Gastrointestinal Motility In Patients Research Articles

Effects of remimazolam tosilate on gastrointestinal hormones and gastrointestinal motility in patients undergoing gastrointestinal endoscopy with sedation: a randomized control trial.

To investigate the impacts of remimazolam tosilate on gastrointestinal hormones and motility in patients undergoing gastrointestinal endoscopy with sedation. A total of 262 American Society of Anesthesiologists Physical Status I or II patients, aged 18-65years, scheduled for gastrointestinal endoscopy with sedation, were randomly allocated into two groups (n = 131 each): the remimazolam tosilate group (Group R) and the propofol group (Group P). Patients in Group R received 0.2-0.25mg/Kg remimazolam tosilate intravenously, while those in Group P received 1.5-2.0mg/kg propofol intravenously. The gastrointestinal endoscopy was performed when the Modified Observer's Assessment of Alertness/Sedation scores were ≤3. The primary endpoints included the endoscopic intestinal peristalsis rating by the endoscopist; serum motilin and gastrin levels at fasting without gastrointestinal preparation (T0), before gastrointestinal endoscopy (T1), and before leaving the Post Anesthesia Care Unit (T2); and the incidences of abdominal distension during Post Anesthesia Care Unit. Compared with Group P, intestinal peristalsis rating was higher in Group R (P < .001); Group R showed increased motilin and gastrin levels at T2 compared with Group P (P < .01). There was a rise in motilin and gastrin levels at T1 and T2 compared with T0 and at T2 compared with T1 in both groups (P < .01). The incidence of abdominal distension was lower in Group R (P < .05). Compared with propofol used during gastrointestinal endoscopy with sedation, remimazolam tosilate mildly inhibits the serum motilin and gastrin levels, potentially facilitating the recovery of gastrointestinal motility.

The effect of rabeprazole on the secretory and motor function of the gastrointestinal tract

Parietal cell proton pump inhibitors (PPIs) have become firmly established in clinician practice. When discussing the features of their action, as a rule, researchers focus on their antisecretory effect. In the available literature, we found only a single report on the effect of PPIs on the motor-evacuation function of the gastrointestinal tract (GIT). We have found that the PPI rabeprazole not only has an antisecretory effect, but also normalizes the motor-evacuation function of all parts of the gastrointestinal tract. In this regard, it can be used in patients with gastric hypersecretion in functional gastrointestinal disorders (FGID) with impaired motor-evacuation function. Aim. To study the effect of the antisecretory drug rabeprazole on the state of gastrointestinal motility in patients suffering from FGID of the gastrointestinal tract and overlap syndrome (overlap syndrome) with functional dyspepsia (FD) with gastric hypersecretion and irritable bowel syndrome (IBS). Material and methods. We examined 30 patients suffering from FGID of the gastrointestinal tract and cross syndrome - FD with gastric hypersecretion and IBS. To relieve clinical symptoms of FD, the drug rabeprazole 20 mg was prescribed once a day for 14 days. Before and after the start of treatment, patients were examined with VAS and SF-36 tests, intragastric pH-metry and peripheral electrogastroenterocolography (EGECG) were performed. Results. In all 30 patients with FGID of the gastrointestinal tract with FD and overlap syndrome with IBS, gastric hypersecretion was eliminated within 3 hours after taking 20 mg of rabeprazole. 2 weeks after the start of treatment, abdominal pain and heartburn were completely eliminated in 28 (93.3%) patients. In all (100%) patients with FGID of the gastrointestinal tract with gastric hypersecretion and overlap syndrome, after two weeks of treatment, sour belching disappeared, and nausea disappeared in 23 (77%) patients. Rabeprazole therapy in the examined individuals was accompanied by a marked improvement in the quality of life in all assessed SF-36 parameters. 2 weeks after starting rabeprazole, in patients with FGID of the gastrointestinal tract and overlap syndrome of FD and IBS, the frequency of bowel movements and stool quality were normalized, and according to the results of EGECG, the relative myoelectric activity (P(i)/PS) of the gastrointestinal tract and the rhythmicity coefficient (Kritm) were normalized. Conclusion. Rabeprazole quickly neutralizes gastric secretion and helps eliminate symptoms of FD. It also has a beneficial effect on the motor-evacuation function of all parts of the gastrointestinal tract, normalizing the frequency of bowel movements, stool quality and myoelectric activity of all parts of the gastrointestinal tract according to EGECG. Rabeprazole can be used in patients with FGID with FD with gastric hypersecretion and overlap syndrome with IBS.

