Pattern and distribution of colonic diverticulosis:Analysis of 2877 barium enemas in Thailand

AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded.The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined.The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were reported.Factors influencing the presence of colonic diverticulosis were evaluated.RESULTS:A total of 2877 suitable DCBE examinations were retrospectively reviewed.The mean age of patients was 59.8±14.7 years.Of these patients,1778(61.8%)were female and 700(24.3%)were asymptomatic.Colonic diverticulosis was identified in 820patients(28.5%).Right-sided diverticulosis(641 cases;22.3%)was more frequently reported than left-sided diverticulosis(383 cases;13.3%).Pancolonic diverticulosis was found in 98 cases(3.4%).The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were 1.5%(42 cases),0.4%(12 cases),and 0.03%(1 case),respectively.There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients(28.3%vs 28.6%,P=0.85).DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals(29.5%vs 25.3%,P=0.03).Change in bowel habit was strongly associated with the presence of diverticulosis(a relative risk of 1.39;P=0.005).The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals(P>0.05).CONCLUSION:Colonic diverticulosis was identified in28.5%of DCBE examinations in Thai adults.There was no association between the presence of diverticulosis and gender or age.

Compound Daxueteng Enemas Combined with GnRH-a on Endometriosis after Laparoscopic Surgery: a clinical research

Objective To evaluate the effect of Compound Daxueteng Enemas combined with gonadotropin-releasing hormone agonists (GnRH-a) on endometriosis (EMs) after laparoscopic surgery. Methods From January 2015 to March 2017,65 EMs cases of blood and heat accumulationsyndrome undergoing laparoscopic conservative surgeryin Zhejiang Provincial Hospital of TCM were randomlyassigned to group of Compound Daxueteng Enemaswith 18 cases (given retention enema of Compound DaxuetengEnemas after surgery),group of GnRH-a with 24cases (given hypodermic injection of GnRH- a after surgery)and group of combined treatment with 23 cases(given retention enema of Compound Daxueteng Enemascombined with hypodermic injection of GnRH-a after surgery).The treatment course lasted 4 months.

Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates inflammatory response ulcerative colitis through TLR4/NF-κB signaling pathway

BACKGROUND Ulcer colitis(UC)is a chronic,nonspecific,and noninfectious inflammatory bowel disease.Recently,Toll-like receptors(TLRs)have been found to be closely associated with clinical inflammatory diseases.Achieving complete remission in patients with intermittent periods of activity followed by dormancy is challenging.Moreover,no study has explored the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.AIM To explore the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.METHODS This prospective clinical study included patients who met the exclusion criteria in 2020 and 2021.The patients with UC were divided into two groups(control and experimental).The peripheral blood of the experimental and control groups were collected under aseptic conditions.The expression of TLR4 protein,NF-κB,IL-6,and IL-17 was detected in the peripheral blood of patients in the experimental group and control group before and 1 month after taking the drug.Linear co rrelation analysis was used to analyze the relationship between the expression level of TLR4 protein and the expression levels of downstream signal NF-κB and inflammatory factors IL-6 and IL-17,and P<0.05 was considered statistically significant.RESULTS There were no significant differences in the patient characteristics between the control and experimental groups.The results showed that the expression levels of TLR4 and NF-κB in the experimental group were significantly lower than those in the control group(P<0.05).The levels of IL-6 and IL-17 in the experimental group were significantly lower than those in the control group(P<0.05).The TLR4 protein expression in the experimental group was positively correlated with the expression level of downstream signal NF-κB and was positively correlated with the levels of downstream inflammatory cytokines IL-6 and IL-17(r=0.823,P<0.05).CONCLUSION Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates the inflammatory response of UC through the TLR4/NF-κB signaling pathway.

A systematic review of the efficacy of traditional Chinese medicine retention enema in the treatment of ulcerative colitis

The objective of this study is to summarize the efficacy and safety of traditional Chinese medicine(TCM)enema in the treatment of ulcerative colitis(UC).The randomized controlled trials on TCM enema intervention in the treatment of UC were searched in seven databases:PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Database,and VIP Database from January 1,2013 to June 6,2022,and the data were analyzed using RevMan 5.3 software.A total of 18 studies involving 1514 UC patients were included.Meta analysis results showed that compared with conventional Western medicine,Chinese medicine enema had a significant effect on UC,and the clinical effective rate of the experimental group using Chinese medicine enema was 4.45 times that of the control group using conventional Western medicine(odds ratio=4.45,95%confidence interval[3.27,6.06]).Therefore,Chinese medicine enema is effective in the treatment of UC,and can significantly reduce related symptoms.

