Overlapping gastroesophageal reflux disease and irritable bowel syndrome:Increased dysfunctional symptoms

AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4±11.5 years) met Rome or Rome criteria(depending on the year of diagnosis)for IBS.2658 patients were diagnosed with GERD based on clinical presentation and endoscopic findings.We assessed other functional symptoms(epigastric pain,nausea,vomiting,belching,constipation and diarrhea)in patients suffering from GERD,IBS or both.RESULTS: Among IBS subjects, 63.6% (69.0% women, 31.0% men; mean age: 36.4±10.3 years) also hadGERD, whereas 34.7% of the non-IBS patients had GERD [odds ratio (OR) =3.2, 95% confidence interval (CI): 2.9-3.7, P<0.0001]. Among patients with GERD, 33.9% of subjects met Rome criteria compared to 13.5% of non-GERD patients (OR=3.6, 95% CI: 3.1-4.3, P<0.0001). Prevalence of all functional symptoms was higher in overlapping GERD and IBS subjects, when compared with their prevalence in the IBS subjects without GERD or GERD only subjects (P<0.05).CONCLUSION: This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.

Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease

Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of noxious and non-noxious stimuli,and the fields of gastroenterology and neurology.Patients with spinal cord injury,myelomeningocele,multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation,incontinence,gastrointestinal motor dysfunction and altered visceral sensitivity.Spinal cord injury is associated with severe autonomic dysfunction,and bowel dysfunction is a major physical and psychological burden for these patients.An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease.Multiple sclerosis is a neurodegenerative disorder in which axonal injury,neuronal loss,and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability.Parkinson's disease is a multisystem disorder involving dopaminergic,noradrenergic,serotoninergic and cholinergic systems,characterizedby motor and non-motor symptoms.Parkinson's disease affects several neuronal structures outside the substantia nigra,among which is the enteric nervous system.Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease,even before the involvement of the central nervous system.This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease,as it could represent the point of entry for a putative environmental factor to initiate the pathological process.This review covers the data related to the etiology,epidemiology,clinical expression,pathophysiology,genetic aspects,gastrointestinal motor dysfunction,visceral sensitivity,management,prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases.Embryological,morphological and experimental studies on animal models and humans are also taken into account.

Endothelial dysfunction in inflammatory bowel diseases:Pathogenesis,assessment and implications

Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease(IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of leukocyte adhesiveness and leukocyte diapedesis, as well as an increased vascular smooth muscle tone and procoagulant activity is observed. Structural changes of the vascular endothelium comprise as well capillary and venule remodeling and proliferation of endothelial cells. Hypoxia in the inflammatory area stimulates angiogenesis by upregulation of vascular endothelial growth factor, fibroblast growth factor and tumor necrosis factor-α. Inflammatory mediators also alter the lymphatic vessel function and impair lymph flow, exacerbating tissue edema and accumulation of dead cells and bacteria. The endothelial dysfunction might be diagnosed by the use of two main methods: physical and biochemical. Physical methods are based on the assessment of large arteries vasodilatation in response to an increased flow and receptors stimulation. Flowmediated vasodilatation(FMD) is the method that is the most widely used; however, it is less sensitive in detecting early changes of the endothelium function. Most of the studies demonstrated a decrease of FMD in IBD patients but no changes in the carotic intima-media thickness. Biochemical methods of detecting the endothelial dysfunction are based on the assessment of the synthesis of compounds produced both by the normal and damaged endothelium. The endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis in the general population. In IBD patients, the risk of cardiovascular diseases is controversial. Large, prospective studies are needed to establish the role of particular medications or dietary elements in the endothelial dysfunction as well to determine the real risk of cardiovascular diseases.

MicroRNAs:New therapeutic targets for intestinal barrier dysfunction

Defects in intestinal barrier function characterized by an increase in intestinal permeability contribute to intestinal inflammation.Growing evidence has shown that an increase in intestinal permeability has a pathogenic role in diseases such as inflammatory bowel disease(IBD)and celiac disease,and functional bowel disorders such as irritable bowel syndrome.Therefore,clarification of the inflammatory responses,the defense pathway and the corresponding regulatory system is essential and may lead to the development of new therapies.MicroRNAs(miRNAs)are small(19-22nt)noncoding RNA molecules that regulate genes at the post-transcriptional level by base-pairing to specific messenger RNAs for degradation to repress translation.Recent studies suggested that miRNAs are important in the immune response and mediate a critical role in multiple immune response-related disorders.Based on these discoveries,attention has been focused on understanding the role of miRNAs in regulating intestinal barrier dysfunction,especially in IBD.Here,we provide a review of the most recent state-of-the-art research on miRNAs in intestinal barrier dysfunction.

Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial

BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P<0.05).After EST,the serum indexes of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before(P<0.05).After EST,67(84.8%)and 8(10.1%)of the 79 patients with biliary-type SOD had obviously effective(VRS-5=0 points)and effective treatment(VRS-5=1-2 points),with an overall effectiveness rate of 94.9%(75/79).There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST(P>0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients.

Disruption of interstitial cells of Cajal networks after massive small bowel resection

AIM: To investigate the disruptions of interstitial cells of Cajal (ICC) in the remaining bowel in rats after massive small bowel resection (mSBR). METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were divided randomly into three experimental groups (n = 10 each): Group A rats underwent bowel transection and re-anastomosis (sham) and tissue samples were harvested at day 7 post-surgery. Group B and C rats underwent 80% small bowel resection with tissue harvested from Group B rats at day 7 post-surgery, and from Group C rats at day 14 postsurgery. The distribution of ICC at the site of the resid-ual small bowel was evaluated by immunohistochemical analysis of small intestine samples. The ultrastructural changes of ICC in the remnant ileum of model rats 7 and 14 d after mSBR were analyzed by transmission electron microscopy. Intracellular recordings of slow wave oscillations were used to evaluate electrical pacemaking. The protein expression of c-kit, ICC phenotypic markers, and membrane-bound stem cell factor (mSCF) in intestinal smooth muscle of each group were detected by Western blotting. RESULTS: After mSBR, immunohistochemical analysis indicated that the number of c-kit-positive cells was dramatically decreased in Group B rats compared with sham tissues. Significant ultrastructural changes in ICC with associated smooth muscle hypertrophy were also observed. Disordered spontaneous rhythmic contractions with reduced amplitude (8.5 ± 1.4 mV vs 24.8 ± 1.3 mV, P = 0.037) and increased slow wave frequency (39.5 ± 2.1 cycles/min vs 33.0 ± 1.3 cycles/min, P = 0.044) were found in the residual intestinal smooth muscle 7 d post mSBR. The contractile function and electrical activity of intestinal circular smooth muscle returned to normal levels at 14 d post mSBR (amplitude, 14.9 ± 1.6 mV vs 24.8 ± 1.3 mV; frequency, 30.7 ± 1.7 cycles/min vs 33.0 ± 1.3 cycles/min). The expression of Mscf and c-kit protein was decreased at 7 d (P = 0.026), but gradually returned to normal levels at 14 d. The ICC and associated neural networks were disrupted, which was associated with the phenotype alterations of ICC. CONCLUSION: Massive small bowel resection in rats triggered damage to ICC networks and decreased the number of ICC leading to disordered intestinal rhythmicity. The mSCF/c-kit signaling pathway plays a role in the regulation and maintenance of ICC phenotypes.

Methodological issues in the study of intestinal microbiota in irritable bowel syndrome

Irritable bowel syndrome (IBS) is an intestinal functional disorder with the highest prevalence in the industrialized world. The intestinal microbiota (IM) plays a role in the pathogenesis of IBS and is not merely a consequence of this disorder. Previous research efforts have not revealed unequivocal microbiological signatures of IBS, and the experimental results are contradictory. The experimental methodologies adopted to investigate the complex intestinal ecosystem drastically impact the quality and significance of the results. Therefore, to consider the methodological aspects of the research on IM in IBS, we reviewed 29 relevant original research articles identified through a PubMed search using three combinations of keywords: &#x0201c;irritable bowel syndrome + microflora&#x0201d;, &#x0201c;irritable bowel syndrome + microbiota&#x0201d; and &#x0201c;irritable bowel syndrome + microbiome&#x0201d;. For each study, we reviewed the quality and significance of the scientific evidence obtained with respect to the experimental method adopted. The data obtained from each study were compared with all considered publications to identify potential inconsistencies and explain contradictory results. The analytical revision of the studies referenced in the present review has contributed to the identification of microbial groups whose relative abundance significantly alters IBS, suggesting that these microbial groups could be IM signatures for this syndrome. The identification of microbial biomarkers in the IM can be advantageous for the development of new diagnostic tools and novel therapeutic strategies for the treatment of different subtypes of IBS.

