Intestinal Motility Disorders Research Articles

A DENOISING METHOD FOR COLONIC PRESSURE SIGNAL BASED ON CEEMDAN-WT

Colonic pressure is a principal parameter reflecting intestinal motility, and is also an important basis for diagnosing intestinal motility disorders. The physiological signals of the colon are mixed with the disturbing signals such as breathing and heartbeat due to the complex environment of the intestine. It is essential to find an effective method to reduce the noise in the signals. To solve this problem, a combined denoising method of colonic pressure signals is proposed in this paper, which combines the complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN) and wavelet transform. In this method, colonic peristalsis pressure signal is first separated out by wavelet transform, then decomposed by CEEMDAN. According to pearson correlation coefficient, the high-frequency intrinsic mode functions (IMFs) with noise was selected and denoised by wavelet threshold. Finally, the signal was reconstructed by combining the reserved IMFs with the denoised IMFs. The validity of the proposed method is verified by the real colon pressure data collected by the wireless motility capsule in this paper. The experimental results show that the combined denoising method can deal with the noise better than the single denoising method on the premise of fully retaining the real components of the colonic pressure signal.

Comparison of Long-term Outcomes between Hirschsprung's Disease Patients after Soave Procedure and Duhamel Procedure Based on the Paediatric Incontinence and Constipation Scoring System: A Retrospective Cohort Study

Introduction: Hirschprung's disease is a congenital disease that causes intestinal motility disorders. Hirschprung's disease is still the most common condition that causes intestinal obstruction in children. The incidence of Hirschprung's disease is 1:5000 live births. The incidence ratio of this disease is around 4:1 between men and women, with a higher percentage of men 1,3,4. Approximately 75% of cases of Hirschprung's disease occur in the rectosigmoid colon area, 17% in the splenic flexure or transverse colon and 8% along the colon and terminal ileum. The Duhamel technique still remains a popular procedure most surgeons especially for long segment treatment and redo procedures.28, 30 The advantage of the Duhamel Procedure is that it is easy to perform, reduces the risk of damage to surrounding structures such as genitourinary innervation, but has the possibility of complications of anastomotic leakage which causes fistulas and abscesses.
 Materials and Methods: Total subjects of this study was 441 patients with Hirschprung's disease who were treated with the Soave procedure and the Duhamel procedure at Dr. Moewardi General Hospital in Surakarta, Central Java, Indonesia for the period January 2017 - January 2022. This type of research is descriptive analytics with a retrospective cohort.
 Results: The results of the study can be concluded that patients with HAEC increases the risk of constipation. Congenital abnormalities predispose to fecal incontinence. Differences in surgical techniques do not significantly influence or increase the risk of constipation and fecal incontinence based on statistical tests. However, the increased risk of constipation and fecal incontinence is higher in patients undergoing the Duhamel surgical procedure.
 Conclusion: Conclusions that can be drawn from research regarding the comparison of long-term outcomes of Hirschsprung disease patients after Soave and Duhamel operations based on the Pediatric Incontinence and Constipation Scoring System at Dr. Moewardi General Hospital in Surakarta, Indonesia for period January 2017 – January 2022, it can be concluded that there is no significant difference in the outcome of patients who underwent the Soave or Duhamel procedures. The Duhamel procedure has a higher prevalence of complications of constipation and fecal incontinence compared to the Soave procedure. The presence of HAEC before the surgical procedure increases the risk of constipation, significantly in the Soave and Duhamel procedures.

Ernica Clinical Consensus Statements on Total Colonic and Intestinal Aganglionosis

