Neural and humoral factors in postoperative ileus

Rennie, John; Christofides, Nicos; Mitchenere, P.; Fletcher, David; Stockley‐Leathard, Helen L.; Bloom, Steve; Johnson, A. G.; Rains, A. J. Harding

doi:10.1002/bjs.1800671005

Cited by 36 publications

(11 citation statements)

References 17 publications

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“…14) Clinically, it has been also reported that the blood motilin concentration is reduced in patients after laparotomy and postoperative ileus is improved as soon as the blood motilin concentration begins to recover from the early postoperative levels. 15,16) The amino acid sequence of human motilin remained unclear for a long time after the discovery of porcine motilin, but in 1987 was found to be identical to that of porcine motilin. 17) We thought that motilin may be useful for the treatment of gastroparalysis due to the pharmacological actions mentioned above.…”

mentioning

confidence: 99%

Effects of SK-896, a New Human Motilin Analogue ([Leu13]motilin-Hse), on Postoperative Ileus in Dogs after Laparotomy.

Furuta

Takeda

Nakayama

et al. 2002

Biological & Pharmaceutical Bulletin

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The effects of SK-896, a new human motilin analogue ([Leu 13 ]motilin-Hse), on digestive tract motility in postoperative ileus were evaluated in a dog model of ileus after laparotomy. SK-896 was intravenously administered at 0.17, 0.33 and 0.67 m mg/kg starting soon after operation and then at 6-h intervals, for a total of 9 times. SK-896 progressively, dose-dependently and significantly increased the duodenal motility from 1 h after operation. The recovery time of the gastrointestinal-interdigestive migrating complex (GI-IMC) activity, which is an indicator of normal gastrointestinal tract activity after laparotomy, was 56.5؎5.0 h in the control group. SK-896 significantly shortened this recovery time. On the other hand, the plasma SK-896 concentrations declined diexponentially after administration, and can be described by a linear pharmacokinetic model within the dose range used. In addition, the pharmacokinetics of SK-896 did not change significantly at any postoperative time. There was no correlation between the plasma SK-896 concentrations and the intensity of duodenal motility, because the activity in the duodenum decreased transiently 13 h after laparotomy and increased with time thereafter. The changes in the activity are considered to reflect the progressive changes in the state of ileus. In conclusion, SK-896 increased the duodenal motility significantly, shortening the recovery time of GI-IMC-like activity in dogs with post-laparotomy ileus. Therefore, it is expected from these results that SK-896 would be useful and effective for the treatment of gastroparalysis after abdominal surgery.

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mentioning

confidence: 99%

Effects of SK-896, a New Human Motilin Analogue ([Leu13]motilin-Hse), on Postoperative Ileus in Dogs after Laparotomy.

Furuta

Takeda

Nakayama

et al. 2002

Biological & Pharmaceutical Bulletin

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“…20,37,38 This was present at a range of frequencies, usually reported as 2-9 cpm, 9-14 cpm, and occasionally a high range of 20-28 cpm. 20,28,37,39 The dominant frequency identified varied by anatomical location; 2 studies reported 3 cpm activity in the sigmoid colon, 40,41 whereas other studies found that 9-14 cpm slow wave frequencies predominate in the right, transverse, and left colon during the first few days post-operatively. 20,28,37,38 Analyses of slow wave frequencies over time showed conflicting results.…”

Section: Transit Studiesmentioning

confidence: 99%

Colonic Electromechanical Abnormalities Underlying Post-operative Ileus: A Systematic and Critical Review

Wells

O’Grady

Bissett

2019

J Neurogastroenterol Motil

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Post-operative ileus (POI) is an inevitable consequence of major abdominal surgery, and may be prolonged in up to 30% of patients. Ileus is commonly presumed to result from paralysis of the GI tract, though there is little direct evidence to support this view. The aim of this review is to systematically search and critically review the literature investigating post-operative colonic electrical and mechanical activity. MEDLINE and Embase databases were systematically searched for articles investigating post-operative colonic motor or electrical activity in human patients. Nineteen original articles investigating post-operative colonic motor or electrical activity were identified. Most studies have used low-resolution techniques, with intermittent recordings of colonic motility. Numerous studies have shown that colonic electrical and motor activity does not cease routinely following surgery, but is of abnormal character for 3–6 days following laparotomy. One recent high-resolution manometry study identified hyperactive cyclic motor patterns occurring in the distal colon on the first post-operative day. Low-resolution studies have shown colonic slow waves are not inhibited by surgery, and are present even in the immediate post-operative period. Recovery of normal motility appears to occur in a proximal to distal direction and is temporally correlated with the clinical return of bowel function. No studies have investigated motility specifically in prolonged POI. Future studies should use high-resolution techniques to accurately characterise abnormalities in electrical and mechanical function underlying POI, and correlate these changes with clinical recovery of bowel function.

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“…This might be responsible for the reduced duration and the retrograde migration of phase III of the MMC. The return of motilin to normal levels correlates with the resolution of ileus [50,51]. While sympathetic activation and the neurohumoral stress response have their onset immediately after surgery, inflammation of the gastrointestinal wall develops over several hours after the surgical intervention.…”

Section: Etiology Of "Normal" Postoperative Ileusmentioning

confidence: 99%

Gastrointestinal motility in acute illness

Fruhwald

Holzer

Metzler

2008

Wien Klin Wochenschr

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Critical illness affects gastrointestinal motility - not only as a primary problem, which brings the patient to the intensive care unit (ICU), but also as a complication consecutive to the ICU stay. Motility disturbances may result from impaired function of gastrointestinal muscle, pacemaker cell function and nerve activity. The most important neural control system is the enteric nervous system that contains the largest collection of neurons (10(8) cells) outside the central nervous system. Through its organization it can operate independently of the brain and generate motility patterns according to need: a postprandial motility pattern starting after food intake, and an interdigestive motility pattern starting several hours after a meal. Undisturbed intestinal motility depends critically on a balanced interaction between inhibition and excitation, and a disturbance in this balance leads to severe derangements of intestinal motility. These motility disturbances differ in clinical appearance and location but can affect all parts of the gastrointestinal tract. This review focuses on select motility disturbances such as gastroparesis, postoperative ileus, and Ogilvie's syndrome. Generally effective methods to treat these conditions are given. Finally, we focus on special management options to prevent such motility disturbances or to reduce their severity.

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Neural and humoral factors in postoperative ileus

Cited by 36 publications

References 17 publications

Effects of SK-896, a New Human Motilin Analogue ([Leu13]motilin-Hse), on Postoperative Ileus in Dogs after Laparotomy.

Effects of SK-896, a New Human Motilin Analogue ([Leu13]motilin-Hse), on Postoperative Ileus in Dogs after Laparotomy.

Colonic Electromechanical Abnormalities Underlying Post-operative Ileus: A Systematic and Critical Review

Gastrointestinal motility in acute illness

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