Inflammatory bowel disease and thromboembolism

Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians&#x02019; awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Irritable bowel syndrome:The evolution of multi-dimensional looking and multidisciplinary treatments

Irritable bowel syndrome(IBS)is common in the society.Among the putative pathogeneses,gut dysmotility results in pain and disturbed defecation.The latter is probably caused by the effect of abnormal gut water secretion.The interaction between abnormal gas accumulation,abdominal pain and bloating remains controversial.Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients.The identification of biologic markers based on genetic polymorphisms is undetermined.Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS.Certain food constituents may exacerbate bowel symptoms.The impact of adult and childhood abuses on IBS is underestimated.Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses.Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment.New drugs targeting receptors governing bowel motility,sensation and secretion can be considered,but clinicians must be aware of their potential serious side effects.Psychiatric drugs and modalities may be the final options for treating intractable subjects.Probiotics of multi-species preparations are safe and worth to be considered for the treatment.Antibiotics are promising but their longterm safety and effectiveness are unknown.Diet therapy including exclusion of certain food constituents is an economic measure.Using relatively safe complementary and alternative medicines(CAMs)may be optional to those patients who failed classical treatment.In conclusion,IBS is a heterogeneous disorder with multidimensional pathogeneses.Personalized medicines with multidisciplinary approaches using different classes of drugs,psychiatric measures,probiotics and antibiotics,dietary therapy,and finally CAMs,can be considered.

Diet in neurogenic bowel management:A viewpoint on spinal cord injury

The aim of this review is to offer dietary advice for individuals with spinal cord injury(SCI)and neurogenic bowel dysfunction.With this in mind,we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy,autonomic dysreflexia and neurogenic bladder.In addition,SCI is often associated with a sedentary lifestyle,which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation,including cardiovascular and chronic kidney diseases.The Mediterranean diet,along with exercise and dietary supplements,has been suggested as an anti-inflammatory intervention in individuals with SCI.However,individuals with chronic SCI have a daily intake of whole fruit,vegetables and whole grains lower than the recommended dietary allowance for the general population.Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake;therefore,this finding could explain the low consumption of plant foods.Low consumption of fibre induces dysbiosis,which is associated with bothendotoxemia and inflammation.Dysbiosis can be reduced by exercise and diet in individuals with SCI.Therefore,to summarize our viewpoint,we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines.Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI,chronic kidney diseases,chronic pain and irritable bowel syndrome.We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength,flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits.Finally,dietary advice for Paralympic athletes is suggested.

Autoantibodies and an immune-based rat model of inflammatory bowel disease

The exact causes of inflammatory bowel disease(IBD)are not yet fully defined.From a vast body of literature,we know that the immune response has long been involved in the pathogenesis of IBD,including both ulcerative colitis and Crohn’s disease.A variety of specific alterations can lead to immune activation and inflammation directed to the colon,as revealed by some animal models.Current research has focused on the role of antibodies in downstream events and mechanisms of autoimmunity and inflammation.It is not well known whether the production of antibodies is a serologic consequence of IBD,or if it is a result of barrier dysfunction induced by inflammation.Here,we present a new hypothesis to distinguish the complex links between genetic susceptibility,barrier dysfunction,commensal and pathologic microbial factors and inflammatory response(especially autoantibodies)in the pathogenesis of IBD.To ascertain the hypothesis,we developed a pilot model with the concept of the presence of antibodies against enteric bacterial antigens in IBD.Results confirmed our hypothesis.Our hypothesis suggests the possibility of subcutaneous vaccination of animals with administration of all or specific enteric bacterial antigens.

Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function

To compare our developed nerve preserving technique with the non-nerve preserving one in terms of de novo bowel symptoms. METHODSPatients affected by symptomatic apical prolapse, admitted to our department and treated by nerve preserving laparoscopic sacropexy (LSP) between October, 2010 and April, 2013 (Group A or “interventional group”) were compared to those treated with the standard LSP, between September, 2007 and December, 2009 (Group B or “control group”). Functional and anatomical data were recorded prospectively at the first clinical review, at 1, 6 mo, and every postsurgical year. Questionnaires were filled in by the patients at each follow-up clinical evaluation. RESULTSForty-three women were enrolled, 25/43 were treated by our nerve preserving technique and 18/43 by the standard one. The data from the interventional group were collected at a similar follow-up (> 18 mo) as those collected for the control group. No cases of de novo bowel dysfunction were observed in group A against 4 cases in group B (P = 0.02). Obstructed defecation syndrome (ODS) was highlighted by an increase in specific questionnaires scores and documented by the anorectal manometry. There were no cases of de novo constipation in the two groups. No major intraoperative complications were reported for our technique and it took no longer than the standard procedure. Apical recurrence and late complications were comparable in the two groups. CONCLUSIONOur nerve preserving technique seems superior in terms of prevention of de novo bowel dysfunction compared to the standard one and had no major intraoperative complications.

Cardiovascular implications of inflammatory bowel disease: An updated review

Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying mechanisms.Furthermore,it discusses the impact of current IBD treatments on cardiovascular risk.Additionally,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid arthritis.This article aims to comprehensively evaluate the existing evidence supporting these associations.To achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of keywords.The search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery disease.This review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.

调神健脾针刺法联合电针治疗腹泻型肠易激综合征的疗效观察及对肥大细胞活化的影响

目的观察调神健脾针刺法联合电针治疗对腹泻型肠易激综合征(irritable bowel syndromediarrheal,IBS-D)的临床疗效及其对患者肠黏膜肥大细胞活化的影响。方法将60例IBS-D患者按随机数字表法分为药物组和观察组,每组30例。药物组予口服马来酸曲美布汀分散片治疗,观察组予调神健脾针刺法联合电针治疗。观察两组治疗前后肠易激综合征症状严重程度量表(irritable bowel syndrome-symptom severity scale,IBS-SSS)评分、肠易激综合征生活质量量表(irritable bowel syndrome-quality of Life,IBS-QOL)评分和医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评分及肠黏膜肥大细胞(mast cells,MCs)活化程度的变化。比较两组临床疗效。结果观察组总有效率优于药物组(P<0.05)。治疗后,两组IBS-SSS和HADS评分均降低(P<0.05),且观察组均优于药物组(P<0.05)。治疗后,两组IBS-QOL评分均升高(P<0.05),且观察组高于药物组(P<0.05)。治疗后,两组MCs数量与脱颗粒比例均降低(P<0.05),且观察组优于药物组(P<0.05)。结论“调神健脾”针刺法联合电针治疗IBS-D的临床疗效优于单一口服药物治疗,可缓解腹痛等临床症状,提高生活质量,改善抑郁状态,降低MCs活化程度。

腹部高频深部振动疗法在颈、胸段脊髓损伤患者神经源性肠功能障碍康复中的作用

目的:探讨腹部高频深部振动疗法在颈、胸段脊髓损伤(spinal cord injury,SCI)患者神经源性肠功能障碍(neurogenic bowel dysfunction,NBD)康复作用的效果评价。方法:选取在我院住院治疗的颈、胸段SCI后NBD患者59例,采用随机对照设计,使用随机数字表法将患者分为对照组30例,观察组29例。两组患者均接受标准NBD康复护理,对照组额外进行了手动腹部按摩疗法,观察组接受腹部高频深部振动疗法,研究周期4周。比较两组患者入组前后国际脊髓损伤肠道功能评价(2.0版)、大便的性状(Bristol粪便分型法)、生存质量测定量表评分(QOL-BRE)及肠道相关并发症(药物依赖、腹痛/腹胀、漏粪发生、不完全性肠梗阻)发生率。结果:观察组干预后国际脊髓损伤肠道功能评分分级优于对照组(P<0.01);观察组干预后排便性状Bristol粪便分型Ⅳ(理想型:香蕉状便)(62%)高于对照组(26.7%)(P<0.01);观察组干预后生存质量评分显著高于对照组评分(P<0.05);观察组干预后肠道相关并发症(药物依赖6%、腹痛/腹胀0、漏粪发生0、肠梗阻0)低于对照组(药物依赖50%、腹痛/腹胀30%、漏粪发生27%、肠梗阻17%)(P<0.05)。结论:腹部高频深部振动疗法可促进颈、胸段SCI神经源性肠患者肠道功能恢复,减少对药物依赖,降低肠道相关并发症,提高其生存质量,操作简易方便高效。