BackgroundHirschsprung disease is a congenital intestinal motility disorder characterized by an absence of enteric ganglion cells. Total colonic aganglionosis and near total or total intestinal aganglionosis, defined as absence of ganglion cells in the entire colon and with variable length of small bowel involved, are life-threatening conditions which affect less than 10 % of all patients with Hirschsprung disease. The aim of this project was to develop clinical consensus statements within ERNICA, the European Reference Network for rare congenital digestive diseases, on four major topics: Surgical treatment of total colonic aganglionosis, surgical treatment of total intestinal aganglionosis, management of poor bowel function in total colonic and/or intestinal aganglionosis and long-term management in total colonic and or intestinal aganglionosis. MethodsA multidisciplinary panel of representatives from ERNICA centers was invited to participate. Literature was searched, using specified search terms, in Medline (ALL), Embase and Google Scholar. Abstracts were screened and full text publications were selected. The panel was divided in four groups that extracted data from the full text publications and suggested draft statements for each of the major topics. A modified Delphi process was used to refine and agree on the statements. ResultsThe consensus statement was conducted by a multidisciplinary panel of 24 participants from 10 European countries, 45 statements reached consensus after 3 Delphi-rounds. The availability of high-quality clinical evidence was limited, and most statements were based on expert opinion. Another 25 statements did not reach consensus. ConclusionsTotal colonic and total intestinal aganglionosis are rare variants of Hirschsprung disease, with very limited availability of high-quality clinical evidence. This consensus statement provides statements on the surgical treatment, management of poor bowel function and long-term management for these rare patients. The expert panel agreed that patients benefit from multidisciplinary and personalized care, preferably in an expert center. Type of StudyClinical consensus statement. Level of Evidence3a.

Experiences and satisfaction of video follow up of children with paediatric gastrointestinal conditions linking tertiary centre with guardians and clinicians at the local hospital: a cross-sectional study

BackgroundChildren with complicated gastrointestinal conditions are dependent on follow up by tertiary care specialists throughout childhood to prevent and treat complications. In Sweden, paediatric surgical- and intestinal rehabilitation centres are centralised which means that many patients and guardians have to travel long distances to access tertiary referral centres. Our tertiary referral centre has developed a model of shared care with video conferences for follow up with our centre and the patient and guardians attending together with the responsible professionals at the local hospital. This study aimed to investigate the experiences and satisfaction with video follow-up visits (VFV) between a tertiary referral centre and guardians and clinicians at their local hospital.MethodsEligible participants were families with children with oesophageal atresia, intestinal failure and intestinal motility disorders and their local clinicians attending VFV with our tertiary referral centre from 2015 to 2020. Questionnaires included fixed-response alternatives, a 6-point Likert scale and open questions.ResultsFifty-seven out of 102 families (56%) and 19 out of 27 local clinicians (70%) responded the questionnaires. In 68% of the VFV, two guardians attended compared to 35% in the physical visits. Of the guardians attending VFV, 82% lost ≤ half a working day and 91% attending physical visits lost ≥ one full working day. Median distance to the tertiary referral centre was 267 km and attending VFV avoided emissions of 7.2 metric tonnes of CO2. Of the guardians, 90% and of the clinicians 95% were satisfied with VFV. Advantages were avoidance of travelling and the participants shared the same information.ConclusionsVFV is an appropriate alternative to physical visits with a high grade of satisfaction among the guardians and clinicians. VFV was time-saving for the families and reduced CO2 emissions.

Ishrana radnika koji rade u noćnoj smeni - razlog ili izgovor za nepravilnu ishranu

The availability of artificial light and light-emitting devices has changed human life in relation to time, enabling 24-hour health care, trade, and production, as well as the expansion of social life around the clock. In Europe, about 21% of the labor force consists of shift workers. 10% of the employed population work evening shifts or the night shift, and 7% of employees in Europe regularly work the night shift. According to the Bureau of Labor Statistics, more than 15 million Americans work the night shift. Shift work, especially night-time work, seriously affects dietary habits. It is known that night-time work produces a conflict between the socially determined rhythm of eating and the circadian biological rhythms related to the feeling of hunger, satiety, as well as the metabolism itself. Night meals cause disorders of intestinal motility, affect digestion, absorption, but also the utilization of nutrients and possible medical therapy (if the individual has one). From the point of view of chronobiology, humans belong to diurnal species, which to a certain extent explains why night shift workers have a decreased appetite at night, when the human body is programmed for rest and fasting, as well as for endogenous mobilization of glucose. From the psychosocial aspect, shift workers usually experience a discrepancy between their daily routines (including the meal schedule) and those they have with family and friends, which further leads to even more severe disorders of dietary habits. However, it is difficult to give dietary recommendations regarding nutrition. Firstly, there are no clear views on whether night shift workers should eat during the night hours or not. Secondly, even if night eating is encouraged, definitive evidence is lacking on which types of food should be consumed and which should be avoided. Thirdly, the most nutritious foods may not be available at that time of night. Finally, eating at night certainly has an impact on the metabolism. With all the above in mind, we have tried to provide some useful guidelines regarding these issues.

