restoration of normal bowel function after abdominal surgery. Aim: this study aimed to determine the efficacy of early mobilization on bowel motility for children after abdominal surgery. Design: a quasi experimental research design was used to conduct this study. Subjects and method: a convenience sample of 60 children aged from 6 to 18 years. Setting: this study was conducted at the pediatric surgery unit in Assuit university children hospital. Tools: three tools were used to collect the necessary data, a structure questionnaire, child's mobilization and bowel motility monitoring sheet. Results: revealed that (100%) of the studied group walked three time per day while only (6.7%) in the control group during the post-operative day zero, time to passage of first flats and passage of first feces was statistically significant difference P=0.032* P=0.015* respectively. Conclusion: the early mobilization had beneficial effect on early passage of flatus and feces in children after abdominal surgery. Recommendations: training educational program for the nurses about early mobilization after abdominal surgery, this study should be replicated and expanded to include a larger sample.

The Clinical Impact of Delayed Management of Hirschsprungs Disease

Background: Hirschsprung's disease (HD) is a developmental disorder of the enteric nervous system that is characterized by the absence of ganglion cells in the myenteric and submucosal plexus from the anorectum for a variable colonic or intestinal distance. HD is a congenital bowel motility disorder which occurs in approximately one of every 5000 live births. This results in a lack of peristalsis leading to a huge dilatation of the colon proximal to the aganglionic bowel. Aim of work: The purpose of the present study is to investigate the clinical impact of delayed management of children with HD. and how it would affect their outcomes? Methods: The present study was performed in the period from July 2018 to august 2019 in Pediatric Surgery Department of Zagazig University Hospital. 18 patients enrolled inprospective clinical study Results: The delayed diagnosis of HD is associated with a different pattern of presentation compared with neonatal HD. Most of the cases were presented by chronic constipation, abdominal distension and bilious vomiting. Moreover, outcome is worse in older children who are diagnosed with this disease. Conclusions: HD in older children associated with long hospital stay, increased cost of treatment compared with the younger children. Postoperative outcome in older children associated not only with increased risk of serious morbidities but also indirectly affect their long-term outcome.

Relationship Between Recreational Marijuana Use and Bowel Function in a Nationwide Cohort Study.

Although the endogenous cannabinoid system modulates bowel function, our understanding of the impact of recreational marijuana (MJ) use on bowel motility is limited. This study examines the effect of MJ on self-reported bowel function among a large cohort of US adults. We identified adults (age: 20-59 years) who completed both the drug use and bowel health questionnaires in the National Health and Nutrition Examination Survey over a 6-year period from 2005 to 2010 (n = 9,645). Constipation and diarrhea were defined according to stool form (Bristol Stool Form Scale) and/or frequency criteria. Adjusted odds ratios (AORs) for likelihood of constipation or diarrhea were estimated in a multinomial logistic model according to MJ use status. Overall, constipation prevalence was lower among those with recent MJ use compared with those with past/never use (7.5% vs 10.2%, P = 0.03). Recent MJ use was associated with a 30% decreased odds of constipation (crude odds ratio: 0.71 [0.56-0.98], P = 0.005), which persisted after stepwise adjustment for age and other demographic factors including sex, ethnicity, education, body mass index, and socioeconomic status (AOR: 0.64 [0.49-0.83], P = 0.001); comorbidities, substance use (alcohol, tobacco, heroin, and cocaine), constipating medications, general health condition, rigorous physical activity, and emotional disturbances (AOR: 0.68 [0.48-0.93], P = 0.016); and diet (AOR: 0.68 [0.52-0.89], P = 0.006). There was no association between recent MJ use and diarrhea. In a nationally representative sample of community-dwelling US adults, recent MJ use was associated with decreased odds of constipation, counter to the known physiologic effects of cannabinoids on colonic motility.

