Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders

Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis.Endolumenal functional lumen imaging probe(EndoFLIP)an emerging technology,uses impedance planimetry to measure hollow organs cross sectional area,distensibility and compliance.It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters,oesophageal body,the pylorus and the anal canal.In this article,we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice.The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing.EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.

Retrospective Analysis of the Effect of Auricular Acupuncture on Pain and Gastrointestinal Motility Recovery After Laparoscopic Surgery for Colorectal Cancer

Objective:To investigate the effect of auricular acupuncture on postoperative pain and gastrointestinal motility recovery after laparoscopic surgery for colorectal cancer.Methods:The clinical data of patients who underwent laparoscopic radical surgery for colorectal cancer in our hospital from April 2020 to December 2021 were collected.Based on the inclusion and exclusion criteria,76 patients were included in the retrospective analysis.Depending on whether they received auricular acupuncture or not,the patients were divided into two groups:46 patients in the experimental group(auricular acupuncture)and 30 patients in the control group.The differences between the two groups were analyzed.Results:The time to first flatus of the experimental group was significantly shorter than that of the control group(52.2±7.36 h versus 66.3±7.83 h;P<0.001).Similarly,the time to first defecation of the experimental group was significantly shorter than that of the control group(76.3±7.76 h versus 86.1±10.79 h;P<0.001).The time to first fluid intake of the auricular group was significantly shorter than that of the control group(90.4±8.92 h versus 107.3±9.66 h,P<0.001).Compared with the control group,the experimental group scored significantly lower on the visual analogue scale on postoperative days 2 and 3(P<0.001).Conclusion:Auricular acupuncture is an effective traditional Chinese medicine external treatment method.It can promote gastrointestinal motility recovery in patients after laparoscopic radical surgery for colorectal cancer and also reduce postoperative pain and discomfort.Furthermore,this therapy is easy to operate and well-accepted by patients.Therefore,it should be strongly promoted in clinical practice.

Simotang enhances gastrointestinal motility,motilin and cholecystokinin expression in chronically stressed mice

AIM:To investigate the effect of Simotang(Decoction of Four Powered Drugs) on gastrointestinal motility,motilin and cholecystokinin expression in chronically stressed mice.METHODS:Forty mice were randomly divided into control group,stress group(model group),mosapride group and Simotang group,10 in each group.A variety of unpredictable stimulations were used to induce chronic stress in mice.Then,the mice were treated with distilled water,mosapride or Simotang for 7 d.Gastric emptying and intestinal propulsion function were detected.Serum level of motilin was measured by enzyme-linked immunosorbent assay.Expression of cholecystokinin(CCK) in intestine,spinal cord and brain of mice was detected by immunohistochemistry and semi-quantitative reverse transcription polymerase chain reaction,respectively.RESULTS:Simotang improved the gastric emptying and intestinal propulsion in chronically stressed mice.Furthermore,the serum motilin level was significantly higher and the expression levels of CCK-positive cells and genes were significantly lower in intestine,spinal cord and brain of Simotang group than in those of model group(P<0.05).No significant difference was found in serum motilin level and expression levels of CCK-positive cells and genes between the mosapride and Simotang groups.CONCLUSION:Simotang enhances the gastrointestinal motility in chronically stressed mice by regulating the serum motilin level and the expression of cholecystokinin.

Effect of L-NAME on nitric oxide and gastrointestinal motility alterations in cirrhotic rats

