Intestinal tachyarrhythmias during small bowel ischemia

Seidel, Scott A.; Hegde, Sanjay S.; Bradshaw, Leonard A.; Ladipo, J K; Richards, William O.

doi:10.1152/ajpgi.1999.277.5.g993

Cited by 32 publications

(30 citation statements)

References 11 publications

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“…Sarna and Otterson (23) described the occurrence of what they labeled amyogenesia (abolition of slow waves) and dysmogenesia (irregular slow waves) in dogs upon infusion by morphine or loperamide and related them to cardiac and skeletal muscle fibrillation. Intestinal ischemia in the rabbit has been shown to induce tachyarrhythmia (27) and, in an inflammation-induced motor dysfunction in the mouse small intestine, a patchwork of electrical quiescence occurring next to areas with normal or high-frequency slow wave activity were noted (5). Most recently, a tachyduodenia was detected in a patient suffering from a mitochondrial encephalomyopathy (25).…”

Section: Discussionmentioning

confidence: 99%

Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats

Lammers¹,

Stephen²,

Karam

2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Lammers WJ, Stephen B, Karam SM. Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats. Am J Physiol Gastrointest Liver Physiol 302: G684 -G689, 2012. First published December 29, 2011; doi:10.1152/ajpgi.00332.2011.-In a few recent studies, the presence of arrhythmias based on reentry and circus movement of the slow wave have been shown to occur in normal and diseased stomachs. To date, however, reentry has not been demonstrated before in any other part of the gastrointestinal system. No animals had to be killed for this study. Use was made of materials obtained during the course of another study in which 11 rats were treated with streptozotocin and housed with age-matched controls. After 3 and 7 mo, segments of duodenum, jejunum, and ileum were isolated and positioned in a tissue bath. Slow wave propagation was recorded with 121 extracellular electrodes. After the experiment, the propagation of the slow waves was reconstructed. In 10 of a total of 66 intestinal segments (15%), a circus movement of the slow wave was detected. These reentries were seen in control (n ϭ 2) as well as in 3-mo (n ϭ 2) and 7-mo (n ϭ 6) diabetic rats. Local conduction velocities and beat-to-beat intervals during the reentries were measured (0.42 Ϯ 0.15 and 3.03 Ϯ 0.67 cm/s, respectively) leading to a wavelength of 1.3 Ϯ 0.5 cm and a circuit diameter of 4.1 Ϯ 1.5 mm. This is the first demonstration of a reentrant arrhythmia in the small intestine of control and diabetic rats. Calculations of the size of the circuits indicate that they are small enough to fit inside the intestinal wall. Extrapolation based on measured velocities and rates indicate that reentrant arrhythmias are also possible in the distal small intestine of larger animals including humans. slow wave; diabetes; wavelength THE SMOOTH MUSCLE LAYER OF the gastrointestinal (GI) tract generates spontaneous electrical activities that are referred to as "slow waves." These slow waves are dependent on the interstitial cells of Cajal in the myenteric plexus (ICC-MY) and are important for maintaining normal GI motility (8, 9).In a recent study, we investigated the propagation of slow waves in a streptozotocin (STZ) model of diabetes in rats. The purpose of that study was to correlate the expected decrease in slow wave propagation with the reported decrease in the census of ICC-MY in the small intestine (8,10,20,30). To our initial surprise, we did not measure a significant decrease in slow wave propagation although there was a reduction in the number of ICC-MY by ϳ50% (10). We concluded from that study that the reduction of ICC-MY was not enough to block slow wave propagation.Further analysis of the propagation in both control and in 3-and 7-mo diabetic rats, however, revealed another unexpected result. In ϳ15% of the segments, slow wave propagation did not originate from one or a few foci (10, 11). Instead, the slow wave was seen to propagate in a circular fashion for relatively long periods of time, whereby the impulse could rotate ...

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Section: Discussionmentioning

confidence: 99%

Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats

Lammers¹,

Stephen²,

Karam

2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Frequencies ranged from 25 to 50 cpm. These tachyarrhythmias were seen only during ischemia, suggesting that they are pathognomonic for intestinal ischemia [44]. In patients with intestinal idiopathic pseudo-obstruction, responses of intestinal myoelectrical activity to distention was found to be altered [45].…”

Section: Intestinal Slow-wave Dysrhythmiamentioning

confidence: 95%

“…However, a number of studies did report intestinal slowwave dysrhythmia in a number of clinical settings such as nausea and vomiting, intestinal pseudo-obstruction and intestinal ischemia [45,[55][56][57][58][59]. Abnormalities in intestinal slow waves include dysrhythmia, reduced frequency, and uncoordinated slow waves along the intestine, and are associated with impaired intestinal contractions [42,44].…”

Section: Effects On Intestinal Slow-wave Dysrhythmiamentioning

confidence: 99%

Mechanisms and Potential Applications of Intestinal Electrical Stimulation

Yin¹,

Chen²

2009

Dig Dis Sci

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It is concluded that intestinal electrical stimulation may have promising applications for treating motility disorders associated with altered intestinal contractile activity. The most recent studies have revealed possible applications of intestinal electrical stimulation for the treatment of obesity. Basic research results are promising; however, further clinical studies are needed to bring IES from bench to bedside.

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“…Serum assays such as D-dimers [112][113][114] , alcohol dehydrogenase [115] , glutathione S-transferase [116] and cobalt-albumin binding [117] , and measurement of pH and potassium in peritoneal irrigation fluid [118] , as well as liver tissue oxygenation index [119] are good examples of current research. Seidel et al showed that mesenteric electrical activity may detect mesenteric ischemia with a high degree of sensitivity and specificity [120] . However, promising studies in animals remain to be validated under clinical conditions.…”

Section: Perspectives For the Futurementioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Intestinal tachyarrhythmias during small bowel ischemia

Cited by 32 publications

References 11 publications

Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats

Functional reentry and circus movement arrhythmias in the small intestine of normal and diabetic rats

Mechanisms and Potential Applications of Intestinal Electrical Stimulation

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

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