The Role of Gum Chewing in Regaining Bowel Motility in Patients Undergoing Cesarean Section: A randomized controlled trial

Background: Paralytic ileus is one of the problems that are faced following abdominal surgeries including caesarean section which leads to post-operative pain, abdominal distension, delayed oral feeding, prolonged hospital stay and increased hospital cost. Objective: To assess the effectiveness of chewing gum as safe, effective and easy option to compete paralytic ileus. Patients and Methods: One hundred sixty two parturient women who had caesarean section delivery under spinal anesthesia were recruited and randomly allocated to two groups; group A the study group which were allowed to chew sugarless gums two hours after caesarean section for 30 minutes and repeated every two hours till auscultation of normal intestinal sounds or passage of flatus. Group B the control group underwent conventional care which is nothing per oral till audible intestinal sounds or passage of flatus. It was difficult to apply complete blindness due to the study design so the physician is only blinded. The primary outcome is the time of auscultation of first normal intestinal sounds and the secondary outcomes are time of passage of flatus, stools. Results: Both groups were comparable regarding to their demographic data. There was a statistical significance difference between both groups regarding auscultation of first intestinal sounds, passage of flatus, passage of stools and postoperative hospital stay (P value 0.001, 0.001, 0.001 and 0.001, respectively). No statistical significance difference between both groups regarding presence of abdominal distension, postoperative vomiting, patient satisfaction and presence of obstetric complications.Conclusion: The routine use of gum chewing together with early ambulation and no use of narcotics following caesarean section offers a safe, easy, effective option for early resumption of intestinal function and consecutively associated with short hospital stay.

The Effects of CarumCarvi (BuniumPersicumBoiss) on Early Return of Bowel Motility after Caesarean Section: Double-Blind, Randomized, Placebo-Controlled Trial

Objective: To investigate the effect of the Carum carvi (Bunium persicum Boiss) plant, a gas solvent, on resumption of bowel motility after caesarean section. Materials and methods: A randomized controlled trial was done on a group of 98 women undergoing elective caesarean section under general anesthesia in a university hospital. Patients in the intervention group (Group A) drank 10 ml of a syrup containing 8 g of Bunium persicum Boiss in 20 ml of syrup 6 to 7 hours after surgery. The control group (Group B) comprised 10 patients who drank 10 ml of placebo syrup 6 to 7 hours after surgery. Demographic characteristics, time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement, and length of hospital stay were compared between the two groups. Results: Compared with the control group, the intervention group had a significantly shorter mean time to hearing the first intestinal sounds (10.66 ± 2.38 vs. 19.54 ± 3.85 h), mean time to first flatus (13.91 ± 3.73 vs. 24.82 ± 5.83 h), mean time to first bowel movement (19.31 ± 4.63 vs. 30.70 ± 10.21 h), and mean length of hospitalization (31.70 ± 7.70 vs. 49.20 ± 10.16 h) (p < 0.05). No patients developed serious side effects associated with consumption of the syrup. Conclusion: The use of a gas solvent such as Bunium persicum Boiss after caesarean section can speed the resumption of postoperative bowel motility.

The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy

We aimed to investigate the effects of chewing gum on bowel activity and postoperative pain in patients undergoing laparoscopic hysterectomy. Patients were randomised into two groups (n = 58, study; n = 51, control). In the study group, patients started chewing sugarless gum every 2 h for 15 min, beginning at the second postoperative hour. The control group did not chew gum, and they received standard postoperative care. Both groups were compared primarily in terms of the amount of time until the first bowel movement, the time of the first passage of flatus and the time of first defaecation. The amount of time until the first bowel movement, the time of the first passage of flatus and the time of the first defaecation were found to be significantly shorter in the chewing gum group (p < .001). The amount of postoperative analgesics that were needed and VAS scores at 6-hours and 24-hours postoperatively, were found to be lower in the study group than in the control group (p < .001). Chewing gum was found to have beneficial effects on bowel motility and postoperative pain in patients undergoing laparoscopic hysterectomy. This affordable and simple method could be recommended to patients after total laparoscopic hysterectomy.Impact statementWhat is already known on this subject? Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract.What do the results of this study add? The findings of previous randomised controlled studies have been inconsistent regarding the effect of chewing gum on postoperative bowel function following abdominal gynecological surgery. In this randomised prospective study, we found that chewing gum early in the postoperative period after total laparoscopic hysterectomy hastened time to bowel motility and flatus. To our knowledge this is the first study of the impact of chewing gum on bowel motility after total laparoscopic hysterectomy.What are the implications of these findings for clinical practice and/or further research? Chewing gum early in the postoperative period following laparoscopic hysterectomy hastens time to bowel motility and flatus. The use of chewing gum is a simple and cheap strategy for promoting the recovery of gastrointestinal functions.

