Colonic Stasis Research Articles

Pathomorphological changes in the wall of the colon in patients with chronic colonic stasis

Aim. To evaluate the severity of pathomorphological changes in the wall of the large intestine at various stages of chronic colonic stasis.Materials and Methods. This study examined pathomorphological changes in biopsy specimens of the mucous membrane and resected sections of the large intestine from 92 patients with different stages and etiologies of chronic colonic stasis. The distribution of patients by disease stage was as follows: 31 patients (33.7%) were in the compensated stage, 33 patients (35.9%) were in the subcompensated stage, and 28 patients (30.4%) were in the decompensated stage of chronic colonic stasis.Results. Pathomorphological changes in the mucosa and other layers of the large intestine in patients with chronic colonic stasis varied in severity, ranging from minor superficial alterations to pronounced and extensive changes. Focal dystrophic processes with signs of diffuse inflammation, destructive changes in the glands of the mucous membrane, and focal inflammatory infiltrates were observed. The intestinal villi were elongated and showed divisions with swollen vessels.Conclusion. The severity of pathomorphological changes in the mucosa and other layers of the large intestine directly correlates with the stages and duration of colonic stasis. These findings indicate the presence of both degenerative and inflammatory processes in the mucosal-submucosal and muscular layers of the large intestine.

Modern Diagnostic Approaches and Management Tactics for Patients with Chronic Colonic Stasis in Decompensated Forms of Colon Dysfunction

Today, colonic stasis is a significant medical and social problem worldwide. According to research by a number of authors, in developed countries, constipation affects to varying degrees from 30 to 50% of the working-age population and from 5 to 20% of children. Constipation occurs 5 times more often in the elderly than in young people. The etiology of chronic colonic stasis is diverse: from functional disorders of gastrointestinal motility to intestinal abnormalities, in some cases leading to disability and a significant decrease in the quality of life of patients. Prolonged, sometimes unsuccessful, medical treatment of chronic colonic stasis ultimately raises the question of the need for surgical intervention. The purpose of this review was to study and summarize the results and experience of researchers over the past 10 years devoted to the search for the most effective methods of surgical treatment of chronic colonic stasis in decompensated form of colon dysfunction (including dolichosigmoid) in combination with drug therapy. The search for information for the review was carried out on the following resources: PubMed, MEDLINE, Embase, Springer, ScienceDirect, journals of the CIS countries and the Republic of Kazakhstan.

Some issues of classification and etiopathogenesis of chronic colonic stasis

This paper presents a review of the literature, which covers the main issues of the etiology and pathogenesis of chronic colonic stasis, starting from the era of Avicenna to modern views. Various classifications are provided, covering all the nuances of this polyetiological problem, and risk factors that contribute to the development of such a severe pathology.

Chronic colonic stasis: some aspects diagnosis and treatment

The article provides a review of the literature data on the study of diagnostics and the choice of a conservative or surgical method for the treatment of chronic colonic stasis (CCS). The literature data on the information content of various methods for diagnosing malformations and fixation of the colon, studying the rate of movement of intestinal contents along the colonic part of the gastrointestinal tract are presented. It has been established that in the diagnosis of chronic colonic stasis there are a number of difficulties, for the solution of which it is necessary to use a complex of various methods of instrumental diagnostics. The views on conservative treatment and approaches to the choice of surgical treatment option for CCS are highlighted. Literature data indicate that the most accurate indications for the use of conservative or surgical methods of treatment have not yet been established, and criteria for selecting patients have not been established.

A topical thermosensitive hydrogel system with cyclosporine A PEG-PCL micelles alleviates ulcerative colitis induced by TNBS in mice.