AIM: To investigate the effect of L-NAME on nitric oxide and gastrointestinal motility alterations in cirrhotic rats. METHODS: Rats with cirrhosis induced by carbon tetrachloride were randomly divided into two groups, one n =13 receiving 0.5mg.kg(-1) per day of N(G)-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, for 10 days, whereas the other group (n =13) and control (n =10) rats were administrated the same volume of 9g.L(-1) saline. Half gastric emptying time and 2h residual rate were measured by SPECT, using (99m)Tc-DTPA-labeled barium sulfate as test meal. Gastrointestinal transition time was recorded simultaneously. Serum concentration of nitric oxide (NO) was determined by the kinetic cadmium reduction and colorimetric methods. Immunohistochemical SABC method was used to observe the expression and distribution of three types of nitric oxide synthase (NOS) isoforms in the rat gastrointestinal tract. Western blot was used to detect expression of gastrointestinal NOS isoforms. RESULTS: Half gastric emptying time and trans-gastrointestinal time were significantly prolonged(124.0 +/- 26.4 min; 33.7 +/- 8.9 min; 72.1 +/- 15.3 min; P【0.01), (12.4 +/- 0.5h; 9.5 +/- 0.3h; 8.2 +/- 0.8h; P【0.01), 2h residual rate was raised in cirrhotic rats than in controls and cirrhotic rats treated with L-NAME (54.9 +/- 7.6%,13.7 +/- 3.2%, 34.9 +/- 10.3%, P【0.01). Serum concentration of NO was significantly increased in cirrhotic rats than in the other groups (8.20 +/- 2.48) micromol.L(-1), (5.94 +/-1.07) micromol.L(-1) and control (5.66 +/- 1.60 micromol.L(-1), P【0.01. NOS staining intensities which were mainly located in the gastrointestinal tissues were markedly lower in cirrhotic rats than in the controls and cirrhotic rats after treated with L-NAME. CONCLUSION: Gastrointestinal motility was remarkably inhibited in cirrhotic rats, which could be alleviated by L-NAME. Nitric oxide may play an important role in the inhibition of gastrointestinal motility in cirrhotic rats.

Neuromechanism of acupuncture regulating gastrointestinal motility

Acupuncture has been used in China for thousands of years and has become more widely accepted by doctors and patients around the world. A large number of clinical studies and animal experiments have confirmed that acupuncture has a benign adjustment effect on gastrointestinal(GI) movement;however, the mechanism of this effect is unclear, especially in terms of neural mechanisms, and there are still many areas that require further exploration. This article reviews the recent data on the neural mechanism of acupuncture on GI movements. We summarize the neural mechanism of acupuncture on GI movement from four aspects: acupuncture signal transmission, the sympathetic and parasympathetic nervous system, the enteric nervous system, and the central nervous system.

Schistosoma mansoni proteins attenuate gastrointestinal motility disturbances during experimental colitis in mice

AIM:To investigate the therapeutic effect of Schistosoma mansoni(S.mansoni) soluble worm proteins on gastrointestinal motility disturbances during experimental colitis in mice. METHODS:Colitis was induced by intrarectal injection of trinitrobenzene sulphate(TNBS) and 6 h later,mice were treated ip with S.mansoni proteins.Experiments were performed 5 d after TNBS injection.Inflammationwas quantified using validated inflammation parameters. Gastric emptying and geometric center were measured to assess in vivo gastrointestinal motility.Peristaltic activity of distal colonic segments was studied in vitro using a modified Trendelenburg set-up.Cytokine profiles of T-lymphocytes isolated from the colon were determined by real time reverse transcriptase-polymerase chain reaction. RESULTS:Intracolonic injection of TNBS caused severe colitis.Treatment with S.mansoni proteins significantly ameliorated colonic inflammation after 5 d.TNBS did not affect gastric emptying but significantly decreased the geometric center and impaired colonic peristaltic activity 5 d after the induction of colitis.Treatment with S.mansoni proteins ameliorated these in vivo and in vitro motility disturbances.In addition,TNBS injection caused a downregulation of effector T cell cytokines after 5 d,whereas a S.mansoni protein effect was no longer observed at this time point. CONCLUSION:Treatment with S.mansoni proteins attenuated intestinal inflammation and ameliorated motility disturbances during murine experimental colitis.

Role of sex hormones in gastrointestinal motility in pregnant and non-pregnant rats

AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided into(1) non-pregnant,(contractility, n =6; transit, n = 6); and(2) pregnant(contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry(ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination. RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions(3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying(168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control(54.23 ± 15.14 ng/m L and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0(44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL). CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.

Gastrointestinal motility disorders in inflammatory bowel diseases

The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic, environmental, immunological and microbial predisposing factors. In addition, significant symptom overlapping may occur, muddling the waters within the clinical context. Although on one hand this represents a challenge for the clinician for a potential under- or over-treatment and diagnostic delay, on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic (often low-grade) inflammation, motor disorders and deranged sensory function. The best example is probably represented by Crohn&#x02019;s disease and ulcerative colitis. In fact, a number of gastrointestinal motor disorders have been described in association with these diseases, disorders which span from the esophagus to the anorectum, and which will be extensively covered in this review. It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes; however, given the high prevalence of functional gastrointestinal disorders in the general population, this overlap might also be serendipitous. However, it is worth noting that literature data on this topic are relatively scarce, sometimes quite outdated, and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease. Nevertheless, both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease, correlate with greater psychological comorbidity and poorer quality of life, and may negatively influence the therapeutic approaches.