Effect of Acupoint Stimulation on Improving Gastrointestinal Motility in Patients After Gastrectomy: A Systematic Review and Meta-Analysis.

Introduction: Gastrointestinal immobility is experienced by many patients who undergo gastric surgery. This complication delays enteral nutrition, prolongs hospitalization, and causes discomfort. Acupoint stimulation is a popular alternative nonpharmacological treatment for gastrointestinal immobility. This study aimed to explore the effects of acupoint stimulation on gastrointestinal immobility after gastrectomy. Design: Systematic review and meta-analysis. Methods: Databases (PubMed, Cochrane, Joanna Briggs Institute EBP Database, Medline, CINAHL Complete, and Airiti library) were searched from their inception to April 2022 for relevant articles. Articles in Chinese and English were included, without limitations on year, region, or country. The inclusion criteria were studies with participants >18 years of age, postgastric surgery, and hospitalization. In addition, randomized controlled trials (RCTs) were included. Data were analyzed using random effects models, and data heterogeneity was investigated using subgroup analysis. Meta-analysis was performed using Review Manager 5.4 software. Results: We included 785 participants from six studies. Invasive and noninvasive acupoint stimulation reduced the time of gastrointestinal mobility better than usual care. In the control group, the time of first flatus was 43.56 ± 9.57 h to 108 ± 19.2 h, and the time of first defecation was 77.27 ± 22.67 h to 139.2 ± 24 h. In the experimental group, the time of first flatus and defecation was 36.58 ± 10.75 h to 79.97 ± 37.31 h and 70.56 ± 15.36 h to 108.55 ± 10.75 h, respectively. Subgroup analysis showed that invasive acupoint stimulation with acupuncture reduced the time of first flatus and defecation to 15.03 h (95% confidence interval [CI] = -31.06 to 1.01) and 14.12 h (95% CI = -32.78 to 4.54), respectively. Noninvasive acupoint stimulation, including acupressure and transcutaneous electrical acupoint stimulation (TEAS), reduced the time of first flatus and defecation to 12.33 h and (95% CI = -20.59 to -4.06) and 12.20 h (95% CI = -24.92 to 0.52), respectively. Conclusions: Acupoint stimulation improved the gastrointestinal immobility of postgastrectomy. In the included RCT articles, invasive and noninvasive stimulations were effective. However, noninvasive acupoint stimulation, such as with TEAS and acupressure, was more efficient and convenient than invasive stimulation. Overall, health care professionals with adequate training or under the supervision of an acupuncturist can effectively perform acupoint stimulation to improve the quality of postgastrectomy care. They can select commonly used and effective acupoints to enhance gastrointestinal motility. Clinical relevance: Acupoint stimulation, such as acupressure, electrical acupoint stimulation, or acupuncture, can be included in postgastrectomy routine care to improve gastrointestinal motility and reduce abdominal discomfort.

The state of the intestinal microbial-tissue complex in patients with chronic kidney disease