Ulcerative colitis (UC) is an idiopathic, chronic, relapsing disease. In most cases, only the distal colon is affected, and the colonic stasis or fast colonic transit through the inflamed colon usually results in reduced exposure of the distal inflamed colon. Although the immunosuppressant cyclosporine A (CsA) has been used in patients with severe colitis who do not respond to corticosteroids, the clinical application of CsA remains limited due to the systemic toxicities and insufficient accumulation at the site of action for the intravenous and oral routes. In this study, we loaded CsA into the amphipathic poly(ethylene glycol)-poly(ε-caprolactone) (PEG-PCL) micelles and then embedded them in hydrogels consisting of chitosan, poloxamer 188, and poloxamer 407 to construct a thermosensitive and mucoadhesive hydrogel drug delivery system (PLCP). The PLCP presented a high drug-loading capacity and showed a stable and rapid gelation rate after rectal administration into the body. Compared to CsA-loaded micelles and Sandimmun (Neoral®), the developed thermosensitive gel exhibited prolonged retention on the inflamed colon, as seen from in vitro adhesion and in vivo distribution experiments. It also fast mitigated colitis symptoms in TNBS-treated mice by regulating the expression levels of proinflammatory cytokines (TNF-α, IL-1β, COX-2, and iNOS2), anti-inflammatory cytokines (IL-10, Nrf2, NQO1, and HO-1), and other relevant biochemical factors. Our results suggested that CsA-loaded micelle thermal hydrogel system could be a promising strategy by enhancing the retention in the diseased colon and promoting the relief and recovery of UC.

Functional constipation in children

Constipation is one of the most common nosologies that a pediatric gastroenterologist deals with during outpatient visits. In the vast majority of children with constipation the problem is functional in nature. According to studies published in the Russian Federation, the frequency of constipation in children accounts for about 25–30%. The joint clinical guidelines of the European and North American Societies of Pediatric Gastroenterologists, Hepatologists and Nutritionists for the management of children with functional constipation were published in 2014. The national guidelines for the diagnosis and treatment of functional constipation are based on these guidelines. According to the clinical guidelines, the 2006 Rome III criteria should be used to establish the diagnosis of functional constipation in children. In May 2016, the Rome IV criteria that provide separate diagnostic criteria for infants and children under 4 years of age and children over 4 years and teenagers were adopted. A group of children with symptoms of constipation, who have already had toilet skills at the time of diagnosis, was identified among infants and children under 4 years of age. The presence of anxiety symptoms or refractory constipation (constipation that does not resolve within 3 months while taking adequate therapy) is considered an indication for use of additional examination methods, including instrumental ones. The manifestation of constipation is often associated with a change in eating habits - the period of introduction of complementary feeding in infants or the beginning of going to a day-care centre, inadequate fluid intake. The onset of constipation often coincides with the period of the development of hygiene skills (potty training). The voluntary stool retention by a child who is trying to avoid painful defecation experiences is the main mechanism for the development of constipation. The aim of functional constipation treatment is to soften the stools, which facilitates painless defecation and ensure that there is an urge to defecate. Clinical examples of the treatment of patients with functional constipation and chronic colonic stasis, functional constipation and encopresis are provided. The outcome of the treatment of functional constipation is to ensure painless defecation and the development of a stable defecation reflex. The drug therapy for functional constipation is based on the use of laxatives. Dietary advice and behavioral therapy also play an important role.

Mechanism of Lactobacillus reuteri Probiotic in Increasing Intestinal Mucosal Immune System

Probiotics are defined as live microorganisms which, when consumed in adequate quantities as food ingredients, provide health benefits to the host. Lactobacillus, Bifidobacterium, and Saccharomyces, are three probiotics that are intensively used as probiotics in humans and animals. Probiotics have beneficial effects on health when given adequate amounts. The concept of probiotics on human health, namely modulating the gut microbiota and its effect on the host. Probiotics play an important role in maintaining intestinal integrity through a number of different interactions, including changes in cytokine expression in the mucosa. Probiotics compete with intestinal pathogens for mucosal receptors, thereby increasing interepithelial resistance. Probiotics such as Lactobacillus casei sp GG strain was used as a prophylaxis that could increase the expression of epithelial mucin, thereby reducing the translocation of pathogenic bacteria. Abnormal local immune response is characterized by decreased secretion of IgA, thus allowing enterocyte attachment and local translocation of bacterial antigens, which are the main stimulation of pathological events. Colonic stasis can promote the growth of pathogenic bacteria which allows malignant porin bacterial strains to thrive. The gut microbiota has a major influence on human health. The microbial population has an important role in the host, such as the metabolic activity of probiotics producing energy and nutrient absorption, developing the host immune system, and preventing colonization and infection of pathogens. Lactobacillus reuteri is a hetero-fermentative bacterium that lives in the digestive tract of humans. L. reuteri has been used to treat infant necrotizing pseudomembrane. In this paper, the mechanism of L reuteri to increase host immunological response will be reviewed.