Nursing Practice for a Case of Acute Left Heart Failure Complicated with Colonic Impaction

Research Background: Heart failure is a type of organic heart disease caused by excessive ventricular load, leading to insufficient myocardial contractility and decreased cardiac output in the body. With the progression of the patient's condition, gastrointestinal dysfunction is frequently complicated. At the same time, the accumulation of feces in the body (colonic impaction) can also increase the burden on the patient’s heart, triggering or exacerbating the occurrence or progression of heart failure. Purpose: this article focuses on the correlation between colonic impaction and heart failure, using the nursing experience of a case of acute left heart failure complicated by colonic impaction as an example, in order to provide clinical evidence for the care of patients with colonic impaction combined with heart failure in the future. Method: By using innovative thinking, the stomach tube is used to replace the enema tube, which is inserted through the anus to reach the end of the colon. By combining acupressure at points such as Zhongwan, Tianzhu, and Guanyuan, it helps promote the elimination of fecal impaction. Conclusion: This case reflects the innovative thinking and adaptability of nurses, providing a new clinical approach for the aggravation of the condition of long-term heart failure patients due to constipation issues. Further research in clinical practice is warranted.

The Value of Ultrasound in the Application of Water Enema in Intussusception

Objective:To introduce high-frequency ultrasound diagnostic technology to cooperate with diagnosis and treatment for patients with intussusception,and to observe its clinical application effect.Methods:The study took patients with intussusception as the object of observation,with a total of 52 cases participating,all of which were clinically admitted from December 2022 to December 2023.After enrollment,the patients underwent high-frequency ultrasound detection in sequence,recording the ultrasound imaging characteristics,and referring to the results of surgical or leaky saline enema reset to confirm the diagnosis(the gold standard)to assess the diagnostic efficacy of high-frequency ultrasound technology.Results:Comparing the confirmed diagnostic results of surgery or leaking saline enema restoration,the detection rate of high-frequency ultrasound technology was 98.07%(P>0.05).Among the 52 patients treated with hydropneumatic enema restoration with the cooperation of high-frequency ultrasound monitoring,39 patients were successfully reset in the first treatment(75.00%),while 9 patients were successfully reset(17.30%)after multiple treatments(≥2 times);the remaining 4 patients were unsuccessful and then converted to surgical treatment,and all of them were successfully treated and cured.Conclusion:For the diagnosis of intussusception,high-frequency color Doppler ultrasound has the advantages of high accuracy and simple operation,which provides a scientific and accurate reference basis for the clinical diagnosis and treatment of patients.

Study of Quality Standards of Xiao’er Qingre Enema Preparation in Hospitals

Objective:To establish the quality standards for the preparation of Xiao’er Qingre enema in hospitals.Method:Thin-layer chromatography(TLC)was used to identify Radix Isatidis and Glycyrrhizae in the prescription.The content of(R,S)-Goitrin was determined by high-performance liquid chromatography(HPLC).Results:In TLC identification,there was no interference between the negative controls of Radix Isatidis and glycyrrhizae,and the spots were well-separated.The HPLC results of(R,S)-Goitrin showed a good linear relationship between the peak area and concentration within the range of 0.476-95.2μg·mL-1(r=0.9999).Conclusion:The TLC and HPLC methods established in this experiment are simple,reproducible,and specific,making them suitable for the quality control Xiao’er Qingre enema preparation in hospitals.