Запор и мультиморбидная патология: взгляд педиатра

The prevalence of constipation among the Russian child population is extremely high. Chronic constipation is a classic example of a multimorbidity and has significant, including disabling, consequences for the child's health. The syndrome of increased intestinal permeability, which occurs with chronic constipation, forms a whole block of systemic pathology involving almost all human systems and organs. More than half (51.7%) of children with chronic constipation have symptoms of chronic fecal intoxication. The article highlights the etiopathogenetic aspects of the increased intestinal permeability in patients with chronic constipation. The article also discusses the association of intestinal motility disorders with the development of dermatosis, urinary tract pathology, allergic, mental and other diseases. The butyrate role as a key molecule of intestinal metabolism is considered. The importance of lactitol in the constipation treatment and increased intestinal permeability correction is also shown. This drug has a complex effect: during its use, there is an increase in the bowel movement frequency, a decrease in the constipation symptoms, as well as the regulation of the intestinal barrier to protect the body from the constipation effects. KEYWORDS: increased intestinal permeability, constipation, multimorbidity, short-chain fatty acids, butyrate, laxative, lactitol. FOR CITATION: Nizhevich A.A., Valeeva D.S., Loginovskaya V.V. Constipation and multimorbidity: a pediatrician's view. Russian Journal of Woman and Child Health. 2024;7(1):71–78 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-11.

Assessment of the Smartpill, a Wireless Sensor, as a Measurement Tool for Intra-Abdominal Pressure (IAP).

Background: The SmartPill, a multisensor ingestible capsule, is marketed for intestinal motility disorders. It includes a pressure sensor, which could be used to study intra-abdominal pressure (IAP) variations. However, the validation data are lacking for this use. Material and Methods: An experimental study was conducted on anesthetized pigs with stepwise variations of IAP (from 0 to 15 mmHg by 3 mmHg steps) generated by laparoscopic insufflation. A SmartPill, inserted by endoscopy, provided intragastric pressure data. These data were compensated to take into account the intrabdominal temperature. They were compared to the pressure recorded by intragastric (IG) and intraperitoneal (IP) wired sensors by statistical Spearman and Bland-Altmann analysis. Results: More than 4500 pressure values for each sensor were generated on two animals. The IG pressure values obtained with the SmartPill were correlated with the IG pressure values obtained with the wired sensor (respectively, Spearman ρ coefficients 0.90 ± 0.08 and 0.72 ± 0.25; bias of -28 ± -0.3 mmHg and -29.2 ± 0.5 mmHg for pigs 1 and 2). The intragastric SmartPill values were also correlated with the IAP measured intra-peritoneally (respectively, Spearman ρ coefficients 0.49 ± 0.18 and 0.57 ± 0.30; bias of -29 ± 1 mmHg and -31 ± 0.7 mmHg for pigs 1 and 2). Conclusions: The SmartPill is a wireless and painless sensor that appears to correctly monitor IAP variations.

Gut–Brain Axis, Microbiota and Probiotics—Current Knowledge on Their Role in Irritable Bowel Syndrome: A Review