The gut microbiota plays a fundamental role in maintaining normal organism homeostasis, regulating a wide range of metabolic, biosynthetic, and immune functions. This complex ecosystem, together with cellular, and stromal components of the intestinal wall, forms the intestinal microbial-tissue complex, which pathology is considered a universal mechanism for the development of many diseases, including chronic kidney disease. Accumulation of nitrogen metabolism products in the intestine, specific diet, polypharmacy, sedentary lifestyle, limited fluid intake, and violation of gastrointestinal motility in patients with chronic kidney disease lead to a decrease in the number of bacteria synthesizing short-chain fatty acids with crucial physiological effects, along with an increase in the content of anaerobic proteolytic bacteria expressing uricase, urease, and p-cresol-, and indole-forming enzymes. The features of gut dysbiosis depend on the etiology of chronic kidney disease and severity of renal insufficiency and differ significantly in individuals receiving various renal replacement therapies (hemodialysis, peritoneal dialysis, kidney transplant recipients). Abnormal microbial metabolism enhances the production and accumulation of microbial-derived uremic toxins: p-cresyl sulfate, indoxyl sulfate, and trimethylamine-N-oxide. Renal insufficiency, through mechanisms mainly associated with the hydrolysis of accumulated in the lumen of the intestine urea, leads to inflammation, and swelling of the intestinal wall, which is accompanied by disorders of the immune tolerance of the mucous layer and disorganization of intercellular junctional complexes, which are critical modulators of intestinal intercellular transepithelial transport. Uremia-induced impairment of the gut epithelial barrier integrity induces the systemic translocation of numerous immunogenic substances generated by the aberrant microbiota, followed by the development of oxidative stress and chronic subclinical inflammation that causes the progression of chronic kidney disease and related complications. The most pronounced changes were observed in people with end-stage chronic kidney disease. Further study of the bidirectional relationship between the kidneys and intestinal microbial-tissue complex will contribute to the development of new directions of pathogenetic therapy and prevention of adverse outcomes in patients with chronic kidney disease.

Efficacy and safety of neostigmine on treating gastrointestinal dysmotility in severe acute pancreatitis patients: study protocol for a randomized controlled trial

BackgroundAcute pancreatitis is a serious threat to human health and gastrointestinal dysmotility is a common complication for acute pancreatitis patients, resulting in delayed feeding, oral feeding intolerance, paralytic ileus, and abdominal compartment syndrome. Currently, there are limited treatment for this complication.Neostigmine is known to increase gastrointestinal motility and has been used to treat gastrointestinal dysmotility after surgery. However, research in treating acute pancreatitis with neostigmine is currently limited.MethodsThis trial is a randomized, placebo-controlled, double-blinded, mono-centric trial that will test the hypothesis that neostigmine can improve gastrointestinal motility in patients with severe acute pancreatitis. Up to 56 patients will be randomized in this study receiving 0.5 mg/1 ml of neostigmine methylsulfate injection twice per day or 1 ml of saline injection twice per day. Defection time (aim 1), mortality and organ failure (aim 2), borborygmus, starting of enteral nutrition and intra-abdominal pressure (aim 3), and length of ICU and hospital stay (aim 4) will be assessed.DiscussionFindings from this study will provide data supporting the usage of neostigmine for treating severe acute pancreatitis patients with gastrointestinal dysmotility.Trial registrationThis study is registered on chictr.org.cn with the identifier as ChiCTR2200058305. Registered on April 5, 2022.

A randomized controlled trial evaluating the effects of transversus abdominis plane block with compound lidocaine hydrochloride injection on postoperative pain and opioid consumption and gastrointestinal motility in patients undergoing gynecological laparotomy.

Incorporation of transversus abdominis plane (TAP) block into multimodal analgesia has been emphasized in Enhanced Recovery protocols (ERPs). However, benefit is limited in clinical practice. A potential explanation is the short duration of analgesia of standard local anesthetics. Herein, this randomized, double-blind, controlled trial evaluated whether TAPB with long-acting compound lidocaine hydrochloride injection reduces postoperative pain. 164 patients undergoing elective gynecological laparotomy under sevoflurane anesthesia randomly received ultrasound-guided TAP block with either saline, or ropivacaine, or compound lidocaine before anesthesia induction. The postoperative pain intensity (primary outcome) was evaluated by pain 11-point numerical rating scale. We also recorded sufentanil consumptions, time to first flatus, side-effects and hospital stay after surgery. We reported that pain scores at rest at postoperative 3h in group 0.375% ropivacaine was lower than that in group saline [mean 2.4 (SD 1.2) vs. 3.0 (1.0), p = 0.036]. Compared with saline, 0.4% and 0.6% compound lidocaine caused lower pain scores at rest at postoperative 12h [2.8 (0.9) vs. 2.1 (0.9) and 2.0 (0.9), p = 0.016 and p = 0.006]. Sufentanil usage for the first postoperative 48h was lower in group 0.6% compound lidocaine than group saline [24.2 (5.4) vs. 45.6 (7.5) µg, p < 0.001]. Time to first flatus and hospital stay after surgery was shortest and the incidence of postoperative nausea was lowest in patients receiving 0.6% compound lidocaine. TAP block with 0.6% compound lidocaine hydrochloride injection attenuates postoperative pain, reduces opioid consumption, accelerates gastrointestinal function recovery, and shortens length of hospital stay in patients after gynecological laparotomy. ClinicalTrials.gov, identifier: NCT04938882.