Effects of Hwangryunhaedok-tang on gastrointestinal motility function in mice

AIM To investigate the effects of Hwangryunhaedok-tang(HHT) on gastrointestinal(GI) motility in mice.METHODS The effects of a boiling water extract of HHT(HHTE) on GI motility were investigated by calculating percent intestinal transit rates(ITR%) and gastric emptying(GE) values using Evans Blue and phenol red, respectively, in normal mice and in mice with experimentally induced GI motility dysfunction(GMD). In addition, the effects of the four components of HHT, that is, Gardeniae Fructus(GF), Scutellariae Radix(SR), Coptidis Rhizoma(CR), and Phellodendri Cortex(PC), on GI motility were also investigated.RESULTS In normal ICR mice, ITR% and GE values were significantly and dose-dependently increased by the intragastric administration of HHTE(0.1-1 g/kg). The ITR% values of GMD mice were significantly lower than those of normal mice, and these reductions were significantly and dose-dependently inhibited by HHTE(0.1-1 g/kg). Additionally, GF, CR, and PC dosedependently increased ITR% and GE values in normal and GMD mice.CONCLUSION These results suggest that HHT is a novel candidate for the development of a gastroprokinetic agent for the GI tract.

Intra-gastric triacetin alters upper gastrointestinal motility in conscious dogs

AIM: To examine the effect of intra-gastric triacetin on both upper gastrointestinal motility and proximal gastric tone in conscious dogs.

Ion channel mechanism of gastrointestinal motility and gastric hypersensitivity in functional dyspepsia:a review

Functional dyspepsia(FD)is a regularly diagnosed clinical gastrointestinal ailment with a high incidence rate that can considerably impact patients’health and quality of life and impose a substantial financial burden.Modern research on the pathophysiology of functional dyspepsia has not thoroughly explained the underlying reasons.The condition does not manifest any significant organ abnormalities,which raises the disease’s difficulty coefficient.Major pathogenic exceptions in FD include gastrointestinal motor dysfunction,gastrointestinal hormone secretion problem,visceral hypersensitivity,and brain-gut axis.Several ion channels have reportedly been implicated in the pathophysiological process of FD.Therefore,it is crucial to comprehend the probable activities of various ion channels in FD.This study focuses on the current state of research on the possible role of several ion channels in the pathogenesis of FD.

Analysis of the characteristics of gastrointestinal motility based on Hilbert-Huang transform method

Pressure activity data as an important index of gastrointestinal （GI） motility can be obtained from the wireless radiotelemetry capsule. The Hilbert-Huang transform （HHT） method, which is more effective to process non-stationary signal, is proposed to identify the characteristics of GI motility. We decompose the pressure activity data into intrinsic mode functions （IMFs）, calculate the Hi/bert marginal spectrum and attain the peristalsis characteristics of GI tract. The IMFs represent the peristalses modes of GI tract activity embedded in the pressure data. The time-varying characteristic of the method suggests that the HHT is suitable to accommodate other non-stationary biomedical data analysis.

Clinical observation on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture

Objective To observe the effects on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture. Methods Twenty-nine cases of functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor were randomized into electroacupuncture group （19 cases） and control group （10 cases）. In electroacupuncture group, routine treatment after gastrointestinal operation and electroacupucture treatment were applied, Zusanli （足三里 ST 36）, Shangjuxu （上巨虚 ST 37）, Xiajuxu （下巨虚 ST 39） and Hegu （合谷 LI 4） were applied with electroacupuncture; in control group, the routine treatment after gastrointestinal operation was only applied. Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were observed in two groups. Results Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were relieved in two groups; and the effects of abdominal distension, anus exhaust, defecation, amount of gastrointestinal decompression drainage and borborygmus in electroacupuncture group were superior to those in control group （all P〈0.05）. Conclusion For the functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor, the theraputic effect of electroacupuncture combined with routine treatment after operation is better than the routine treatment after operation.