可控性Malone顺行灌肠的护理体会

大便失禁和顽固性便秘是小儿肛门直肠畸形术后常见的问题,至今仍是一个难以解决的课题。1990年Malone等[1]提出应用顺行灌肠的方法进行肠道管理,可有效解决失禁及便秘的问题。我们根据2013年8月至2016年8月15例行Malone顺行灌肠（malone antegrade continence enema,MACE）患儿的护理经验,讨论护理对于Malone顺行灌肠的重要性。

Topical application of glycyrrhizin preparation ameliorates experimentally induced colitis in rats

AIM:To examine the efficacy of glycyrrhizin preparation(GL-p) in the treatment of a rat model of ulcerative colitis(UC).METHODS:Experimental colitis was induced by oral administration of dextran sodium sulfate.Rats with colitis were intrarectally administered GL-p or saline.The extent of colitis was evaluated based on body weight gain,colon wet weight,and macroscopic damage score.The expression levels of pro-inflammatory cytokines and chemokines in the inflamed mucosa were measured by cytokine antibody array analysis.The effect of GL-p on myeloperoxidase(MPO) activity in the inflamed mucosa and purified enzyme was assayed.RESULTS:GL-p treatment significantly ameliorated the extent of colitis compared to sham treatment with saline.Cytokine antibody array analysis showed that GL-p treatment significantly decreased the expression levels of pro-inflammatory cytokines and chemokines,including interleukin(IL)-1β,IL-6,tumor necrosis factor-α,cytokine-induced neutrophil chemoattractant-2,and monocyte chemoattractant protein-1 in the inflamed mucosa.Furthermore,GL-p inhibited the oxidative activity of mucosal and purified MPO.CONCLUSION:GL-p enema has a therapeutic effect on experimental colitis in rats and may be useful in the treatment of UC.

Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip

Rectal perforations due to glycerin enemas(GE) typically occur when the patient is in a seated or lordotic standing position.Once the perforation occurs and peritonitis results,death is usually inevitable.We describe two cases of rectal perforation and fistula caused by a GE.An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE.Her case was further complicated by an abscess in the right rectal wall.The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE.In both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip(OTSC) procedure.These procedures resulted in dramatic improvement in both patients.Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general condition.Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

Demographic determinants of risk,colon distribution and density scores of diverticular disease

AIM:To investigate associations between ethnicity,age and sex and the risk,colon distribution and density scores of diverticular disease(DD).METHODS:Barium enemas were examined in 1000 patients:410 male,590 female;760 whites,62 Asians,44 black africans(BAs),and 134 other blacks(OBs).Risks and diverticula density of left-sided DD(LSDD) and rightsided-component DD(RSCDD = right-sided DD + right and left DD + Pan-DD) were compared using logistic regression.RESULTS:Four hundred and forty-seven patients had DD(322 LSDD and 125 RSCDD).Adjusted risks:(1) LSDD:each year increase in age increased the odds by 6%(95% CI:5-8,SE:0.8%,P < 0.001);Asians:odds ratio(OR):0.23(95% CI:0.10-0.53,SE:0.1,P ≤ 0.001) and OBs:OR:0.25(95% CI:0.14-0.43,SE:0.07,P ≤ 0.001) appeared protected vs Whites;(2) RSCDD:each year increase in age increased the odds by 4%(95% CI:2-6,SE:1%,P < 0.001);females were 0.60 times(95% CI:0.40-0.90,SE:0.12,P = 0.01) less likely than males to have RSCDD;BAs were 3.51 times(95% CI:1.70-7.24,SE:1.30,P < 0.001) more likely than Whites to have RSCDD;and(3) DD density scores:each year increase in age increased the odds of highdensity scores by 4%(95% CI:1-6,SE:1%,P < 0.001);RSCDD was 2.77 times(95% CI:1.39-3.32,SE:0.67,P < 0.001) more likely to be of high density than LSDD.No further signif icant differences were found in the adjusted models.CONCLUSION:Right colonic DD might be more common and has higher diverticula density in the west than previously reported.BAs appear predisposed to DD,whereas other ethnic differences appear conserved following migration.