Enterolithiasis

Objective. To study the prevalence, etiopathogenesis, clinical features, diagnosis and treatment of enterolithiasis.
 Materials and methods. For 26 years, 30 patients (16 men, 14 women) with intestinal calculi were observed. Elderly and senile patients prevailed (18 persons). Six patients had enterolites, 24 coprolites. In general, 41 calculi measuring from 2.5 to 22 cm (31 concrement was 6 cm and larger) were diagnosed in patients. Calculi were most often formed in the sigmoid and rectum. Fibrocolonoscopy, proctosigmoidoscopy, ultrasound, computed tomography were used.
 Results. It was established that chronic colonic stasis, congenital and acquired intestinal diseases, intake of indigestible and extraneous for the intestine substances (chalk, barium, magnesium and aluminum salts) played a leading role in the formation of intestinal calculi. In 25 patients, calculi caused complications, of which the most severe were perforation of the intestine and acute intestinal obstruction.
 Conclusions. Improvement of diagnostics and the developed differentiated treatment tactics permitted to improve treatment results better and achieve recovery in all 30 patients.

The Correction Methods of the Intestinal Microflora in Chronic Colonic Stasis by Siphon Enema and Probiotics as a Means of the Hirschsprung-associated Enterocolitis Prevention

AIM: The purpose of the current article is to study the state of the intestinal microflora in the context of chronic colonic stasis and assesses the methods of its correction by means of siphon enema and probiotics’ implication (bifidumbacterin and lactobacterin) to prevent the development of HAEC.
 METHODS: This study was conducted in the Astana City Children’s Hospital No. 2 and involved 60 children who applied for medical help with symptoms of chronic constipation. They were admitted to the hospital in a planned or emergency manner with suspected Hirschsprung’s disease in the period from 2015 to 2017, after approval of the Ethics Committee. An X-ray contrast study of the large intestine (irrigography) was performed in all the children for a diagnostic purpose. The following parameters of the state of the large intestine were studied: The function of the ileocecal valve (Bauhin’s valve), the diameter and shape of the large intestine, the presence of pathological formations, and symptoms of intestinal obstruction. Statistical analysis was carried out using Student’s test for dependent and independent samples by means of the BioStat Software.
 RESULTS: After treatment, the bacteriological examination of stool samples demonstrated an increase in the number of beneficial microorganisms and a decrease in the number of opportunistic microorganisms. The growth in the number of patients with the normal intestinal microflora (14 patients – 70%) was observed along with the reduction in the number of patients with intestinal dysbiosis, with a statistically significant difference (p < 0.001).
 CONCLUSION: The developed method of correcting the quantitative composition of the intestinal microflora is very effective and can be implemented in clinical practice.

The Correction Methods of the Intestinal Microflora in Chronic Colonic Stasis by Siphon Enema and Probiotics as a Means of the Hirschsprung associated Enterocolitis Prevention

AIM: The purpose of the current article is to study the state of the intestinal microflora in the context of chronic colonic stasis and assesses the methods of its correction by means of siphon enema and probiotics’ implication (bifidumbacterin and lactobacterin) to prevent the development of HAEC. METHODS: This study was conducted in the Astana City Children’s Hospital No. 2 and involved 60 children who applied for medical help with symptoms of chronic constipation. They were admitted to the hospital in a planned or emergency manner with suspected Hirschsprung’s disease in the period from 2015 to 2017, after approval of the Ethics Committee. An X-ray contrast study of the large intestine (irrigography) was performed in all the children for a diagnostic purpose. The following parameters of the state of the large intestine were studied: The function of the ileocecal valve (Bauhin’s valve), the diameter and shape of the large intestine, the presence of pathological formations, and symptoms of intestinal obstruction. Statistical analysis was carried out using Student’s test for dependent and independent samples by means of the BioStat Software. RESULTS: After treatment, the bacteriological examination of stool samples demonstrated an increase in the number of beneficial microorganisms and a decrease in the number of opportunistic microorganisms. The growth in the number of patients with the normal intestinal microflora (14 patients – 70%) was observed along with the reduction in the number of patients with intestinal dysbiosis, with a statistically significant difference (p < 0.001). CONCLUSION: The developed method of correcting the quantitative composition of the intestinal microflora is very effective and can be implemented in clinical practice.