481 Motility Abnormalities Identified by Wireless Motility Capsule in Postural Orthostatic Tachycardia Syndrome

INTRODUCTION: Gastrointestinal symptoms are common in patients with postural tachycardia syndrome (POTS). Previous studies have reported a wide range of abnormalities, particularly delayed gastric emptying in POTS. Wireless motility capsule (WMC) is a minimally invasive test that allows the evaluation of gastrointestinal physiology. We aimed to investigate the diagnostic yield of WMC in patients with POTS. METHODS: We conducted a retrospective review of all patients at our institution with both formal WMC testing (SmartpillTM) and autonomic testing for evaluation of gastrointestinal and neurological symptoms respectively. Patient demographics and results of respective testing were extracted. We compared transit abnormalities and contraction patterns between patients meeting diagnostic criteria for POTS and those without POTS. Transit abnormality percentages were compared using chi2 testing, and contraction pattern parameters were compared using 2-sample t-testing. RESULTS: A total of 27 women with both WMC and autonomic testing were studied. The mean age was 39.6 (range 18-68). Fourteen patients had POTS, while the other 13 had either mild or no autonomic abnormalities. Patients with POTS were more likely to have delayed small bowel transit (42.9% vs 7.69%, P = 0.037), but no differences were seen in gastric or colonic transit delays (Table 1). Additionally, POTS patients were more likely to exhibit a hypocontractile pattern throughout the gastrointestinal tract compared to non-POTS patients. Specifically, maximal gastric pressure, and small bowel peak amplitude and motility index were significantly lower in POTS patients. There was a trend towards lower colonic maximum pressure, contraction/min and peak amplitude in POTS patients that did not reach significance (Table 1). CONCLUSION: Our data shows that gastrointestinal motility abnormalities, as observed in WMC, are more common in patients with POTS. Patients with POTS were more likely to have delayed small bowel transit, as well as hypocontractile gastrointestinal patterns, particularly in the small bowel, compared to non-POTS patients. WMC offers a unique opportunity to evaluate patients with autonomic dysfunction and POTS. Further prospective evaluation and higher sample sizes are needed.

2818 Physician Perspective on Inpatient Constipation and the Use of the EMR for Prevention

INTRODUCTION: Constipation is a common problem among patients hospitalized in the United States. Hospitalized patients are particularly vulnerable to constipation due to increased age, decreased mobility, and administration of medications causing decreased bowel motility. Identifying those at risk for constipation on admission and properly discharging patients on bowel regimens when needed can significantly reduce morbidity and mortality of hospitalized patients and save facilities the added costs of complications from constipation. The objective of this study was to assess physician awareness of managing inpatient constipation and receptiveness to changes in the EMR to prevent development of constipation. METHODS: We surveyed residents and attendings within the department of internal medicine at an academic institution to assess awareness of inpatient constipation management and to determine if physicians would support a reminder system to start bowel regimens when appropriate within the EMR. Specific questions from the survey are listed below (Figure 1). RESULTS: 73 resident and attending physicians were surveyed. Physicians marked “sometimes” most often when asked about history taking and medication reconciliation related to constipation on admission and discharge. Most physicians (63%) are in favor of using a protocol as part of the admission order set that would identify those needing to be started on a prophylactic bowel regimen for constipation based on risk factors. Most physicians (82%) do not use as part of their progress note checklist a reminder if patients are on a bowel regimen. Most physicians (79%) are in favor of having a protocol as part of the discharge order set to remind them to discharge patients on a bowel regimen if any constipating medication was prescribed (e.g. opioids). CONCLUSION: Constipation is a problem among many hospitalized patients and physicians frequently fail to implement strategies for prevention. More emphasis needs to be placed on preventing constipation from occurring in the inpatient setting. Limitations of the study are primarily the small sample size and its restriction to internal medicine. Future surveys should also be shared with other services including general surgery prior to implementing any changes. We propose an EMR notification system that identifies patients on admission and discharge who would benefit from a prophylactic bowel regimen based on risk factors, and most physicians at this institution would support such a change to the EMR system.

The assessment of small bowel motility with attentive deformable neural network

The small bowel is the longest part of the gastrointestinal tract and quick assessment of its motility using Cine-MRI is conducive to the diagnosis of gastroenteric diseases. Because of the complex shape changes that occur frequently in the small bowel, approaches involving human designed features and simple convolutional neural network (CNN) methods fail to achieve satisfactory performance on massive datasets. To meet the challenge of assessing small bowel motility automatically, we propose the integration of deformable convolutional networks into attentive encoder–decoder. With the help of deformable convolution, a tailored CNN can track small bowel segments in different shapes from each MR image of a Cine-MRI sequence. The proposed attentive encoder–decoder performed significantly better than conventional recurrent neural network (RNN) in the assessment of small bowel motility. Experimental results demonstrate that the proposed method not only automatically assesses small bowel motility correctly, but also outperforms state-of-the-art methods. Furthermore, it provides useful information about the physiology of small bowel motility patterns, which can be used in the diagnosis of gastroenteric diseases.

