Anal Ultra Slow Waves (A Smooth Muscle Phenomenon Associated with Dyschezia)

Anal ultra slow waves (USWs) have been describedin a variety of anorectal disorders, all of which may beassociated with constipation. We investigated whetherthey represent a marker for dyschezia and whether their occurrence can be modified.Manometric and endosonographic studies were performed in25 patients with dyschezia, in 25 age- and sex-matchedcontrols, and in an equal number of patients with hemorrhoids. Patients exhibiting ultra slowwaves were repeatedly studied with and without localadministration of isosorbide dinitrate. In addition, wedetermined whether stimulatory maneuvers modify the occurrence of USWs. Anal USWs were persistentlyfound in 56% of patients with dyschezia, in 8% ofpatients with hemorrhoids, and in none of the healthycontrols. They were stimulated by anal squeeze and completely abolished by local administration ofisosorbide dinitrate. Ultra slow waves always occurredin conjunction with an increase in anal resting pressureand were tightly associated with a fluctuation in slow wave amplitude. Anal sphinctermorphology was similar in patients with dyschezia and incontrols. We conclude that anal USWs occur mostfrequently in patients with dyschezia and indicatesmooth muscle dysfunction. Treatment directed atabolishing this motor phenomenon may represent a novelapproach to the management of patients withdyschezia.     

麻仁润肠口服液对肠道及排便的作用的实验研究

本文就麻仁润肠口服液的药理作用急性毒性进行了实验研究。药效实验表明，麻仁润肠口服液对结失水型便秘小鼠的排便功能有促进作用，可使排便点数增加，且能明显增强胃肠推进功能。对小鼠的肠管含水量有增加作用，在肠水分增加尤为明显。麻仁润肠口服液对离体兔肠平滑肌的收缩力和频率无影响。急性毒怀实验表明，小鼠胃经最大耐受量为６０ｇ生药／ｋｇ体重，为临床一次无影响。急性毒性实验表明：小鼠一次腹腔注射本品的ＬＤ５０是２     

外科治疗顽固性慢传输性便秘的疗效评价

目的:研究顽固性慢传输性便秘（STC）外科治疗方法与结果。方法:回顾分析我院近几年来治疗STC 24例患者的临床资料。结果:18例患者接受全结肠切除术治疗，6例接受结肠次全切除术，其中14例合并有出口梗阻性便秘（OOC）的患者，术前都给予相关手术矫治，手术治愈率95.8％，术后大便次数平均为（3±1.9）次/d。腹胀由术前的75.0％降为12.5％。1例术后便秘症状复发。结论:结肠切除术是治疗STC的理想手术方式，为保证手术取得良好效果，对合并有OOC的患者术前应行积极矫治处理。     

宣肺中药对慢传输型便秘小鼠肺肠组织神经肽的影响

【目的】观察宣肺中药对慢传输型便秘小鼠肺、肠组织神经激肽A(NKA)、血管活性肠肽(VIP)、肠三叶因子(TFF3)含量的影响,从神经肽角度探讨"肺合大肠"脏腑相关联络机制。【方法】将40只小鼠随机分为正常组、模型组、模型给药组及正常给药组,采用自身粪便与复方地芬诺酯(剂量为2 mg/kg)联合灌胃法复制慢传输型便秘模型。模型给药组及正常给药组给予加味桔梗汤灌胃(剂量为12 g.kg-1.d-1),正常组、模型组则以蒸馏水灌胃,连续7 d。第8天处死动物,测定肺、肠组织中NKA、VIP和TFF3含量。【结果】与正常组比较,模型组小鼠肺、肠组织中NKA含量均显著升高(P<0.01),VIP含量均显著降低(P<0.05或P<0.01);与模型组比较,模型给药组肺、肠组织中NKA含量均显著降低,肺组织中VIP含量显著升高(P<0.05或P<0.01);各组小鼠肺、肠组织TFF3含量均无显著变化。Spearman简单相关分析结果显示:肺、肠组织中NKA、VIP、TFF3含量均呈显著相关关系,其相关系数分别为0.448、0.503、0.423。【结论】宣肺中药加味桔梗汤可改善慢传输型便秘的病理状态,其效应机制可能与调节肺、肠组织中神经肽NKA、VIP的含量密切相关。     

Effects of Biofeedback Therapy on Anorectal Function in Obstructive Defecation

Biofeedback therapy improves symptoms inpatients with constipation and obstructive defecation.Whether it also improves anorectal function is unclear.Our purpose was to investigate prospectively the effects of biofeedback therapy on subjective andobjective parameters of anorectal function in 25consecutive patients with obstructive defecation.Biofeedback therapy consisted of pelvic floor relaxationexercises (phase I) and neuromuscular conditioning ofrectal sensation and rectoanal coordination, with asolid state manometry system and simulated defecationmaneuvers (phase II). The number of sessions wascustomized for each patient. Clinical improvement wasassessed from the changes in anorectal manometry,balloon (50 cc) expulsion test, and the symptom andstool diaries. The number of therapy sessions varied[mean (range) = 6 (2-10)]. After therapy, whenstraining as if to defecate, the percentage analrelaxation, intrarectal pressure, and defecation indexincreased (P < 0.001). The balloon expulsion time,laxative consumption, and straining effort decreased (P< 0.001). Before therapy, 16/25 (64%) patients hadimpaired rectal sensation, and after therapy thisimproved (P < 0.001). After therapy, 15/25 (60%) patients reported 75% satisfaction with bowelhabit and 8/25 (32%) reported 50% satisfaction (P< 0.001); 15/16 (94%) patients discontinued digitaldisimpaction. Biofeedback therapy not only improves subjective but also objective parameters ofanorectal function in at least 76% of patients byrectifying the underlying pathophysiologicdisturbance(s). Sensory conditioning and customizing thenumber of sessions may offer additionalbenefits.     