Colonic stasis and chronic constipation: Demystifying proposed risk factors for colon polyp formation in a spinal cord injury veteran population

Background and Aims: Patients with spinal cord injury (SCI) suffer significant morbidity from neurogenic bowel. Chronic constipation has long-been a proposed risk factor for polyp development. We performed a retrospective cohort study in veterans with SCI to assess polyp presence in the setting of colonic stasis. Methods: All consecutive patients at the James A. Haley Veterans Affairs Hospital with SCI and neurogenic bowel who completed screening colonoscopy between January 1, 2004 to June 30, 2013 were included. Colonoscopies were excluded if they were aborted, not completed to the cecum, of less than adequate preparation, or if polypectomy was precluded. Patient data included level, duration, and completeness of SCI. Polyp data included number, location, and histology. Results: 325 patients ultimately met inclusion criteria. Most were male (96%). The average age at screening colonoscopy was 62.8 years. The majority of patients had injury to the cervical spine (41.5%). Colon polyps were detected in 130 patients (40%). Adenomatous change was seen in 95 (73%) of these patients. The adenoma detection rate (ADR) across all patients was 29.2%. Polyp presence and ADR demonstrated no statistically significant correlation with level, degree, or duration of SCI. Only patient age at time of screening colonoscopy had a significant correlation with polyp and adenoma presence (P<0.05). Conclusions: SCI had no statistically significant correlation with polyp or adenoma presence. The ADR in our veteran SCI population with chronic constipation is comparable with that reported in the general population.

Colonic Stasis and Chronic Constipation: Demystifying Proposed Risk Factors for Polyp Formation and Colon Cancer in a Spinal Cord Injury VA Population

Colonic Stasis and Chronic Constipation: Demystifying Proposed Risk Factors for Polyp Formation and Colon Cancer in a Spinal Cord Injury VA Population

Possibilities Of Surgical Treatment Of Children With Chronic Colonic Stasis

Possibilities Of Surgical Treatment Of Children With Chronic Colonic Stasis

Scintigraphie à l’OctréoScan ® : aspects pratiques. Le point de vue du manipulateur

Evaluation of neuroendocrine tumors extent comprises a somatostatin receptor scintigraphy with OctréoScan ®. This examination begins with the radiopharmaceutical preparation and its quality control (dose, visual appearance, radiochemical purity, pH). The radiopharmaceutical is administered intravenously at a slow rate with respect of the contra-indications and recommendations. The patient's good respect of low residue diet and digestive preparations is essential for a good imaging quality. In addition, the technologist's psychological role (particularly for people suffering from claustrophobia) and adequate procedures must be taken into account. Several days are necessary to perform the examination that comprises whole body and planar (thoracic and abdominal) views, combined SPECT-CT imaging. This hybrid modality using fused images allows a good anatomical localisation of focal areas of increased uptake even in case of faint uptake. Some false-positive can be avoided (colonic stasis, gall bladder). SPECT-CT contribution to the diagnosis is certain.

Lifestyle lavage and laxative abuse; with a nod to gemellus!