Effect of Dexmedetomidine-Assisted Intravenous Anesthesia on Gastrointestinal Motility in Colon Cancer Patients After Open Colectomy.

BackgroundTo explore the effect of dexmedetomidine (Dex)-assisted intravenous anesthesia on gastrointestinal motility in patients with colon cancer (CC) after open colectomy.MethodsA total of 102 patients with CC, undergoing open colectomy in our hospital from January 2018 to January 2020, were selected and randomly divided into an observation group (n = 51) and a control group (n = 51). The patients in the control group received a routine combination of intravenous and inhalation anesthesia (CIIA), while those in the observation group received a Dex-assisted CIIA. The systolic blood pressure (SBP), the diastolic blood pressure (DBP), heart rate (HR), and the mean arterial pressure (MAP) were compared at different time points between the two groups. In addition, the intraoperative general conditions, the dosage of anesthetics, and the recovery of gastrointestinal functions were also compared between the two groups. Moreover, before operation and at 24 h after operation, the levels of serum gastrin (GAS) and plasma motilin (MTL) were detected by radioimmunoassay, and the level of plasma cholecystokinin (CCK) was detected by an enzyme-linked immunosorbent assay. The incidence of gastrointestinal complications was recorded in both groups.ResultsAt T1-T3, the HR, SBP, DBP, and MAP levels were lower in both groups than those at T0. In addition, they were also lower in the observation group than those in the control group, showing significant differences (p < 0.05). The dosage of propofol and remifentanil in the observation group was lower than that in the control group, and there was a significant difference (p < 0.05). In the observation group, the postoperative first exhaust time, first defecation time, first ambulation time, and first feeding time were all earlier than those in the control group with significant differences (p < 0.05). After the operation, the observation group had higher levels of GAS and MTL but a lower level of CCK than the control group, and the differences were significant (p < 0.05). The incidence rate of gastrointestinal complications in the observation group (7.04%) was lower than that in the control group (19.61%), and there was a significant difference (χ2 = 4.346, p < 0.05).ConclusionsDex-assisted intravenous anesthesia can facilitate the recovery of gastrointestinal motility, can regulate the levels of gastrointestinal hormones, and can stabilize the levels of hemodynamic indexes in patients with CC after open colectomy.

Capsule endoscopy findings reflect the gastrointestinal conditions of patients with systemic sclerosis

Systemic sclerosis (SSc) is characterized by fibrosis of the skin and various internal organs. However, there is limited knowledge concerning small-bowel lesions. We evaluated the clinical state of patients with SSc according to the capsule endoscopy (CE) findings. Sixty-five consecutive patients with SSc (61 females; mean age, 64.3 years) underwent CE at Hiroshima University Hospital between April 2012 and December 2019. SSc was subclassified into diffuse and limited cutaneous SSc. Among the 65 patients, 55 (51 females; mean age, 64.5 years; diffuse cutaneous SSc, 27 patients) were evaluated for the presence of fibrosis in the gastrointestinal tract by biopsy. Small-bowel lesions were detected in 27 (42%) patients with SSc. Type 1b angioectasia (Yano-Yamamoto classification) was more frequent in limited cutaneous SSc patients (p = 0.0071). The average capsule transit time of the esophagus was significantly longer in diffuse cutaneous SSc patients (p = 0.0418). There were more cases of Type 1a angioectasia in SSc patients without fibrosis. The average capsule transit time of the esophagus was significantly longer in SSc patients with fibrosis. Thus, this study revealed that the frequency of small-bowel angioectasia and gastrointestinal motility in patients with SSc differed depending on SSc subclassification and the presence of fibrosis.

