Colonic Slow Transit Constipation Research Articles

Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation.

BackgroundFew studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC.MethodsBetween January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared.ResultsThere were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285).ConclusionsOur findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.

Retrospective cohort study on subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy in the treatment of senile slow transit constipation

Objective: To investigate the clinical efficacy of laparoscopic subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) in the treatment of senile slow transit constipation. Methods: A retrospective cohort study was performed. Clinical data of 30 colonic slow transit constipation patients aged ≥70 years old undergoing laparoscopic SCBCAC from July 2012 to October 2016 (bypass plus colostomy group), and 28 patients undergoing laparoscopic subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) from February 2009 to June 2012 (bypass group) at our institute were collected. Efficacy was compared between the two procedures. Inclusion criteria: (1) meeting the Rome III diagnosis criteria for constipation; (2) confirmed diagnosis of slow transit constipation; (3) age ≥ 70 years old; (4) receiving non-surgical treatment for more than 5 years, and Wexner constipation score > 15; (5) follow-up for more than 2 years. Those with psychiatric symptoms or previous psychiatric history, obvious signs of outlet obstructive constipation, organic diseases of the colon and life-threatening cardiovascular diseases or cancer were excluded. In the bypass plus colostomy group, laparoscopy was performed via five trocars. The ileocecal junction and the ascending colon were mobilized and the ileocecal junction was pulled down to the pelvic inlet. The ascending colon was transected and the appendix was excised. The lateral peritoneum of the sigmoid colon and the rectal mesentery were dissected and the upper rectum was transected. The avil of a circular stapler was placed in the bottom of the cecum. The shaft of the stapler was placed in the rectum via the anal canal to complete end-to-side anastomosis (end rectum to lateral cecum). The end of the rectal-sigmoid colon was used for colostomy via an extraperitoneal approach to complete the operation. The following efficacy indexes were collected before surgery and 3, 6, 12, and 24 months after surgery: the number of daily bowel movements, the Wexner incontinence scale (WIS, 0-20, the lower the better), the Wexner constipation scale (WCS, 0-30, the lower the better), the gastrointestinal quality of life index (GIQLI, 0-144, the higher score, the better), abdominal pain intensity indicated by the numerical rating scale (NRS, 0-10, the lower score, the better), and the abdominal bloating score (ABS, 0-4, the lower score, the better). The complications defined as Clavien-Dindo class II or above were observed and recorded. Results: No significant differences in preoperative WCS, WIS, GIQLI, NRS, and ABS were observed between bypass plus colostomy group and bypass group (all P>0.05). All the patients successfully underwent laparoscopic surgery and no patient in either group experienced postoperative fecal incontinence. WCS and GIQLI were significantly improved (all P<0.001) at 3, 6, 12, and 24 months after surgery in both groups. At 12 months after surgery, the number of bowel movements was significantly less in bypass plus colostomy group than that in bypass group [(2.4±0.7) times vs. (3.4±1.2) times, t=4.048, P<0.001]. At 3, 6, 12 and 24 months after surgery, the improvement of GIQLI in bypass plus colostomy group was significantly better than that in bypass group (all P<0.001). At 24 months after surgery, GIQLI in bypass plus colostomy group and bypass group was 122.3±5.3 and 92.8±16.6, respectively, with a significant difference (t=9.276, P<0.001). At 12 and 24 months after surgery, NRS in bypass plus colostomy group was significantly better than that in bypass group (both P<0.001). At 24 months after surgery, NRS in bypass plus colostomy group was 0.9±0.7, while that in bypass group was 3.7±2.7. There was a significant difference between two groups (t=5.585, P<0.001). At 6, 12 and 24 months after surgery, the improvement of ABS in bypass plus colostomy group was also significantly better than that in bypass group. At 24 months after surgery, ABS in bypass plus colostomy group was 0.6±0.6, while that in bypass group was 2.5±1.0, with a significant difference between two groups (t=8.797, P<0.001). At 1 year after surgery, barium enema examination was performed in all the patients of both groups. The barium emptying time was (21.2±3.8) hours and (95.8±86.2) hours in bypass plus colostomy group and bypass group respectively. The former group was significantly better than the latter group (t=4.740, P<0.001). Conclusions: Laparoscopic SCBCAC is an effective and safe procedure for the treatment of senile slow transit constipation and can significantly improve prognosis. Its clinical efficacy is better than laparoscopic SCBAC.