Irritable bowel syndrome (IBS) is a common digestive disorder with a significant impact on both individuals and society in terms of quality of life and healthcare costs. A growing body of research has identified various communication pathways between the microbiota and the brain in relation to motility disorders, with the gut–brain axis being key to the pathogenesis of IBS. Multiple factors contribute to the pathogenetic pathways in IBS, including immune mechanisms, psychosocial factors, increased oxidative stress and pro-inflammatory cytokine release, as well as genetic and hormonal factors. Increased permeability of the normal intestinal barrier allows bacterial products to access the lamina propria, providing a mechanism for perpetuating chronic inflammation and characteristic symptoms. The microbiota influences inflammatory processes in IBS by altering the balance between pro-inflammatory factors and host defence. Probiotics modulate the pathophysiological mechanisms involved in IBS by influencing the composition of the microbiota and improving intestinal motility disorders, visceral hypersensitivity, immune function of the intestinal epithelium, metabolic processes in the intestinal lumen, dysfunction of the microbiota-GBA, and are recognised as effective and safe in IBS therapy. Our study aimed to provide a comprehensive overview of the relationship between the gut–brain axis, microbiota, and IBS, based on current information.

Effects of weaning on intestinal longitudinal muscle-myenteric plexus function in piglets.

Weaning piglets usually suffer from severe diarrhea (commonly known as postweaning diarrhea, PWD) along with intestinal motility disorder. Intestinal peristalsis is mainly regulated by the longitudinal muscle-myenteric plexus (LM-MP). To understand the relationship between intestinal LM-MP function and the development of PWD, we compared the intestinal electrical activity, and the transcriptional profile of the LM-MP between 21-day-old piglets (just weaned, n=7) and 24-day-old piglets (suffered the most severe weaning stress, n=7). The results showed that 24-day-old piglets exhibited different degrees of diarrhea. A significant increase in the slow-wave frequency in the ileum and colon was observed in 24-day-old piglets, while c-kit expression in the intestinal LM-MPs was significantly decreased, indicating that PWD caused by elevated slow-wave frequency may be associated with loss of c-kit. The real-time quantitative PCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA) showed that intestinal LM-MPs in 24-day-old piglets may undergo inflammation and oxidative stress. Significant increases in 8-hydroxy-2'-deoxyguanosine and decreases in thioredoxin suggest that weaning may lead to DNA damage in the LM-MP of 24-day-old piglets. In addition, activating transcription factor 3 was significantly upregulated, indicating nerve damage in the LM-MP of 24-day-old piglets. The transcriptomic results showed that most of the differentially expressed genes in the ileal LM-MP after weaning were downregulated and closely related to the cell cycle process. Subsequent RT-qPCR analysis showed that the relative expression of p21 was upregulated, while the expression of cyclin A2, cyclin B1, and proliferating cell nuclear antigen was downregulated in the ileal and colonic LM-MP of 24-day-old piglets, suggesting that weaning may inhibit cell proliferation and cause G1/S cell cycle arrest in ileal and colonic LM-MP. In conclusion, weaning may lead to cell cycle arrest by causing DNA damage in the LM-MP, impairing intestinal motility regulation, and ultimately leading to diarrhea in piglets.

MiR-26b-3p Promotes Intestinal Motility Disorder by Targeting FZD10 to Inhibit GSK3β/β-Catenin Signaling and Induce Enteric Glial Cell Apoptosis.

Enteric glial cells (EGCs) are the major component of the enteric nervous system and affect the pathophysiological process of intestinal motility dysfunction. MicroRNAs (miRNAs) play an important role in regulating gastrointestinal homeostasis. However, the mechanism of miRNA-mediated regulation of EGCs in intestinal dysmotility remains unclear. In this study, we investigated the effect of EGC apoptosis on intestinal dysmotility, and the effect of miR-26b-3p on EGC proliferation and apoptosis in vivo and in vitro. A loperamide hydrochloride (Lop)-induced constipated mouse model and an in vitro culture system of rat EGCs were established. The transcriptome was used to predict the differentially expressed gene miR-26b-3p and the target gene Frizzled 10 (FZD10), and their targeting binding relationship was verified by luciferase. EGCs were transfected with miR-26b-3p mimic or antagomir, and the FZD10 expression was down-regulated by siRNA. Immunofluorescence and flow cytometry were used to detect EGC apoptosis. MiR-26b-3p and FZD10 expressions were examined using quantitative real-time PCR (qRT-PCR). The CCK-8 assay was used to detect EGC proliferation. The protein levels were detected by Western blotting and enzyme-linked immunosorbent assay (ELISA). The results showed that miR-26b-3p was up-regulated in the Lop group, whereas FZD10 was down-regulated, and EGC apoptosis was increased in the colon of intestinal dysmotility mice. FZD10 down-regulation and miR-26b-3p mimic significantly increased glycogen synthase kinase-3β phosphorylation (p-GSK3β) levels, decreased β-catenin expression, and promoted EGC apoptosis. MiR-26b-3p antagomir alleviated intestinal dysmotility, promoted EGC increased activity of EGCs, and reduced EGC apoptosis in vivo. In conclusion, this study indicated that miR-26b-3p promotes intestinal motility disorders by targeting FZD10 to block GSK3β/β-catenin signaling and induces apoptosis in EGCs. Our results provide a new research target for the treatment and intervention of intestinal dysmotility.