Rectal administration of d-alpha tocopherol for active ulcerative colitis:A preliminary report

AIM: To investigate the anti-oxidant and anti-neutrophil recruitment effects of rectal d-alpha (d-α) tocopherol administration on mild and moderately active ulcerative colitis (UC). METHODS: Fifteen patients with mild and moderately active ulcerative colitis were enrolled in an open-label study of d-α tocopherol enema (8000 U/d) for 12 wk. All patients were receiving concomitant therapy with 5-aminosalicylic acid derivatives (5-ASA) and/or immunomodulator medications. Endoscopic evaluation was performed at baseline and after 4th and 12th weeks. Disease activity was measured with the Mayo disease activity index (DAI) and remission was defined as DAI of ≤ 2 with no blood in stool. Clinical response was defined as a DAI reduction of ≥ 2. RESULTS: At the end of 12th week,the average DAI score significantly decreased compared to the beginning of the study (2.3 ± 0.37 vs 8 ± 0.48,P < 0.0001). One patient was withdrawn after 3 wk for being unavailable to follow-up. On the 4th week of therapy,12 patients showed clinical response,3 of whom (21.4%) achieving remission. After 12 wk,all 14 patients responded clinically to the therapy and remission was induced in 9 of them (64%). No patient reported adverse events or was hospitalized due to worsened disease activity. CONCLUSION: This preliminary report suggests that rectal d-α tocopherol may represent a novel therapy for mild and moderately active UC. The observed results might be due to the anti-inflammatory and anti-oxidative properties of vitamin E.

Preoperative diagnosis of colonic angiolipoma: A case report

Angiolipoma, a common benign tumor mostly seen in the subcutaneous tissue, is a rare pathological condition in the gastrointestinal tract that is usually diagnosed postoperatively. In this case report, an angiolipoma was diagnosed preoperatively by imaging （including CT scans, abdominal echo, barium enema, and colonoscopy）. This pathology was confirmed postoperatively. Computed tomography scan, abdominal echo, and barium enema images were presented.

Successful treatment of severe pouchitis with rebamipide refractory to antibiotics and corticosteroids:A case report

The antibiotics, metronidazole and ciprofloxacin, are the first-line treatment for pouchitis. Patients who do not respond to antibiotics or conventional medications represent a major challenge to therapy. In this report, we have described a successful treatment of severe refractory pouchitis with a novel agent, rebamipide, known to promote epithelial cell regeneration and angiogenesis. A 27-year-old male with ileo-anal pouch surgery presented with worsening anal pain, diarrhea, and abdominal pain. The patient was diagnosed to have pouchitis and was given metronidazole together with betamethasone enema （3.95 rag/dose）. However, despite this intensive therapy, the patient did not improve. On endoscopy, ulceration and inflammation were seen in the ileal pouch together with contact bleeding and mucous discharge. The patient was treated with rebamipide enema （150 rag/close） twice a clay for 8 wk without additional drug therapy. Two weeks after the rebamipide therapy, stool frequency started to decrease and fecal hemoglobin became negative at the 4^th wk. At the end of the therapy, endoscopy revealed that ulcers in the ileal pouch had healed with no obvious inflammation. The effect of rebamipide enema was dramatic and was maintained throughout the ll-mo follow-up. The patient continued to be in remission. No adverse effects were observed during the treatment or the follow-up period. The sustained response seen in this case with severe and refractory pouchitis indicates that agents, which promote epithelial cell growth, angiogenesis and mucosal tissue regeneration, are potential therapeutic agents for the treatment of refractory colorectal lesions.

Effectiveness of therapeutic barium enema for diverticular hemorrhage

AIM:To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.METHODS:We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August2010 and March 2012 at Yokohama Rosai Hospital.Twenty patients were included in the review,consisting of 14 men and 6 women.The median age of the patients was 73.5 years.The duration of the followup period ranged from 1 to 19 mo(median:9.8 mo).Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization,6patients who required it for re-bleeding that developed after the patient left the hospital,and 3 patients who required the procedure for the prevention of rebleeding.Barium(concentration:150 w%/v%)was administered per the rectum,and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy.After confirmation that the ascending colon and cecum were filled with barium,the enema tube was withdrawn,and the patient’s position was changed every 20 min for 3 h.RESULTS:Twelve patients remained free of rebleeding during the follow-up period(range:1-19mo)after the therapeutic barium enema,including 9men and 3 women with a median age of 72.0 years.Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years:4developed early re-bleeding,defined as re-bleeding that occurs within one week after the procedure,and the remaining 4 developed late re-bleeding.The DFI(disease-free interval)decreased 0.4 for 12 mo.Only one patient developed a complication from therapeutic barium enema(colonic perforation).CONCLUSION:Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.