Analysis of Changes of Intestinal Flora in Elderly Patients with Alzheimer's Disease and Liver Cancer and Its Correlation with Abnormal Gastrointestinal Motility.

Objective To investigate the changes of intestinal flora in elderly patients with Alzheimer's disease and liver cancer and its correlation with abnormal gastrointestinal motility. Methods From January 2018 to December 2020, 102 elderly patients with Alzheimer's disease and liver cancer were selected as the observation group. Eighty-nine healthy patients during the same period were selected as the control group. The two groups of intestinal flora (intestinal microbial diversity) were detected by real-time fluorescent quantitative PCR (RT-qPCR) and high-throughput sequencing. The two groups of serum motilin (MTL) and gastrin (GAS) levels were measured by the Hitachi automatic biochemical analyzer 7600. Pearson correlation analysis software was used to analyze the relationship between changes in the intestinal flora and gastrointestinal motility in elderly patients with Alzheimer's disease and liver cancer. Results The contents of Bifidobacteria and Lactobacilli in the observation group were lower than those in the control group, and the contents of Escherichia coli, Helicobacter pylori, and Streptococcus were higher than those in the control group. The Chaol index and Shannon index in the observation group were higher than those in the control group. The gastrointestinal motility levels MTL and GAS of the observation group were higher than those of the control group. The results of Pearson correlation analysis showed that the Chaol index and Shannon index of elderly patients with Alzheimer's disease and liver cancer were positively correlated with MTL and GAS. Conclusion Elderly patients with Alzheimer's disease and liver cancer often have changes in the intestinal flora, which are correlated with abnormal gastrointestinal motility. Strengthening the analysis of changes in patients' intestinal flora can enhance clinical medication knowledge and improve gastrointestinal motility in patients.

Bilateral Subthalamic Nucleus Deep Brain Stimulation Improves Gastric Emptying Time in Parkinson Disease

It is well-established that deep brain stimulation (DBS) can improve motor function in those with Parkinson disease (PD); however, its effects on gastrointestinal disorders remain unclear. From January 2019 to December 2020, 26 patients with PD who had undergone subthalamic nucleus (STN) DBS were included in our study. The evaluated items included the pre- and postoperative dose of levodopa, Unified Parkinson's Disease Rating Scale, part III, scores with and without medication and stimulation, and gastric emptying time (expressed as the peak time of carbon-13C dioxide excretion in the 13C-acetate breath test). Sex-, age-, and body weight-matched controls were recruited to test the gastric emptying time in healthy individuals. All the patients benefited from DBS. The Unified Parkinson's Disease Rating Scale, part III, scores had decreased from 48.5 ± 13.77 to 25.23 ± 8.59 without medication and 31.23 ± 11.4 to 13.92 ± 5.27 with medication. The levodopa equivalent dose had decreased from 1009.8 ± 291 mg to 707.65 ± 193.79 mg. The gastric emptying time was significantly prolonged in the patients with PD before DBS compared with the healthy control group (29.23 ± 6.58 minutes) and had improved to 35.19 ± 10.14 minutes with medication and 38.07 ± 11.17 minutes without medication after 3 months of STN stimulation. At 6 months postoperatively, the gastric emptying time was 32.3 ± 10.02 minutes without medication and 33.84 ± 10.79 minutes with medication. A delayed gastric emptying time is associated with greater PD severity. Antiparkinsonian medications did not affect gastric emptying in patients with PD. STN DBS can improve both movement function and gastrointestinal motility in patients with PD in the long term. The exact mechanism by which DBS improves gastric emptying requires further exploration.

