The Sphincter of O’Beirne—Part 2: Report of a Case of Chronic Constipation with Autonomous Dyssynergia

Chen, Jihong; Collins, Stephen M.; Milkova, Natalija; Pervez, Maham; Nirmalathasan, Sharjana; Tan, Wei; Hanman, Alicia; Huizinga, Jan D.

doi:10.1007/s10620-020-06723-3

Cited by 12 publications

(17 citation statements)

References 53 publications

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“…In addition, the cholinergic output from the parasympathetic nerves stimulates the intrinsic nitrergic nerves (127). Furthermore, the parasympathetic nerves innervate Onuf's nucleus to inhibit pudendal nerve activity to relax the external anal sphincter (128). Relaxation begins with stretch-activated ion channels found in ICC-IM in the rectum as shown in mice (129), similar to that observed in the proximal colon of mice (130).…”

Section: The Internal Anal Sphinctermentioning

confidence: 53%

Interstitial cells of Cajal and human colon motility in health and disease

Huizinga

Hussain

Chen

2021

American Journal of Physiology-Gastrointestinal and Liver Physi

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Our understanding of human colonic motility, and autonomic reflexes that generate motor patterns, has increased markedly through high-resolution manometry. Details of the motor patterns are emerging related to frequency and propagation characteristics that allow linkage to interstitial cells of Cajal (ICC) networks. In studies on colonic motor dysfunction requiring surgery, ICC are almost always abnormal or significantly reduced. However, there are still gaps in our knowledge about the role of ICC in the control of colonic motility and there is little understanding of a mechanistic link between ICC abnormalities and colonic motor dysfunction. This review will outline the various ICC networks in the human colon and their proven and likely associations with the enteric and extrinsic autonomic nervous systems. Based on our extensive knowledge of the role of ICC in the control of gastrointestinal motility of animal models and the human stomach and small intestine, we propose how ICC networks are underlying the motor patterns of the human colon. The role of ICC will be reviewed in the autonomic neural reflexes that evoke essential motor patterns for transit and defecation. Mechanisms underlying ICC injury, maintenance, and repair will be discussed. Hypotheses are formulated as to how ICC dysfunction can lead to motor abnormalities in slow transit constipation, chronic idiopathic pseudo-obstruction, Hirschsprung's disease, fecal incontinence, diverticular disease, and inflammatory conditions. Recent studies on ICC repair after injury hold promise for future therapies.

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Section: The Internal Anal Sphinctermentioning

confidence: 53%

Interstitial cells of Cajal and human colon motility in health and disease

Huizinga

Hussain

Chen

2021

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Assessment of the coloanal reflex with high-resolution colonic manometry, can identify distal colon discoordination and dyssynergia, when the anal sphincters fail to relax in association with propulsive motor patterns or when excessive contraction of the anal sphincters and/or the sphincter of O'Beirne is observed ( 36 ). The sphincter of O'Beirne is the specialized musculature at the rectosigmoid junction that can play a critical role in constipation ( 19 , 36 ). The voluntary contraction of the EAS can be evoked as a reaction to an urge to defecate following the generation of an HAPW or the arrival of a SPW into the rectum, to maintain continence.…”

Section: The Coloanal Reflexmentioning

confidence: 99%

“…The voluntary contraction of the EAS can be evoked as a reaction to an urge to defecate following the generation of an HAPW or the arrival of a SPW into the rectum, to maintain continence. However, excessive, aberrant autonomous contraction of anal sphincters, pelvic floor muscles, and/or the sphincter of O'Beirne that prevent reflex relaxation, constitutes autonomous dyssynergia ( 36 ). The RAIR, on the other hand, is a response to a c onscious experience of rectal distention that can also reveal dyssynergia.…”

Section: The Coloanal Reflexmentioning

confidence: 99%

Distal Colon Motor Coordination: The Role of the Coloanal Reflex and the Rectoanal Inhibitory Reflex in Sampling, Flatulence, and Defecation

et al. 2021

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“…CMPs are thought to be responsible for the 'rectosigmoid brake', acting to limit rectal lling and contributing to the control of continence (8,9). Altered CMPs have been implicated in the pathophysiology of constipation (10,11) and low anterior resection syndrome (12). Hyperactive CMPs have previously been observed intra-operatively while patients are under general anaesthesia for abdominal surgery, potentially representing a novel effect of the surgical stress response (13,14).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Serosal Extracellular Mapping of the Human Distal Colon: A Feasibility Study

Lin

Varghese

et al. 2021

Preprint

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Background:Cyclic motor patterns (CMP) are the predominant motor pattern in the distal colon, and are important in both health and disease. Their origin, mechanism and relation to bioelectrical slow-waves remain incompletely understood. During abdominal surgery, an increase in the CMP occurs in the distal colon. This study aimed to evaluate the feasibility of detecting propagating slow waves and spike waves in the distal human colon through intraoperative, high-resolution (HR), serosal electrical mapping. Methods:HR electrical recordings were obtained from the distal colon using validated flexible PCB arrays (6 x 16 electrodes; 4 mm inter-electrode spacing; 2.4 cm2, 0.3 mm diameter) for up to 15 minutes. Passive unipolar signals were obtained and analysed.Results:Eleven patients (33-71 years; six females) undergoing colorectal surgery under general anaesthesia (4 with epidurals) were recruited. After artifact removal and comprehensive manual and automated analytics, events consistent with regular propagating activity between 2-6 cpm were not identified in any patient. Intermittent clusters of spike-like activities lasting 10-180 s with frequencies of each cluster ranging between 24-42 cpm, and an average amplitude of 0.54 ± 0.37 mV were recorded.Conclusions:Intra-operative colonic serosal mapping in humans is feasible, but unlike in the stomach and small bowel, revealed no regular propagating electrical activity, although sporadic, synchronous spike-wave events were identifiable. Alternative techniques are required to characterise the mechanisms underlying the hyperactive CMP observed in the intra- and post-operative period.

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The Sphincter of O’Beirne—Part 2: Report of a Case of Chronic Constipation with Autonomous Dyssynergia

Cited by 12 publications

References 53 publications

Interstitial cells of Cajal and human colon motility in health and disease

Interstitial cells of Cajal and human colon motility in health and disease

Distal Colon Motor Coordination: The Role of the Coloanal Reflex and the Rectoanal Inhibitory Reflex in Sampling, Flatulence, and Defecation

Intraoperative Serosal Extracellular Mapping of the Human Distal Colon: A Feasibility Study

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