| 21. |
- Halim, Md Abdul, 1983-, et al.
(författare)
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Nitric oxide regulation of migrating motor complex : randomised trial of L-NMMA effects in relation to muscarinic and serotonergic receptor blockade
- 2015
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Ingår i: Acta Physiologica. - : Wiley. - 1748-1708 .- 1748-1716. ; 215:2, s. 105-118
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Tidskriftsartikel (refereegranskat)abstract
- AimThe migrating motor complex (MMC) propels contents through the gastrointestinal tract during fasting. Nitric oxide (NO) is an inhibitory neurotransmitter in the gastrointestinal tract. Little is known about how NO regulates the MMC. In this study, the aim was to examine nitrergic inhibition of the MMC in man using NG-monomethyl-l-arginine (l-NMMA) in combination with muscarinic receptor antagonist atropine and 5-HT3 receptor antagonist ondansetron.MethodsTwenty-six healthy volunteers underwent antroduodenojejunal manometry for 8 h with saline or NO synthase (NOS) inhibitor l-NMMA randomly injected I.V. at 4 h with or without atropine or ondansetron. Plasma ghrelin, motilin and somatostatin were measured by ELISA. Intestinal muscle strip contractions were investigated for NO-dependent mechanisms using l-NMMA and tetrodotoxin. NOS expression was localized by immunohistochemistry.Resultsl-NMMA elicited premature duodenojejunal phase III in all subjects but one, irrespective of atropine or ondansetron. l-NMMA shortened MMC cycle length, suppressed phase I and shifted motility towards phase II. Pre-treatment with atropine extended phase II, while ondansetron had no effect. l-NMMA did not change circulating ghrelin, motilin or somatostatin. Intestinal contractions were stimulated byl-NMMA, insensitive to tetrodotoxin. NOS immunoreactivity was detected in the myenteric plexus but not in smooth muscle cells.ConclusionNitric oxide suppresses phase III of MMC independent of muscarinic and 5-HT3 receptors as shown by nitrergic blockade, and acts through a neurocrine disinhibition step resulting in stimulated phase III of MMC independent of cholinergic or 5-HT3-ergic mechanisms. Furthermore, phase II of MMC is governed by inhibitory nitrergic and excitatory cholinergic, but not 5-HT3-ergic mechanisms.
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| 26. |
- Karlbom, Urban, et al.
(författare)
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Long-term functional outcome after restorative proctocolectomy in patients with ulcerative colitis
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:8, s. 977-984
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to evaluate long-term functional outcome of ileal pouch-anal anastomosis for ulcerative colitis and to compare symptoms over time.Methods: 188 patients were operated with an ileal pouch-anal anastomosis. Short-term functional outcome has previously been evaluated with a symptom questionnaire. The same questionnaire was sent to the 162 patients who were alive and had an intact pouch. A symptom index was studied over time and in relation to early complications and pouchitis.Results: The response rate of the questionnaire was 139/162 at a median of 12.5 (9.5-21) years postoperatively. Overall, the symptom index remained unchanged over time but both the frequency of night-time defecation and episodes of night time incontinence increased. Patients' global assessment was unchanged with approximately 80 per cent stating an excellent or a good result. Frequency of pouchitis doubled in ten years. Symptom index for patients with episodic pouchitis (median 40 (8-89), p=0.018) and recurrent/chronic pouchitis (71 (8-136), p<0.001) was higher than in patients without pouchitis (29 (0-105). Early complications did not affect the symptom index.Conclusion: The overall functional outcome of ileal pouch-anal surgery for ulcerative colitis is stable over time. Patients' satisfaction with outcome remains high. Pouchitis is a determinant of functional outcome.
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| 28. |
- Karlbom, Urban, et al.
(författare)
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Surgery for the failed ileorectal or caecorectal anastomosis in chronic constipation
- 2013
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Ingår i: Reconstructive Surgery of the Rectum, Anus and Perineum. - London : Springer. - 9781848824126 - 9781848824133 ; , s. 267-271
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Bokkapitel (refereegranskat)abstract
- This chapter discusses the reasons for clinical failure after subtotal or total colectomy when the indication is principally for chronic constipation. Well-known side effects of this treatment include diarrhea and urgency as well as fecal incontinence in up to 30 % of operated cases. As an alternative to a more radical resection, segmental left colectomy has been proposed, although the reported results have not been particularly successful: recent comparative, non-randomized data have shown a higher incidence of persistent constipation with a continued requirement for laxatives and enemas postoperatively in those patients undergoing a cecorectal anastomosis when compared with those undergoing an ileorectal anastomosis. The incidence of troublesome diarrhea and fecal incontinence does not, however, seem to differ between these operative groups. This chapter outlines the treatment options available and the approach used when ileorectal or cecorectal anastomoses performed for patients with intractable constipation do not function appropriately.
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