Evaluation of Pacing Parameters to Induce Contractions in the Small Intestine.

Postoperative ileus and chronic intestinal pseudo-obstruction are intestinal motility disorders that can compromise bowel function resulting in a significant reduction in quality of life and prolonged hospital stays. While medication and nutritional support provides relief for some patients, a significant patient population remains untreated. Therefore, alternative treatment options are required. A novel framework that enables small intestine pacing and video mapping of the contractile response was developed. Pacing pulse parameters (pulse-period: 2.7, 10 s, pulse-width: 100, 400 ms, and pulse-amplitude: 4, 6, 8 mA) were systematically varied to investigate the effect of pacing on the small intestine contractility. The contractile response was quantified by computing the strain of the intestinal diameter at the pacing site. The framework was applied in vivo on porcine jejunal loops (n=4) where segmental contractions were induced in response to pacing pulses. Strain increased with increasing pulse-amplitude and pulse-width, while pacing at a period of 2.7 s elicited higher contractile strains compared to pacing at a period of 10 s at all settings (e.g., -0.18 ± 0.06 vs 0.12 ± 0.06 at 8 mA, 400 ms). For a pulse-width of 100 ms, the contractile strain continued to increase with increasing pulse-amplitude, while the induced strain was comparable for all pulse-amplitudes when paced with high pulse-width (400 ms). Therefore, pacing is an effective tool in modulating the intensity of segmental contractions.Clinical Relevance- Different pacing parameters can define contraction intensity and frequency in the small intestine. This is of therapeutic potential for treating motility disorders such as post-operative ileus and chronic intestinal pseudo-obstruction.

Houpo Paiqi Mixture Promotes Intestinal Motility in Constipated Rats by Modulating Gut Microbiota and Activating 5-HT-cAMP-PKA Signal Pathway.

Constipation is a common functional gastrointestinal disorder which needs more effective treatment approaches. Houpo Paiqi Mixture (HPPQM) is a type of Chinese patent medicine developed from a classical formula that has been widely applied to the treatment of intestinal motility disorder. Here we aim to assess the effectiveness of HPPQM in the treatment of constipation in rat models and its potential mechanism. UPLC-MS/MS was performed to investigate the chemical component of HPPQM. Rats were randomly divided into normal control, constipation model (CM), HPPQM (low, middle and high dose) and mosapride groups. Loperamide 8mg/kg was given orally to induce constipation model. The small intestine motility, colonic contraction, rectum propulsion and histological feature of the colon were significantly improved in HPPQM group, compared with CM group (P<0.05). Results of 16S rRNA sequencing revealed that HPPQM treatment strikingly restructured intestinal microbiota in constipated rats by increasing the relative abundances of Bacteroides and Akkermansia and decreasing the relative abundances of Prevotella and Lactobacillus. The levels of GPR43, 5-HT, 5-HT4R, cAMP, PKA were decreased while SERT was increased in constipated rats (P<0.05), which could be restored to normal levels by treatment with HPPQM (P<0.05). Differences in amplitude between experimental CLSMs (with HPPQM added) and control CLSMs were discovered, starting at the concentration of 40 nL/mL (P<0.05). It was found that GLPG0974 and GR113808 could significantly reduce this reactivity (P<0.05). HPPQM manifested a curative effect in constipated rats by promoting intestinal motility. The underlying mechanisms might be related to modulating gut microbiota and activating 5-HT-cAMP-PKA signal pathway.