Impacts of electroacupuncture at auricular concha on gastrointestinal motility in the rats with type 2 diabetes

Objective:To observe the impacts of electroacupuncture(EA)at auricular concha on gastrointestinal motility in the rats with type 2 diabetes(T2D).Methods:A total of 30 SD male rats were collected.8 rats of them were in a control group and the rest22 rats were prepared as the model of T2D by intraperitoneal injection with streptozotocin(STZ)and high-fat forage.Blood glucose≥16.7 mmol/L for 3 times was considered as modeling success in rats,thus the rats were collected in a T2D group(n=16).These 16 T2D rats were divided into a model group(n=8)and an intradermal auricular electroacupuncture stimulation(iaES)group(n=8)according to random number table.In the iaES group,intervention with EA was applied at auricular concha unilaterally each time,once daily,on both sides alternatively,5-day treatment as 1 course,at the interval of 2 days between courses,totally for 4 weeks.No any intervention was given in the model group and the control group.At the end of 4 weeks of intervention,the gastric emptying and intestinal propulsion were determined,ELISA method was adopted to determine gastrin(GAS)and motilin(MTL),and random blood glucose value and food intake were recorded in the iaES group,the model group and the control group successively.Results:After modeling,as compared with the control group,the food intake and random blood glucose were increased significantly(both P<0.001)and body weight was reduced obviously(P<0.01)in the T2D group.After intervention for 4 weeks,compared with the model group,the food intake and gastric content weight were obviously reduced(both P<0.05),the serum GAS content,gastric emptying and intestinal transit rate,as well as random blood glucose reduction were all higher(all P<0.05)in the rats of the iaES group,but the difference was not significant in MTL between the iaES groups and the model group(P>0.05).Conclusion:Electroacupuncture at auricular concha improves gastrointestinal motility in T2D model rats.

Modified Dachengqi Tang improves decreased gastrointestinal motility in postoperative esophageal cancer patients

OBJECTIVE:To investigate the clinical effects of modified Dachengqi Tang(DCQT) on promoting gastrointestinal motility in post-operative esophageal cancer patients.METHODS:Sixty postoperative esophageal cancer patients were enrolled and randomly assigned to the modified treatment group or the control group(30 patients in each group).Patients in the treatment group were given DCQT made from decocted herbs and administered via nasojejunal tube at a dosage of 150 mL.Gastrointestinal motility was assessed by recording time for recovery of bowel sounds,flatus,defecation,and the total amount of gastric drainage during the first three postoperative days.Plasma motilin(MTL) and vasoactive intestinal peptide(VIP) were measured one hour before and three days after surgery.RESULTS:Compared with the control group,the times to first bowel sound,flatus,and defecation were significantly shorter and there was less gastric drainage in the treatment group(P < 0.01,P < 0.01,P < 0.01,and P < 0.05,respectively).In the treatment group,postoperative plasma MTL was significantly higher(P < 0.01) and VIP was significantly lower than those in the control group(P < 0.05).There was no difference found in either MTL or VIP from before to after operation in the treatment group(P > 0.05).MTL was significantly lower and VIP was higher postoperatively in the control group,compared to before surgery(P < 0.01).CONCLUSION:Modified DCQT effectively improved decreased gastrointestinal motility in postoperative esophageal cancer patients by increasing MTL and reducing VIP.

Effects of Sijunzi Dripping Pill on Gastrointestinal Motility of Mice

Objective To study the effects of Sijunzi Dripping Pill（SDP）on gastrointestinal motilityof mice.Methods The diarrhea and swimming model of mice was made by Rhei Radixet Rhizoma-induced spleen deficiency.The intestinal transit,gastric emptying test,serum motilin（MTL）,vasoactive intestinal peptide（VIP）,and substance P（SP）were chosen to observe the effects of high-,mid-,and low-dose SDP on stomach movements,and the water extractive of Sijunzi Decoction was used as positive control.Results Compared with the control group,the gastric emptying rate in the gastrointestinal motility group was significantly decreased,the intestinal propulsion rate was obviously increased,the levels of MTL,prostaglandin E2（PGE2）,and SP were increased（P〈0.05）,while the level of VIP was decreased（P〈0.05）.Compared with the model group,SDP could decrease the intestinal transit rate,whereas increase the gastric emptying rate and the level of MTL（P〈0.05）;The high-dose SDP could decrease the level of PGE2（P〈0.05）and the low-dose SDP could decrease the level of VIP（P〈0.05）;Each group had no significant effect on SP.Conclusion SDP has the good effect on increasing the gastrointestinal motility of mice,and its function may partly relate to the regulation of the levels of MTL and VIP as well as PGE2.