Colonoscopy can miss diverticula of the left colon identified by barium enema

AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.

Ischemic colitis after enema administration: Incidence, timing, and clinical features

BACKGROUND Enema administration is a common procedure in the emergency department(ED). However, several published case reports on enema-related ischemic colitis(IC) have raised the concerns regarding the safety of enema agents. Nevertheless, information on its true incidence and characteristics are still lacking.AIM To investigate the incidence, timing, and risk factors of IC in patients receiving enema.METHODS We consecutively collected the data of all adult patients receiving various enema administrations in the ED from January 2010 to December 2018 and identified patients confirmed with IC following enema. Of 8320 patients receiving glycerin enema, 19 diagnosed of IC were compared with an age-matched control group without IC.RESULTS The incidence of IC was 0.23% among 8320 patients receiving glycerin enema;however, there was no occurrence of IC among those who used other enema agents. The mean age ± standard deviation(SD) of patients with glycerin enemarelated IC was 70.2 ± 11.7. The mean time interval ± SD from glycerin enema administration to IC occurrence was 5.5 h ± 3.9 h(range 1-15 h). Of the 19 glycerin enema-related IC cases, 15(79.0%) were diagnosed within 8 h. The independent risk factors for glycerin-related IC were the constipation score [Odds ratio(OR), 2.0;95% confidence interval(CI): 1.1-3.5, P = 0.017] and leukocytosis(OR, 4.5;95%CI: 1.4-14.7, P = 0.012).CONCLUSION The incidence of glycerin enema-related IC was 0.23% and occurred mostly in the elderly in the early period following enema administration. Glycerin enemarelated IC was associated with the constipation score and leukocytosis.

Therapeutic barium enema for bleeding colonic diverticula:Four case series and review of the literature

The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.

Research progress in the treatment of diabetic kidney disease with Chinese medicine enema

Chinese medicine enema is an effective guiding method to treat diabetic kidney disease,a common chronic complication of diabetes,by regulating the function of the intestines to increase clearing and lower turbidity.We reviewed the treatment of diabetic kidney disease(DKD)with traditional Chinese medicine enemas and found that commonly used traditional Chinese medicines included Rhei Radix Et Rhizoma(Rheum palmatum L.),Ostrea concha(Ostrea gigas Thunberg),Taraxaci Herba(Taraxacum mongolicum Hand.-Mazz.),Astmgali Radix(Astragalus membranaceus Bge.var.mongholicus(Bge.)Hsiao),Salviae Miltiorrhizae Radix Et Rhizoma(Salvia miltiorrhiza Bge.),and Aconiti Lateralis Radix Praeparata(Aconitum carmichaelii Debx).The mechanism of the adjuvant therapeutic effect on DKD may relate to regulating intestinal flora,inhibiting inflammation and oxidative stress and protecting against kidney injury.

Qingchang decoction retention enema may induce clinical and mucosal remission in left-sided ulcerative colitis: A case report

BACKGROUND Ulcerative colitis(UC)is a chronic autoimmune disease characterized by relapsing-remitting abdominal pain,diarrhea,mucopurulent discharge and rectal bleeding.To date,the etiology of the disease remains unknown;therefore,medical therapy is not yet available.Left-sided UC is mainly treated with oral and topical mesalazine.However,due to its modest clinical effect,endoscopic mucosal remission is not achieved in all patients.CASE SUMMARY A 44-year-old man presented to Longhua Hospital with a history of left-sided UC for more than 6 years and slight bloody diarrhea over time.Endoscopy suggested hyperemia,edema,and erosive mucosa involving the rectum and sigmoid colon.The Traditional Chinese medicine Qingchang decoction(QCD)enema treatment was initiated once a day combined with a previous standard dose of mesalazine for 8 wk,and rectal bleeding ceased after 4 wk of treatment.Another QCD enema treatment was provided after symptom relapse due to drug withdrawal for nearly 6 mo.At the 2-mo follow-up,the colonoscopy results indicated mucosal healing with no erosion or ulcers.CONCLUSION The Chinese formula QCD retention enema represents a potential treatment for left-sided UC with predominant rectal bleeding to achieve clinical and mucosal remission.