Effect of Different Analgesic Methods on Gastrointestinal Motility of Patients after Hepatobiliary Surgery

Effect of Different Analgesic Methods on Gastrointestinal Motility of Patients after Hepatobiliary Surgery

Bowel sound-based features to investigate the effect of coffee and soda on gastrointestinal motility

ObjectiveConstipation negatively affects the quality of life by causing abdominal pain and distention. It is common among women and older individuals and frequently encountered in Japan. Coffee and soda ingestion promote gastrointestinal motility; therefore, both liquids are considered effective for alleviating constipation. While invasive approaches or large-scale equipment, such as magnetic resonance imaging and radiography, are needed to confirm their effect on gastrointestinal motility, bowel sound (BS) assessment can be easily and non-invasively performed using low-cost equipment. Differently to coffee, soda contains carbon dioxide and its ingestion may therefore increase gastrointestinal gas and in turn affect the BS generation process. However, the relationship between gastrointestinal gas and acoustic BS features has not yet been investigated. This study aimed to investigate the effect of increased gastrointestinal gas resulting from soda ingestion on the acoustic BS features extracted using a newly improved BS detection technique. MethodsWe used BS-based acoustic features, including number of BSs detected/min, BS length, and BS power, extracted via an artificial neural network-based BS detection approach, which was developed in a previous study and here improved. ResultsBSs detected/min and BS length significantly increased after, compared with before, coffee and soda intake. Furthermore, we found that longer BSs (>128 ms) were more significantly associated with soda (200 mL) intake than with coffee (200 mL) intake. ConclusionsBS length and BSs detected/min can sensitively evaluate gastrointestinal motility, and BS length may reflect information on gastrointestinal gas in addition to gastrointestinal motility. Recording of BS-based acoustic features is a non-invasive and convenient means to evaluate the effects of liquid intake on gastrointestinal motility in patients with functional gastrointestinal disorders.

Correction to: A double-blind placebo controlled study of acotiamide hydrochloride for efficacy on gastrointestinal motility of patients with functional dyspepsia

Correction to: A double-blind placebo controlled study of acotiamide hydrochloride for efficacy on gastrointestinal motility of patients with functional dyspepsia

Assessment of postoperative gastrointestinal motility in colorectal surgery: a study with the Motilis 3D-transit system

PurposePostoperative recovery following colorectal surgery remains impaired by severe complications including postoperative ileus (POI). Human studies of POI have been limited by a lack of safe and easy-to-use objective methods....

Case Report of 62 Cases of Dyspepsia Classified by Symptom Types

Objectives: The purpose of this study was to propose a diagnostic method for classifying patients with dyspepsia by symptom type. The correlation between symptom types and X-ray findings was studied in 62 patients with indigestion. Methods: In this study, the complaints and abdominal X-ray findings were collected for 62 patients who visited the outpatient Korean medicine clinic. The medical information related to dyspepsia was grouped for similar patients and classified by symptom type. Results: The patients with dyspepsia were classified into three types according to their medical symptoms: Distention type (N=43, 68.3%), Abdominal Pain type (N=16, 25.5%), and Constipation type (N=12, 19.0%). Intestinal fecal findings (80.6%) on x-rays were noted in most of the cases, followed by intestinal gas pattern findings (14.5%). Conclusion: Classifying patients with dyspepsia by symptom types is an appropriate diagnostic method due to the unclear pathophysiology of indigestion and the difficulty in applying a Korean medical dialectic. Irrespective of the symptom types, the large number of fecal material findings (80.6%) on x-rays means an effect on the interior environment of the body where intestinal feces accumulate easily and decreased gastrointestinal motility in patients with indigestion. This can be correlated with “food accumulation (食積)” as intestinal feces are tangible substances. In addition, gas in the intestine increases visceral sensitivity, causing abdominal distention or pain. The gas pattern findings (14.5%) on x-ray were observed in the “Distention type” and “Abdominal pain type,” but not in the “Constipation type.” Keywords: case report, dyspepsia, food accumulation, abdominal x-ray

Effect of low-frequency electrical acupoint stimulation on gastrointestinal motility function following radical gastrectomy in patients with gastric cancer