In the July 2009 edition of the Journal [1] Harris and the C-CLEAR group reported a systematic review and meta-analysis of prospective observational studies to quantify colorectal cancer risk associated with an increased BMI involving 67,361 incident cases. A higher BMI was associated with colon and rectal cancer in men but only colon cancer in women. Although increased BMI is associated with a modest increased risk the authors note that this may translate to large attributable proportions in high prevalence obese populations. This is important as such factors are modifiable for colorectal cancer prevention. Unfortunately the authors note that it remains to be seen whether reducing BMI will reduce cancer predisposition and allow formulation of appropriate public health strategies. In this edition of the Journal [2] the same group undertook a similar study to quantify gender specific risk associated with increased leisure time and physical activity, involving 7,873 incident cases. The authors identified an inverse association with colon cancer but not rectal cancer, although they noted that the benefits of less than the highest levels of LTPA may be small. The authors conclude that LTPA only intervention in cancer prevention is unlikely to impact substantially on incidence. In a further review in this edition [3] Seow Choen examines the claims of colonic hydrotherapy against known physiological facts. Advocates note that toxic overload in the colon may induce weight gain, fatigue, constipation, diarrhoea, mood swings, weakened immune system and stress. It is suggested hydrotherapy maybe of benefit in patients with allergies, arthritis, asthma, colonic stasis, bloating, candida, colitis in remission, constipation, diarrhoea, diverticulosis, flatulence, leaky gut, haemorrhoids, toxic headache, halitosis, indigestion, lethargy, mucous colitis, multiple sclerosis, parasitic infections, skin problems and urinary urgency! Seow Choen then provides a critique of the physiological basis for such claims referring to a formidable standard textbook of medical physiology, which struck fear in the heart of this editor as an undergraduate! The paper concludes there is no physiological basis for colonic hydrotherapy which may actually increase toxins and bacteria absorption and in unfortunate instances may result in rectal perforation, aplastic anaemia and disseminated abscess formation. Finally a case report in this edition indicates that melanosis coli from prolonged laxative abuse is reversible [4]. This editor is pleased to note that draconian measures to remove his middle-aged spread may have future benefits with regard to his predisposition to colon cancer but remains in a quandary as to whether to renew his annual gym membership in order to attain any further benefit from the highest levels of leisure time physical activity. He is relieved to acknowledge that the formidable tome which struck fear into his young heart during second MB provides a persuasive argument that his ongoing midlife co-morbidities may not require the services of an irrigationist and is reassured that any intermittent laxative use to regulate his profession induced colonic inertia will not result in lifelong mucosal stigmata. At present, however he will continue to rely on his low-dose aspirin and fish oil supplements as his only current lifestyle modification!

Effects of amino acid-derived luminal metabolites on the colonic epithelium and physiopathological consequences

Depending on the amount of alimentary proteins, between 6 and 18 g nitrogenous material per day enter the large intestine lumen through the ileocaecal junction. This material is used as substrates by the flora resulting eventually in the presence of a complex mixture of metabolites including ammonia, hydrogen sulfide, short and branched-chain fatty acids, amines; phenolic, indolic and N-nitroso compounds. The beneficial versus deleterious effects of these compounds on the colonic epithelium depend on parameters such as their luminal concentrations, the duration of the colonic stasis, the detoxication capacity of epithelial cells in response to increase of metabolite concentrations, the cellular metabolic utilization of these metabolites as well as their effects on colonocyte intermediary and oxidative metabolism. Furthermore, the effects of metabolites on electrolyte movements through the colonic epithelium must as well be taken into consideration for such an evaluation. The situation is further complicated by the fact that other non-nitrogenous compounds are believed to interfere with these various phenomenons. Finally, the pathological consequences of the presence of excessive concentrations of these compounds are related to the short- and, most important, long-term effects of these compounds on the rapid colonic epithelium renewing and homeostasis.

Early postoperative feeding after major gynecologic surgery: Evidence-based scientific medicine

Postoperative gastrointestinal care after major gynecologic surgery has evolved considerably over the last decade. According to evidence-based scientific medicine, the following conclusions can be drawn: (1) Postoperative colonic stasis occurs after major abdominal surgery and persists for approximately 3 days (classes I and IIA). (2) Elective postoperative nasogastric decompression after major abdominal surgery is unnecessary (class I). (3) Early feeding after major gynecologic surgery results in emesis but does not increase the incidence of aspiration pneumonia, dehiscence, or intestinal leaks and decreases hospital stay (class I). (4) Slow advancement of postoperative diet after major gynecologic surgery is probably unnecessary (class III). (5) After major abdominal gynecologic surgery, there appear to be minimal medical benefits (decreased infection rate) of early postoperative feeding (class III). (6) After radical hysterectomy, postoperative bowel stimulation decreases length of hospital stay (class IIA). (Am J Obstet Gynecol 2001;185:1-4.)

Biliary lithocholate and cholestasis during and after total parenteral nutrition: an experimental study.