Donepezil and α-synuclein Constipation: A 36 Month Follow-Up

A case study is described in which four patients diagnosed at different stages of disease progression with the α‐synuclein or Lewy body disorders Parkinson’s disease (PD) and Neurocognitive Disorder with Lewy Bodies (NCDLB) were treated with the acetylcholinesterase inhibitor (AChEI) Donepezil to address the symptoms of constipation, obstipation and impaction. In all four patients, the use of Donepezil was associated with significant symptom reduction, which was maintained at intervals of six, twelve, eighteen and thirty-six months, with no apparent reduction in bowel motility, nor the emergence of any new symptoms. The results suggest that the AChEI Donepezil can have long-term benefit in reducing the symptoms of constipation, obstipation and impaction in patients with α‐synuclein disorders. Keywords: Neurocognitive Disorder with Lewy Bodies, Parkinson’s disease, constipation, Donepezil, acetylcholinesterase inhibitor

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

Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn’s disease

PurposeA multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn’s disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence. MethodsThis was a retrospective study of 59 patients (mean age 40.8 ± 16.1) with Crohn’s disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data. ResultsOn univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility. ConclusionsAs previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.

The Effect of Gastric Electrical Stimulation on Small Bowel Motility in Patients With Gastroparesis and Concomitant Pancreatic and Small Bowel Dysfunction: From Animal Model to Human Application

Patients with gastroparesis often have biliary/pancreatic and small bowel symptoms but the effects of gastric electrical stimulation on small bowel electrical activity of the mid-gut have not been studied. Animal model aim: Establish gastric and upper small bowel/biliary slow wave activity relationships with electrical stimulation. Human study aim: Demonstrate improvement in symptoms associated with proximal small bowel dysmotility in gastric stimulated patients. Animal model: In vivo evoked responses of duodenal and Sphincter of Oddi measures recorded during gastric electrical stimulation in a nonsurvival swine model (N = 3). High-resolution electrical slow wave mapping of frequency, amplitude, and their ratio, for duodenal and Sphincter of Oddi electrical activity were recorded. Human study: Patients (N = 8) underwent temporary gastric stimulation with small bowel electrodes. Subjective and objective data was collected before and after temporary gastric stimulation. Symptom scores, gastric emptying times, and mucosal electrograms via low-resolution mapping were recorded. Animal gastric stimulation resulted in some changes in electrical activity parameters, especially with the highest energies delivered but the changes were not statistically significant. Human study revealed improvement in symptom and illness severity scores, and changes in small bowel mucosal slow wave activity. Gastric electrical stimulation in an animal model seems to show nonsignificant effects small bowel slow wave activity and myoelectric signaling, suggesting the existence of intrinsic neural connections. Human data shows more significance, with possible potential for therapeutic use of electrical stimulation in patients with gastroparesis and pancreato-biliary and small bowel symptoms of the mid-gut. This study was limited by the nonsurvival pig model, small sample size, and open label human study.

Automated versus subjective assessment of spatial and temporal MRI small bowel motility in Crohn's disease

To investigate whether subjective radiologist grading of motility on magnetic resonance enterography (MRE) is as effective as software quantification, and to determine the combination of motility metrics with the strongest association with symptom severity. One hundred and five Crohn's disease patients (52 male, 53 female, 16-68 years old, mean age 34 years old) recruited from two sites underwent MRE, including a 20 second breath-hold cine motility sequence. Each subject completed a Harvey-Bradshaw Index (HBI) symptom questionnaire. Five features within normally appearing bowel were scored visually by two experienced radiologists, and then quantified using automated analysis software, including (1) mean motility, (2) spatial motility variation, (3) temporal motility variation, (4) area of motile bowel, (5) intestinal distension. Multivariable linear regression derived the combination of features with the highest association with HBI score. The best automated metric combination was temporal variation (p<0.05) plus area of motile bowel (p<0.05), achieving an R2 adjusted value of 0.036. Spatial variation was also associated with symptoms (p<0.05, R2 adjusted = 0.034); however, when visually assessed by radiologists, none of the features had a significant relationship with the HBI score. Software quantified temporal and spatial variability in bowel motility are associated with abdominal symptoms in Crohn's disease. Subjective radiologist assessment of bowel motility is insufficient to detect aberrant motility. Automated analysis of motility patterns holds promise as an objective biomarker for aberrant physiology underlying symptoms in enteric disorders.

