Gastrointestinal Motility Disorders in Patients with Inactive Crohn's Disease

Annese, Vito; Bassotti, Gabrio; Napolitano, G.; Usai, Paolo; Andriulli, Angelo; Vantrappen, Gaston

doi:10.3109/00365529709002989

Cited by 120 publications

(85 citation statements)

References 34 publications

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“…39 Plasma motilin levels are also significantly elevated among human patients with inflammatory bowel disease or Crohn's disease. 31,50 These findings are consistent with evidence that implicates motilin in diarrheal diseases. 51,52 Among humans, there is evidence that colicky infants have higher serum motilin levels than do infants without colic.…”

Section: Linkage Of High Intestinal Motilin Levels With Higher Risk Osupporting

confidence: 81%

Maternal Smoking and Infantile Gastrointestinal Dysregulation: The Case of Colic

Shenassa¹,

Brown

2004

Pediatrics

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ABSTRACT. Background. Infants' healthy growth and development are predicated, in part, on regular functioning of the gastrointestinal (GI) tract. In the first 6 months of life, infants typically double their birth weights. During this period of intense growth, the GI tract needs to be highly active and to function optimally. Identifying modifiable causes of GI tract dysregulation is important for understanding the pathophysiologic processes of such dysregulation, for identifying effective and efficient interventions, and for developing early prevention and health promotion strategies. One such modifiable cause seems to be maternal smoking, both during and after pregnancy.Purpose. This article brings together information that strongly suggests that infants' exposure to tobacco smoke is linked to elevated blood motilin levels, which in turn are linked to an increased risk of GI dysregulation, including colic and acid reflux. We base this hypothesis on evidence supporting a link between maternal smoking and infantile colic (IC) and on additional evidence proposing increased motilin release, attributable to exposure to tobacco smoke and its metabolites, as a physiologic mechanism linking maternal smoking with infantile GI dysregulation.Methods. We critically review and synthesize epidemiologic, physiologic, and biological evidence pertaining to smoking and colic, smoking and motilin levels, and motilin and colic.Results. Six studies have investigated the link between maternal smoking and IC, but IC was defined according to Wessel's rule of threes (crying for >3 hours per day, >3 days per week, for >3 weeks) in only 1 of these studies. The remaining studies used definitions that ranged from less-stringent variations of Wessel's criteria to definitions that would suggest excessive crying but not necessarily colic. Results from 5 of these studies suggest that there is an independent association between maternal smoking and excessive crying, as well as IC. Recent studies of the GI system provide strong, but indirect, corroborating evidence suggesting physiologic pathways through which maternal smoking can be linked to IC. This physiologic evidence can be outlined as follows: (1) smoking is linked to increased plasma and intestinal motilin levels and (2) higher-than-average levels of motilin are linked to elevated risks of IC. Although these findings from disparate fields suggest a physiologic mechanism linking maternal smoking with IC, the entire chain of events has not been examined in a single cohort. A prospective study, begun in pregnancy and continuing through the first 4 months of life, could provide definitive evidence linking these disparate lines of research. Key points for such a study are considered.Conclusions. New epidemiologic evidence suggests that exposure to cigarette smoke and its metabolites may be linked to IC. Moreover, studies of the GI system provide corroborating evidence that suggests that (1) smoking is linked to increased plasma and intestinal motilin levels and (2) higher-than-average intesti...

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Section: Linkage Of High Intestinal Motilin Levels With Higher Risk Osupporting

confidence: 81%

Maternal Smoking and Infantile Gastrointestinal Dysregulation: The Case of Colic

Shenassa¹,

Brown

2004

Pediatrics

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“…Several disturbances of gut function have been demonstrated in IBD, such as changes in sensory perception (Farthing & Lennard-Jones, 1978;Rao et al, 1987) and changes in gut motility (Snape et al, 1980;Loening-Baucke et al, 1989;Koch et al, 1990;Annese et al, 1997;Chrysos et al, 2001). These ®ndings re¯ect both in¯ammation-induced changes in the responsiveness of the smooth muscle and nerves.…”