Foundation and Clinical Research on the Effect of Traditional Chinese Herbs on Gastrointestinal Motility

Gastric dyskinesis functional dyspepsia is a commonly clinical condition characterized as epigastric discomfort,distension after meals,early satiety and belching,which are commonly associated with the dysfunction of gastrointestinal motility.

Expression of motilin in the hypothalamus and the effect of central eryth-romycin on gastric motility in diabetic rats

Objective To investigate the expression of motilin-immunoreactive neurons in the hypothalamus and the effect of central administration of erythromycin （EM） on the regulation of gastric motility in diabetic rats. Methods The motilin immunoreactive neurons in the hypothalamus and the hippocampus were detected by immunohistochemistry with rabbit anti-motilin polyclonal antibody. To measure the gastric motility, force transducers were surgically affixed to the gastric serosa. A microinjection syringe was connected via a plastic tube to an injection cannula, which was connected with a stainless steel guide cannula. The syringe was inserted into the right lateral cerebral ventricle for microinjecting the chemicals. Results Diabetic mellitus was successfully induced in cohorts of rats. Motilin-immunoreactive neurons significantly increased in the paraventricular （PVN） and supraoptic nuclei （SON） of the hypothalamus in the diabetic rats. Intracerebroventricular （i.c.v.） administration of EM, a motilin receptor agonist, stimulated the gastric motility of diabetic rats. EM （91.56 nmol, i.c.v.） dose-dependently increased the amplitude by （174.82±48.62）% （P 〈 0.05）, and increased the frequency by （70.43±27.11）% （P 〈 0.05） in 5 min. The stimulatory effect lasted more than 15 min to the end of the measurement, and can be blocked partially by the prior treatment of motilin receptor antagonist GM-109. Conclusion Motilin-immunoreactive neurons are increased in the PVN and SON of the hypothalamus in diabetic rats. Centrally administered EM may regulate gastric motility by binding to the central motilin receptors, and central motilin might be involved in regulation of gastric motility in diabetic rats.

Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy

AIM: To explore the mechanisms of uncut Roux-en-Y gastrojejunostomy, which is used to decrease the occurrence of Roux stasis syndrome.METHODS: The changes of myoelectric activity, mechanic motility and interstitial cells of Cajal (ICC) of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy were observed. RESULTS: When compared with the cut group, the amplitude (1.15 ± 0.15 mV vs 0.48 ± 0.06 mV, P < 0.05) and frequency (14.4 ± 1.9 cpm vs 9.5 ± 1.1 cpm, P < 0.01) of slow waves and the incidence (98.2% ± 10.4% vs 56.6% ± 6.4%, P < 0.05) and amplitude (0.58 ± 0.08 mV vs 0.23 ± 0.06 mV, P < 0.01) of spike potential of the Roux limb in the uncut group were significantly higher. The migrating myoelectric complexes (MMC) phase Ⅲ duration in the uncut group was significantly prolonged (6.5 ± 1.1 min vs 4.4 ± 0.8 min, P < 0.05), while the MMC cycle obviously shortened (42.5 ± 6.8 vs 55.3 ± 8.2 min, P < 0.05). Both gastric emptying rate (65.5% ± 7.9% vs 49.3% ± 6.8%, P < 0.01) and intestinal impelling ratio (53.4% ± 7.4% vs 32.2% ± 5.4%, P < 0.01) in the uncut group were significantly increased. The contractile force index of the isolated jejunal segment in the uncut group was significantly higher (36.8 ± 5.1 vs 15.3 ± 2.2, P < 0.01), and the expression of c-kit mRNA was significantly increased in the uncut group (0.82 ± 0.11 vs 0.35 ± 0.06, P < 0.01). CONCLUSION: Uncut Roux-en-Y gastrojejunostomymay lessen the effects of operation on myoelectric activity such as slow waves, spike potential, and MMC, decrease the impairment of gastrointestinal motility, and remarkably increase the expression of c-kit mRNA.