Gut dysmotility in children with neurological impairment: the nutritional management.

Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.

More than missing neurons: Intestinal fibrosis in Hirschsprung disease

More than missing neurons: Intestinal fibrosis in Hirschsprung disease

Slowed gastrointestinal transit is associated with an altered caecal microbiota in an aged rat model.

Gastrointestinal (GI) motility is largely dependent upon activity within the enteric nervous system (ENS) and is an important part of the digestive process. Dysfunction of the ENS can impair GI motility as is seen in the case of constipation where gut transit time is prolonged. Animal models mimicking symptoms of constipation have been developed by way of pharmacological manipulations. Studies have reported an association between altered GI motility and gut microbial population. Little is known about the changes in gut microbiota profile resulting specifically from pharmacologically induced slowed GI motility in rats. Moreover, the relationship between gut microbiota and altered intestinal motility is based on studies using faecal samples, which are easier to obtain but do not accurately reflect the intestinal microbiome. The aim of this study was to examine how delayed GI transit due to opioid receptor agonism in the ENS modifies caecal microbiota composition. Differences in caecal microbial composition of loperamide-treated or control male Sprague Dawley rats were determined by 16S rRNA gene amplicon sequencing. The results revealed that significant differences were observed at both genus and family level between treatment groups. Bacteroides were relatively abundant in the loperamide-induced slowed GI transit group, compared to controls. Richness and diversity of the bacterial communities was significantly lower in the loperamide-treated group compared to the control group. Understanding the link between specific microbial species and varying transit times is crucial to design interventions targeting the microbiome and to treat intestinal motility disorders.

Improvement of loperamide-hydrochloride-induced intestinal motility disturbance by Platycodon grandiflorum polysaccharides through effects on gut microbes and colonic serotonin.

Constipation is a common gastrointestinal symptom characterized by intestinal motility disorder. The effects of Platycodon grandiflorum polysaccharides (PGP) on intestinal motility have not been confirmed. We established a rat model of constipation induced by loperamide hydrochloride to elucidate the therapeutic effect of PGP on intestinal motility disorder and to explore the possible mechanism. After PGP treatment (400 and 800 mg/kg) for 21d, PGP clearly relieved gastrointestinal motility, including fecal water content, gastric emptying rate, and intestinal transit rate. Moreover, the secretion of motility-related hormones, gastrin and motilin, were increased. Enzyme-linked immunosorbent assay, western blot, immunohistochemistry, and immunofluorescence results confirmed that PGP significantly increased the secretion of 5-hydroxytryptamine (5-HT) and the expression of related proteins, such as tryptophan hydroxylase 1, 5-HT4 receptor, and transient receptor potential ankyrin 1. 16S rRNA gene sequencing showed that PGP significantly increased the relative abundance of Roseburia, Butyricimonas, and Ruminiclostridium, which were positively correlated with 5-HT levels. However, the relative abundance of Clostridia_UCG-014, Lactobacillus, and Enterococcus were decreased. PGP improved intestinal transport by regulating the levels of 5-HT, which interacts with the gut microbiota and the intestinal neuro-endocrine system, further affecting constipation. Overall, PGP is a potential supplement for the treatment of constipation.

Пригнічувальна дія загального анестетика кетаміну на транзієнти внутрішньоклітинної концентрації іонів кальцію та скорочення гладеньком’язових клітин тонкої кишки миші

The mechanisms of the negative consequences of general anaesthetics action on the nervous system have been studied in detail, but regarding smooth muscle function, such issues have not yet been sufficiently addressed. In this study, we investigated the effect of the general intravenous anaesthetic ketamine on the level of intracellular calcium in isolated ileum myocytes and the contractile activity of smooth muscle strips of the mouse small intestine. The concentration of intracellular calcium in cells was measured using the Ca2+-sensitive fluorescent dye Fura-2, and tensiometry was used to record the contractile activity of smooth muscles. It was shown that ketamine at a concentration of 100 µM significantly, by 40%, suppressed carbachol-induced contractile reactions of the ileum. The inhibitory effect correlated with the suppression of the intracellular calcium responses to carbachol in isolated smooth muscle cells after the addition of ketamine to the extracellular solution, which was by 65% on average. These results contribute to our better understanding of the possible membrane and intracellular mechanisms of the development of post-surgical intestinal motility disorders.