MicroRNA-128 differential expression in mouse model of slow transit constipation

Objective To explore the expression of microRNA (miRNA, miR)-128 in colonic slow transit constipation (STC) mouse model. Methods Fifty-four female mice were assigned randomly into normal saline (NS) group, morphine group, morphine + rhubarb group. The mice in the morphine group and morphine + rhubarb group were given morphine hydrochloride by subcutaneous injection. After the successful establishment of the acute constipation model, the animals in the morphine + rhubarb group received gradually increasing doses of rhubarb by intragastric administration. The bowel habits, intestinal transit distances and histomorphology changes of mice were observed. The miR-128 expression in colon was detected by q-PCR. Results The intestinal transit in morphine + rhubarb group, NS group, and morphine group was (-1.60±3.21), (14.75±3.75), and (6.50±1.50) cm, respectively (morphine + rhubarb group versus NS group, P=0.003; morphine + rhubarb group versus morphine group, P=0.024). The colon tissue in morphine + rhubarb group was obviously thin and the muscle structure was disordered. The expression of miR-128 was significantly down-regulated in the morphine + rhubarb group. The expression of miR-128 in morphine + rhubarb group, NS group, and morphine group was (7.30±8.40)×10-7, (3.03±1.98)×10-6, and (3.72±0.69)×10-6, respectively (NS group versus morphine + rhubarb group, P=0.048; morphine group versus morphine + rhubarb group, P=0.037). Conclusion This study successfully established STC mouse model and found that miR-128 expression was significantly down-regulated in this animal model. Key words: Slow transit constipation; Model, animal; MicroRNAs; MicroRNA-128

Function of colonic mucosal barrier of patients with colonic slow transit constipation

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease. Key words: Constipation; Colonic diseases; Intestinal mucosa

Differential expression of microRNAs in colonic slow transit constipation

Objective To explore the microRNA (miRNA) differential expression in the patients with colonic slow transit constipation (STC),and to provide the evidence that miRNA may be involved in the molecular pathogensis of STC.Methods Six colonic STC tissue samples and 6 normal coloic tissue samples were obtained surgically.miRNA expression was assessed using miRNA microarray.Results miRNA microarray identified five miRNA,(miR-20b,miR-27b,miR-30b,miR-128 and miR-129-3p),with down-regulated expression ( over 1.2-fold lower) in colonic STC tissues compared to normal colonic tissues (P ＜ 0.05).miR-128 and miR-129-3p were more than 2-fold decreased respectively.Conclusion Some miRNA are expressed differently between colonic STC tissues and normal colonic tissues,which may be involved in the pathogensis of STC. Key words: microRNA; Slow transit constipation; Microarray

Clinical study on deep insertion at Tianshu (ST 25) for colonic slow transit constipation

Objective To observe the clinical effect of deep insertion at Tianshu (ST 25) for colonic slow transit constipation (STC).

Nursing of patients with pelvic floor hernia, internal rectal prolapse combined with slow transit constipation

Objective To study the characteristics of peri-operative nursing of pelvic floor hernia, rectal prolapse combined with slow transit constipation. Methods 20 patients with pelvie floor hernia, internal rectal prolapse combined with slow-transit constipation were selected and given corresponding nursing according to peri-operative characteristics, and its influence on surgical effect of patients was ob-served. Results 18 cases restored to normal defecation, 2 cases still needed assisted defecation cathartic, but the amount decreased significantly. Conclusions Peri-operative nursing can promote the recovery of patients with pelvic floor hernia, rectal prolapse combined with colonic slow transit constipation. Key words: Pelvic floor hemia; Internal rectal prolapse; Slow transit constipation; Surgery; Nursing

Effects of Yiqi Kaimi Recipe on gastrointestinal motility and neuropeptides in rats with colonic slow transit constipation

To observe the effects of Yiqi Kaimi Recipe (YQKMR), a traditional Chinese compound medicine, on gastrointestinal motility and neuropeptides in rats with colonic slow transit constipation. Eighty specific pathogen free rats were included, and there were sixty rats with slow transit constipation (STC) and twenty normal rats. Sixty rats with STC were randomly divided into untreated group, cisapride-treated group and YQKMR-treated group, and twenty normal rats were allocated to normal control group. Percentage of carbon propelling, contraction frequency and amplitude of the muscle segments in vitro, and expressions of nitric oxide synthase-1 (NOS1) and substance P proteins were observed. Compared with the normal control group, the percentage of carbon propelling, and the contraction frequency and amplitude of the muscle segments in the untreated group decreased obviously (P<0.05) The percentage of carbon propelling, and the contraction frequency and amplitude of the muscle segments in the YQKMR-treated group and cisapride-treated group were higher than those in the untreated group (P<0.05). The expression of NOS1 protein in the untreated group was higher than that in the normal control group, YQKMR-treated group and cisapride-treated group. However, there were no significant differences between the YQKMR-treated group and the normal control group (P>0.05). The expression of substance P protein in the untreated group was lower than that in the normal control group, and there was no significant difference between the YQKMR-treated group and the normal control group too (P>0.05). Yiqi Kaimi Recipe could promote colon motility by increasing the contraction frequency and amplitude of the smooth muscle, and this may be due to its effect of regulating the expressions of NOS1 and substance P proteins in the enteric plexus.

Constipation of anorectal outlet obstruction: Pathophysiology, evaluation and management

Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.