To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy, and its impact on regulation of inflammatory response, so as to evaluate its clinical value. A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group (n＝43), low-frequency electrical acupoint stimulation (LEAS) group (n＝45), fast track surgery (FTS) group (n＝46) and FTS＋LEAS group (n＝43). Patients of the conventional group received conventional treatment (pre-surgical mechanical bowel preparation, post-surgical fasting, and indwelling abdominal drainage tube, etc.). Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli (ST36), Shangjuxu(ST37), Xiajuxu(ST39) and Sanyinjiao(SP6) for 30 min, once daily from 1 day after the operation to first postoperative flatus. FTS group was given fast track surgery treatment, such as preoperative education, preoperative nutritional support, early oral feeding, early removal of abdominal drainage tube, etc. The FTS＋LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment. Levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at 1, 3, and 6 d after the operation in the 4 groups were assayed. The first postoperative flatus and defecation time were recorded. After the treatment, the first postoperative flatus and defecation time in the LEAS, FTS and FTS＋LEAS groups were significantly shorter than those of the conventional group (P<0.05), and the first flatus time of the FTS＋LEAS group was even earlier than that of the FTS group (P<0.05). No significant differences were found among the 3 groups in the postoperative defecation time (P>0.05). The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1st postoperative day, and the highest level was on 3 d after the operation. Compared with the conventional group, CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS＋LEAS groups were significantly lower (P<0.05). Compared with the LEAS group, the levels of N, CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS group were significantly increased (P<0.05). Compared with the FTS group, the level of CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS＋LEAS group were significantly decreased (P<0.05). FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy, which may be associated with its effect in alleviating postoperative inflammatory responses.

Effect of early oral feeding on gastrointestinal motility in patients undergoing colorectal resection: a meta-analysis of randomized clinical trials

Background: The use of early oral feeding (EOF) to enhance the recovery of gastrointestinal (GI) motility after elective colorectal cancer surgery remains controversial. There was no updated meta-analysis to determine the efficacy and safety of this invention. Methods: Randomized controlled trials (RCTs) were identified from PubMed, Embase, and the Cochrance Central Register of Controlled Trials (CENTRAL). Eleven RCTs (1,216 participants) were included in our meta-analysis. Results: The EOF was associated with a shorter time of first flatus (MD =−0.58, 95% CI: −0.70 to −0.47, P&lt;0.00001, I 2 =19%), shorter first defecation (MD =−0.79, 95% CI: −1.00 to −0.59, P&lt;0.00001, I 2 =0%), and reduced length of hospital stay (MD =−1.48, 95% CI: −2.11 to −0.85, I 2 =78%) compared to conventional oral feeding (COF). There was no significant difference between the EOF and COF group in the incidence of nausea, vomiting, nasogastric tube (NGT) reinsertion, the risk of wound infection, and the occurrence of pneumonia and anastomotic dehiscence. The risk of total postoperative complications was much lower in the EOF group than the COF group [relative risk (RR) 0.59, 95% CI: 0.48 to 0.73, I 2 =46%, P&lt;0.00001]. Conclusions: Our findings suggest that EOF is appropriate for patients after elective colorectal cancer surgery and it is good for the recovery of GI motility.

Interactions Between Commensal Bacteria and Enteric Neurons, via FPR1 Induction of ROS, Increase Gastrointestinal Motility inMice.