基于线粒体功能障碍探讨中医药防治炎症性肠病的研究进展

炎症性肠病(IBD)是一组以慢性肠道炎症为主要特征的全球性疾病,包括克罗恩病(CD)和溃疡性结肠炎(UC),目前病因和发病机制尚不完全清楚。线粒体是细胞中的重要器官,研究发现,线粒体膜电位下降、腺嘌呤核苷三磷酸(ATP)产生减少、氧化应激加剧等现象可能促使免疫系统的异常激活,引起肠道黏膜屏障的受损,导致IBD的发生,并加速炎症进展。中药含有多种生物活性成分,具有修复线粒体功能、抑制炎症反应的潜力。因此本文基于线粒体功能对中医药防治炎症性肠病进行总结梳理,发现中医药对线粒体具有缓解氧化应激、调控线粒体自噬等作用,从而发挥抗炎、抗氧化、减轻肠黏膜损伤、延缓病情的作用,且中医药调控线粒体DNA(mtDNA)突变涉及到的炎-癌转化机制是当前的研究热点。

脊髓损伤后神经源性肠道功能障碍的治疗研究进展

脊髓损伤作为致残率、致死率较高的疾病不但给社会医疗资源带来沉重的负担还给患者及其家属带来长期的压力。神经源性肠道功能障碍作为脊髓损伤后常见的并发症,常常以便秘、大便失禁等症状困扰着患者及其家属,给脊髓损伤后期护理工作带来极大的困难,严重阻碍了脊髓损伤患者的整体康复。因此本文从神经源性肠道功能障碍的致病机制及目前可能的治疗方法两个方面,总结脊髓损伤后神经源性肠道功能障碍研究治疗进展和存在的问题,为未来相关研究提供新的思路。

次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床研究

目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口服乳果糖治疗。比较两组治疗前后排便频率、排便时间、Wexner便秘评分、神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)评分及便秘患者生活质量量表(patient-assessment of constipation quality of life,PAC-QOL)各项评分,并对并发症发生率进行评价。结果两组治疗后排便频率较同组治疗前均显著提高,排便时间均显著缩短,PAC-QOL各项评分均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗后排便频率、排便时间及PAC-QOL各项评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4周后Wexner便秘评分及NBD评分较同组治疗前均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗2、4周后Wexner便秘评分及NBD评分均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。研究组治疗期间并发症发生率为5.3%,对照组为5.6%,两组比较差异无统计学意义(P>0.05)。结论对脊髓损伤后神经源性肠道功能障碍(便秘型)患者采取次髎穴埋线治疗,可提升排便频率,缩短排便时间,改善肠道功能障碍与便秘症状,提高患者生活质量,安全性好。

脊髓损伤神经源性肠道功能障碍患者经肛门灌洗的效果

目的探讨经肛门灌洗在脊髓损伤神经源性肠道功能障碍患者中的应用效果。方法将80例脊髓损伤后肠道功能障碍患者按住院先后顺序分为对照组(40例)和干预组(40例);对照组实施常规肠道管理方案,干预组在常规护理基础上使用简易工具进行经肛门灌洗。结果两组各有39例完成全程研究。干预后干预组腹胀发生率及排便频率得分显著低于对照组(均P<0.05)。结论经肛门灌洗可有效减轻脊髓损伤后肠功能障碍患者腹胀、排便频率异常等肠道症状,改善患者肠道功能。

线粒体损伤在炎症性肠病中的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种严重危害人类健康的慢性复发性肠道炎症疾病。其发病机制尚不明确,可能涉及遗传、免疫和环境等多种因素。近年来,越来越多的研究表明线粒体损伤与功能异常在IBD的发生发展中发挥着重要作用。本综述对炎症性肠病中线粒体损伤的相关研究进行了全面回顾和梳理,重点探讨线粒体氧化应激损伤、自噬功能障碍、动力学紊乱、呼吸功能缺陷对IBD的影响,尝试寻找其潜在治疗靶点,旨在为IBD的科学防治提供新依据。