Impact of pre-operative walking on post-operative bowel function in patients with gynecologic cancer

BackgroundThere is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic...

Neuronal Nitric Oxide Mediates the Anti-inflammatory Effects of Intestinal Ischemic Preconditioning

BackgroundIschemic preconditioning (IPC) can provide a defense against ischemia–reperfusion (IR)-induced acute inflammation and barrier dysfunction in many organs. Because nitric oxide (NO) has been implicated as a trigger or mediator in the IPC mechanism and because neuronal NO synthase (nNOS) is a dominant isoform of NOS in the gastrointestinal tract, our aim was to investigate the role of nNOS in IPC-induced protection after mesenteric IR. Materials and methodsIntestinal IR was induced in sodium pentobarbital–anesthetized dogs by clamping the superior mesenteric artery for 60 min followed by 2 h of reperfusion (IR group; n = 7). In further groups, IPC was used (three cycles of 5-min ischemia/5-min reperfusion periods) before IR in the presence or absence of selective inhibition of nNOS with 7-nitroindazole (5 mg/kg, intravenously, in a bolus 15 min before IPC, n = 6 each). Changes in mesenteric vascular resistance, intramucosal pH (pHi), and small bowel motility were monitored. Plasma nitrite/nitrate levels, intestinal NO synthase activity, leukocyte accumulation, mast cell degranulation, and histologic injury were also determined. ResultsIschemia significantly decreased mesenteric vascular resistance and pHi, whereas IR induced a temporary bowel hypermotility and acute inflammatory reaction. IPC facilitated pHi recovery, attenuated motility dysfunction, elevated NOS-dependent NO production, and reduced leukocyte accumulation, mast cell degranulation, and mucosal injury. Pretreatment with 7-nitroindazole halted the IPC-induced increase in NO availability, pHi recovery, and the anti-inflammatory and morphologic effects. ConclusionsOur data demonstrate that NO generated by intestinal nNOS plays a pivotal role in IPC-linked tissue protection by inhibiting an IR-related acute inflammatory response.

310.7: Spleen preservation attenuates GVHD in multivisceral transplant recipients.

Purpose: The immunological benefits of the spleen are well acknowledged, but splenectomy is often performed in recipients of multivisceral transplantation. Technical reason and the lack of room in the abdominal cavity are the key arguments to justify removal of the native spleen. We aimed to analyze the beneficial role of the spleen in MVTx recipients in a series of pediatric intestinal transplantation. Patients and methods: A total of 103 IT (55MV, 25SB, 22CLSB, 3MMV) were performed in 84 patients (male-60%-, mean age 5.3yrs) between 1999 and 2018. Mean time on the waiting list was 272days waiting list mortality was 25%. Main indications for the transplant on the first instance were short bowel syndrome (69%), motility disorders(12%) and epithelial diseases(9.5%). For the present study we included only pediatric (<18 years) cases that underwent multivisceral transplantation. Patients were divided patients in three groups, native spleen preservation, native spleen removal and spleen graft inclusion. We analyzed survival, GVHD, hemolytic disorders. Results: From the whole series, only 55 patients were included, all of them received a multivisceral graft. The spleen was included in the graft in 18.1% of patients, splenectomy was performed in 40%, in several of them after failed attempt of preservation; and native spleen was preserved in 41.8% Rejection in different forms was more frequent in patients who preserved the spleen, 4% presented humoral rejection, and acute cellular rejection was two times and chronic rejection four times more frequent compared with patients who underwent splenectomy. None of the patients with the spleen included in the graft presented humoral or chronic rejection, PTLD was also (1.8 times) more frequent in this group. The proportion of GVHD was significantly lower in the group of spleen preservation compared to splenectomy and graft spleen (RR 2.75, OR 3.33) (p<0.05). We also found a trend towards less hemolytic disorders in patients with spleen preservation. Conclusion: Native spleen preservation demonstrated to attenuate the occurrence and severity of GVHD in pediatric MVTx recipients. This technique should be considered in all patients, although technical difficulties, prolonged ischemia of the graft and other factors can preclude the success of the procedure.