通便方的通便机理研究

为探讨通便方（由具益气健脾、养阴、润肠通便作用的白术、玄参等药物组成）的通便机理,观察了该方对阿托品、肾上腺素、盐酸吗啡引起小鼠小肠推进运动抑制的影响及小鼠肠道水分和离体肠管运动的影响。研究结果表明,通便方能拮抗肾上腺素、阿托品、盐酸吗啡引起小鼠小肠推进的抑制;能显著增加小鼠肠腔水分;对家兔离体十二指肠自发运动有兴奋作用,能拮抗肾上腺素引起的离体十二指肠运动抑制和乙酰胆碱引起离体回肠的强直性收缩。     

Bolus Obstruction of Pouch Outlet by a Granular Bulk Laxative after Gastric Banding

Background: Constipation is an occasional problem after gastric banding and is often caused by insufficient liquid intake. As a result, the use of laxatives is widespread in such patients. Depending on the laxative, improper use can lead to bolus obstruction above the band, as occurred in this case. Case Report: A 59-year-old female with uncomplicated laparoscopic adjustable gastric banding presented 2 months after surgery with food and liquid intolerance and dysphagia after ingestion of a granular bulking laxative. Despite deflating the band, the bolus could not be washed out. Endoscopic extraction was required, revealing a 4×2 cm bolus of the laxative and a small compression ulcer. Discussion: Patients not complying with nutritional recommendations after gastric banding may have insufficient liquid intake and, consequently, constipation. Under these conditions, the use of a granular bulking laxative entails the risk of esophageal obstruction above the band. Conclusion: Nutritional counseling after gastric banding should include the recommendation of liquid intake of at least 1.5 l/day. If constipation occurs, osmotic or paraffin oil laxatives should be used instead of bulking laxatives.     

Colchicine Is an Effective Treatment for Patients with Chronic Constipation (An Open-Label Trial)

Chronic constipation is a common clinicalcondition that frequently does not respond to routinetherapeutic measures. We hypothesized that colchicinewould be effective in this condition because we reported that it stimulates intestinal motility in ratsand commonly causes diarrhea in patients taking the drugfor either gouty arthritis or Familial Mediterraneanfever. We prospectively studied seven patients with chronic constipation who were refractoryto medical therapy and treated them with oral colchicine0.6 mg per os three times a day for eight weeks in anopen-label pilot study. During the study, the mean number of spontaneous bowel movementssignificantly increased (P < 0.05) from 1.7 ±0.5 noted during routine therapy of constipation withlaxatives and enemas to 6.4 ± 0.7 per week; meancolonic transit time significantly (P < 0.05) decreased from58.1 ± 2.5 to 47.1 ± 5.0 hr; and symptomsof abdominal pain, nausea, and bloating significantly (P< 0.05) improved during therapy with colchicine. Oralcolchicine (0.6 mg three times a day) therapy appears tobe an a promising treatment for chronic constipation anda placebo-controlled trial is indicated to confirm thesefindings.     

Effects of Regular Exercise in Management of Chronic Idiopathic Constipation

Regular physical exercise has long beenconsidered in the management of chronic constipation.This recommendation is probably based on the assumptionthat exercise shortens the transit time through the gastrointestinal tract. However, on the basisof previous studies, the effect of exercise on thetransit remains controversial at best. Therefore, it wasthe goal of the present study to assess the influence of regular physical exercise, what averagepeople may consider routine exercise, in the managementof chronic idiopathic constipation. The study populationconsisted of eight patients, seven women and a man, with chronic idiopathic constipation. Theywere studied for six weeks, including two weeks of restand four weeks of regular exercise. Patients had asubmaximal exercise test, before and after the exercise period, to determine their rate ofperceived exertion (RPE), the target heart rate, and theintensity of exercise they can perform. In addition totheir routine daily activities, they exercised 1 hr a day, five days a week according to theirperformance at the initial exercise tolerance test. Theykept a daily activity log and maintained their normaldietary intake during this period. The patients overall physical activity was assessed by apedometer. They also maintained a diary of the numberand consistency of their bowel movements and the amountof straining required for defecation. The impact of exercise on constipation was assessed byutilizing an index that took into consideration allthree parameters of bowel function. Results of the studyrevealed that patients covered 1.8 ± 0.33 and3.24 ± 0.28 miles/day in the rest period andduring the exercise period, respectively (P = 0.007).The intensity of exercise may have improved the level oftraining as reflected on the mean maximum time before and after exercise period (P = 0.039). Thislevel of exercise did not improve their constipationindices, which were 9.11 ± 0.65 and 8.57 ±1.08 in the rest and exercise periods, respectively (P= 0.68). In conclusion, physical activity, to the extentthat people consider regular exercise,does not play a role in the management of chronicidiopathic constipation.     

慢性结肠炎等疾病患者的大便异常与结肠电频谱改变

为探讨慢性结肠炎等疾病患者的大便异常与结肠电频谱改变的关系,对１１４例患者临床观察发现,消化道疾病患者有大便异常或倾向的比率颇高,所占比率从高至低依次为慢性结肠炎（ＣＳ,８０．０％）〉＋二指肠溃疡（ＤＵ,６９．２％）及十二指肠炎（ＤＳ;６８．７％）〉慢性胃炎（ＧＳ,５４．８％）。ＣＳ组有腹泻倾向者占５６．０％,便秘占２４．０％;ＤＳ组便烂便频者亦占４３．８％,都是明显高于ＧＳ组及对照组。