Reduced gastrointestinal (GI) motility is a feature of disorders associated with intestinal dysbiosis and loss of beneficial microbes. It is not clear how consumption of beneficial commensal microbes, marketed as probiotics, affects the enteric nervous system (ENS). We studied the effects of the widely used probiotic and the commensal Lactobacillus rhamnosus GG (LGG) on ENS and GI motility in mice. Conventional and germ free C57B6 mice were gavaged with LGG and intestinal tissues were collected; changes in the enteric neuronal subtypes were assessed by real-time polymerase chain reaction, immunoblots, and immunostaining. Production of reactive oxygen species (ROS) in the jejunal myenteric plexi and phosphorylation (p) of mitogen-activated protein kinase 1 (MAPK1) in the enteric ganglia were assessed by immunoblots and immunostaining. Fluorescence in situ hybridization was performed on jejunal cryosections with probes to detect formyl peptide receptor 1 (FPR1). GI motility in conventional mice was assessed after daily gavage of LGG for 1 week. Feeding of LGG to mice stimulated myenteric production of ROS, increased levels of phosphorylated MAPK1, and increased expression of choline acetyl transferase by neurons (P < .001). These effects were not observed in mice given N-acetyl cysteine (a ROS inhibitor) or LGGΩSpaC (an adhesion-mutant strain of LGG) or FPR1-knockout mice. Gavage of mice with LGG for 1 week significantly increased stool frequency, reduced total GI transit time, and increased contractions of ileal circular muscle strips in exvivo experiments (P < .05). Using mouse models, we found that LGG-mediated signaling in the ENS requires bacterial adhesion, redox mechanisms, and FPR1. This pathway might be activated to increase GI motility in patients.

Gastrointestinal motility in patients with end-stage renal disease on chronic hemodialysis.

Previous studies indicated delayed gastric emptying in patients with end-stage renal disease (ESRD) using indirect methods. The objective of the current study was to examine gastrointestinal motility using a direct method as well as the role of the incretin hormones and glucagon. Patients on chronic hemodialysis and with either normal glucose tolerance, impaired glucose tolerance or type 2 diabetes, and healthy control subjects (N=8, respectively) were studied. Gastric emptying time was measured by repeated gamma camera imaging for 6 hours after intake of a radioactive labeled standardized mixed solid and liquid meal. Glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) levels were measured. Patients were age, gender and BMI matched with controls. We found significantly higher gastric retention at 15 minutes, prolonged gastric mean emptying time, and gastric half-emptying time of the solid marker in all three groups of ESRD patients compared to controls. Significant differences in mean total area under the concentration curve (AUC) values across the four groups for GIP (P=0.001), but not for GLP-1 and glucagon. The ESRD group had significant higher total AUC of GIP and glucagon compared to controls (P<0.001 and P<0.04) but not for GLP-1 (P=0.4). No difference in incremental AUC was found. We found altered gastrointestinal motility in dialysis patients, with higher gastric retention and prolonged gastric emptying, and higher total AUC of GIP and glucagon independent of the presence of diabetes or prediabetes.

The effect of simethicone on postoperative ileus in patients undergoing colorectal surgery (SPOT), a randomized controlled trial

BackgroundPostoperative ileus is a poorly understood multifactorial outcome following colorectal surgery that presents significant clinical challenges and contributes to increased morbidity, length of stay, and healthcare cost. To date, there are few pharmacological interventions that shorten the duration of postoperative ileus. ObjectiveThis study is the first to evaluate the efficacy of simethicone in treating postoperative ileus symptoms in patients undergoing colorectal surgery. DesignA multicenter, double-blinded, placebo controlled randomized controlled trial. SettingsThis trial was conducted at two academic tertiary care centres in Ontario, Canada. Participants118 patients undergoing colorectal surgery. InterventionsPatients were randomized to receive either a five-day course of oral simethicone (n = 58) or a placebo (n = 60). Main outcome measuresThe primary outcome was time to first passage of flatus. Secondary outcomes included time to first bowel movement, postoperative length of stay, and postoperative pain. Statistical analyses were performed on an intention-to-treat basis. Statistical significance set at p = 0.05. ResultsThe median time to first passage of flatus in simethicone arm was 25.2 h and 26.7 h in controls (P = 0.98). There were no significant differences in the median time to first bowel movement (simethicone = 41.1 h vs. control = 42.9 h, P = 0.91) or median length of hospital stay (simethicone = 4.5 days vs. control = 4.0 days, P = 0.63). ConclusionsThis study failed to show a difference in return of gastrointestinal motility in patients receiving simethicone following colorectal surgery. Postoperative ileus remains a significant clinical and economic burden to the healthcare system and further research is needed to identify a reliable and effective method of treatment.