Section: Introductionmentioning

confidence: 99%

Generalized loss of inhibitory innervation reverses serotonergic inhibition into excitation in a rabbit model of TNBS‐colitis

Depoortere¹,

Thijs²,

Peeters³

2002

British J Pharmacology

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1 In¯ammation may a ect subpopulations of neurons of the myenteric plexus. 2 In the present study the e ect of trinitrobenzene sulphonic acid (TNBS) induced colitis on nitrergic, purinergic and adrenergic inhibitory neurotransmission was studied as well as the consequences of the related changes on the response of 5-HT agonists using these neurotransmitters to mediate their e ect. 3 Strips from normal and colitis rabbits (135 mg kg 71 TNBS) were subjected to electrical ®eld stimulation (EFS, 0.3 ms, 6V, 0.5 ± 32 Hz, 10 s train). The response was measured isometrically in the absence or presence of L-NAME, suramin, guanethidine, the 5-HT agonists (5-HT 1/5A/7 : 5-carboxamidotryptamine (5-CT), 5-HT 2 : a-methyl-5-HT, 5-HT 3 : 2-methyl-5-HT, 5-HT 4 : 5-methoxytryptamine (5-MeOT)) or a combination. 4 In normal strips L-NAME (1 ± 32 Hz), suramin (0.5 ± 2, 8 Hz) and guanethidine (4, 16, 32 Hz) increased the response to EFS. This e ect was abolished in in¯amed strips and was accompanied by a decrease in nNOS expression. 5 In normal strips all 5-HT agonists induced pronounced (5-CT, a-methyl-5-HT) or small (2-methyl-5-HT, 5-MeOT) inhibitory neural responses. In in¯amed strips this was reversed to cholinergic excitatory responses.6 The e ect of in¯ammation on the 5-HT 4 response was mimicked by preincubation of normal strips with L-NAME or suramin. Accordingly, in in¯amed strips L-NAME or suramin did not a ect the excitatory e ects of 5-MeOT. 7 TNBS-colitis abolishes nitrergic, purinergic and adrenergic neurotransmission. This reverses serotonergic inhibition into excitation.

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“…Several studies have detected similar colonic motility patterns in quiescent IBD than those described in IBS (higher number of low-amplitude propagated contractions) [62][63][64] . Subtle changes in antroduodenal motility in quiescent CD have also been described [65] .…”

Section: Ibd Induces Dysmotilitymentioning

confidence: 98%

Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

Teruel

Garrido

Mesonero

2016

WJGPT

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it in the present work. We describe a problematic that comprises physiopathological uncertainties, diagnostic difficulties, as IBS-like symptoms are very similar to those produced by an inflammatory flare, and the necessity of appropriate management of these patients, who, although in remission, have impaired quality of life. Ultimately, from almost a philosophical point of view, the presence of IBS-like symptoms in IBD patients in remission supposes a challenge to the traditional functional-organic dichotomy, suggesting the need for a change of paradigm. Core tip: Many inflammatory bowel disease patients in remission suffer from ongoing gastrointestinal symptoms that resemble those of irritable bowel syndrome and that hinder their quality of life. We review the pathogenesis of these symptoms, their prevalence and the best management strategies. Author contributions: All authors contributed equally to this work. Conflict-of-interest statement:The authors declare no conflicts of interest. AbstractInflammatory bowel disease (IBD) patients in remission may suffer from gastrointestinal symptoms that resemble irritable bowel syndrome (IBS). Knowledge on this issue has increased considerably in the last decade, and it is our intention to review and summarize REVIEWSubmit a

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Gastrointestinal Motility Disorders in Patients with Inactive Crohn's Disease

Abstract: Most patients with inactive, uncomplicated Crohn's disease show marked gastrointestinal motor disorders, characterized either by reduced incidence of small-bowel contractions and increased incidence of single or clustered propagated contractions.

Cited by 120 publications

References 34 publications

Maternal Smoking and Infantile Gastrointestinal Dysregulation: The Case of Colic

Maternal Smoking and Infantile Gastrointestinal Dysregulation: The Case of Colic

Generalized loss of inhibitory innervation reverses serotonergic inhibition into excitation in a rabbit model of TNBS‐colitis

Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

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