Irritable bowel syndrome – a literature review

Introduction: Irritable bowel syndrome (IBS) is one of the most common diseases affecting people around the world. It is characterized by irregular bowel movements and abdominal pain. IBS significantly reduces the quality of life of patients. Despite such a frequent occurrence of this disease, its correct diagnosis and treatment still causes many problems for primary care physicians. Aim of the study: The aim of the study is to present the current state of knowledge on the pathophysiology, diagnostics and drugs used in irritable bowel syndrome. Description of the state of knowledge: Many factors may play a role in the pathogenesis of IBS. The most common are: genetic factors, intestinal motility disorders, visceral hypersensitivity, mental disorders, especially disorders of the brain-gut axis regulation, past intestinal infections, intestinal microbiota disorders and food intolerances. The Rome IV criteria are currently used in the diagnosis of IBS. Treatment of irritable bowel syndrome includes lifestyle modification and dietary management, pharmacotherapy and psychotherapy. Summary: Irritable bowel syndrome is a chronic disease, symptoms often recur and complete recovery is not possible.

Gut-brain axis: Mechanisms and potential therapeutic strategies for ischemic stroke through immune functions.

After an ischemic stroke (IS) occurs, immune cells begin traveling to the brain and immune system from the gut and gastrointestinal tract, where most of them typically reside. Because the majority of the body's macrophages and more than 70% of the total immune cell pool are typically found within the gut and gastrointestinal tract, inflammation and immune responses in the brain and immune organs require the mobilization of a large number of immune cells. The bidirectional communication pathway between the brain and gut is often referred to as the gut-brain axis. IS usually leads to intestinal motility disorders, dysbiosis of intestinal microbiota, and a leaky gut, which are often associated with poor prognosis in patients with IS. In recent years, several studies have suggested that intestinal inflammation and immune responses play key roles in the development of IS, and thus may become potential therapeutic targets that can drive new therapeutic strategies. However, research on gut inflammation and immune responses after stroke remains in its infancy. A better understanding of gut inflammation and immune responses after stroke may be important for developing effective therapies. This review discusses the immune-related mechanisms of the gut-brain axis after IS and compiles potential therapeutic targets to provide new ideas and strategies for the future effective treatment of IS.

Hubungan Status Gizi Pasien Penyakit Hirschsprung dengan Infeksi Luka Operasi di RSPAL dr. Ramelan Surabaya Periode Waktu 2016-2020

Background: Hirschsprung's disease is a congenital intestinal motility disorder that causes functional intestinal obstruction due to the absence of enteric ganglion cells in the distal intestine. The management of each case of Hirschsprung's disease is surgery, where surgery on the digestive tract increases the occurrence of surgical site infections. Disturbances in the gut cause decreased resistance to infection, delayed cognitive development, and problems with nutritional status.&#x0D; Methods: This study was a descriptive and analytical observational study, where the primary data were taken from the registration data of Hirschprung's disease patients at RSPAL dr. Ramelan Surabaya in 2016-2020. The nutritional status of the patient was determined by plotting the weight per age curve according to WHO for children aged 0-5 years.&#x0D; Results: Observations of 38 patients who met the study requirements, obtained 4 patients who had poor nutritional status and 1 patient who had excess nutritional status, none of which experienced complications in the form of surgical wound infections. In 10 patients with poor nutritional status, 2 experienced complications in the form of surgical wound infection and 23 patients with good nutritional status, 1 experienced complications in the form of surgical wound infection. The results of the contingency coefficient correlation test showed P-value = 0.408 (p&gt;α).&#x0D; Conclusion: There was no relationship between the nutritional status of Hirschprung's disease patients with surgical wound infections at RSPAL dr. Ramelan Surabaya&#x0D; Keywords: Hirschsprung's disease, nutritional status of children, surgical site infection.