To evaluate the role of lithocholic acid (LCA) in the etiology of parenteral nutrition-associated cholestasis (PN-AC), we studied (i) the changes in the percentage of biliary LCA and (ii) the emergence and resolution of cholestatic changes in the liver after total parenteral nutrition (TPN) and after 6 weeks of oral feeding following the TPN. We compared these changes in rabbits on TPN support (via a central vein) for 14 days (TPN, n = 8) with those after 6 weeks of refeeding (Post-TPN, n = 8). Age-matched rabbits on lab chow served as controls (CHOW, n = 8). At the end of the diet regimens, the common bile duct was cannulated under anesthesia, and hepatic bile collected for measurements of bile flow and bile acid (BA) secretion rates, and BA profiles. The 60-min biliary excretion of sulfobromophthalein (BSP) after an intravenous bolus (5 mg/kg) was determined. A liver biopsy was taken for light microscopy. After 14 days of TPN, bile flow was reduced by 60%, bile acid secretion by 52%, and BSP excretion by 38%. On refeeding, only the BSP excretory rate recovered fully. In the TPN group, histology of the liver showed hepatocellular degeneration and portal tract inflammation; these resolved after refeeding leaving a mild portal fibrosis in 4/8 rabbits. Total colonic stasis occurred during TPN. With TPN, a decrease in the percentage of biliary glycochenodeoxycholate and an increase in LCA% were seen, whereas after refeeding the increase was in the percentage of glycoursodeoxycholate. An LCA% > or = 6 was associated with liver cell damage. After 6 weeks of refeeding, the structural cholestasis disappeared, but the decreases in basal bile flow and bile acid secretion (functional cholestasis) persisted. These data associate an increase in biliary LCA with the emergence of cholestasis during TPN in rabbits.

Role of proctography in severe constipation

As referred to in the literature, patients complaining of constipation may have a spastic or, in the case of chronic staining, weak pelvic floor. Twenty-two severely constipated patients who did not improve after a high fiber diet were submitted to whole gut transit time (TT), proctographic, and anorectal manometric studies. A control group consisting of five subjects for TT, five subjects for proctogram, and ten subjects for manometry was also studied. Transit time was delayed (P less than 0.001) in all patients. Manometry in the constipated group showed a high rectal threshold (64.1 vs. 17.1 ml of air, P less than 0.01), but no other significant difference. Proctograms in 10 of 22 patients (Group A) showed no differences in the anorectal angle (ARA) and in its distance from the pubococcygeal line (DLPC) in respect to the control group; 12 of 22 patients (Group B) had a paradoxical closure of the ARA at straining in respect to resting position (101.2 degrees vs. 120.1 degrees), and a higher DLPC than Group A and the control group in all positions studied. There was no difference in TT for rectal stasis of radiopaque markers between the two pathologic groups. Patients in Group B were older than patients in Group A (55.3 vs. 42.9 years, P less than 0.05). In conclusion, proctograms showed alterations of the pelvic floor, but there was no correlation between protographic data and rectal or colonic stasis of the radiopaque markers, or clinic severity of constipation, but a correlation between ages did exist.

Gastrointestinal Motility in Patients with Ulcerative Colitis

In the first study 62 patients with ulcerative colitis and 20 healthy controls were fed a test meal of mashed potatoes and baked beans containing transit markers. Mouth-to-caecum transit was significantly slower in the patients than in controls; gastric emptying, however, was similar. Patients with active colitis had proximal colonic stasis, with rapid transit through the rectosigmoid region. In the patients with quiescent colitis the colonic distribution of markers was normal. Stool weight and frequency were significantly higher in the patients with active colitis. In the second study anorectal function was assessed in 29 patients with ulcerative colitis and in 12 healthy controls by measuring interluminal pressures at multiple sites in the anus and rectum before and during serial distention of a rectal balloon. Overall, resting and maximum squeeze sphincter pressures did not differ in patients with active or quiescent colitis and controls; however, in six patients with moderately severe colitis and incontinence, maximum squeeze pressure was significantly lower than in controls. The rectal volumes required to induce sensations of wind, a desire to defaecate, and pain were significantly lower in the patients with active colitis than patients with quiescent colitis and controls. Rectal pressures in response to rectal distention were higher in patients with active colitis. During disease remission rectal sensitivity decreased and rectal compliance increased. In the third study integrated pressure activity of the sigmoid colon, rectum, and anus was studied in patients with ulcerative colitis and healthy controls before and during provocation by rectal infusion of 1500 ml of warm saline.(ABSTRACT TRUNCATED AT 250 WORDS)