Upper and lower gastrointestinal motor and sensory dysfunction after human spinal cord injury

Enck, Paul; Greving, I.; Klosterhalfen, Sibylle; Wietek, Beate

doi:10.1016/s0079-6123(05)52025-9

Cited by 26 publications

(11 citation statements)

References 39 publications

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“…This may be partially explained by the work of Gondim et al (14), who showed less inhibition of gastric emptying if large bowel emptying has occurred. Enck et al (15) also found that reduced gastric emptying may be attributable to a cologastric inhibitory reflex triggered by delayed colonic emptying.…”

Section: Introductionmentioning

confidence: 96%

Gastric Dysmotility After Abdominal Surgery in Persons With Cervical Spinal Cord Injury: A Case Series

Pacheco

Garstang

2007

The Journal of Spinal Cord Medicine

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Background: Spinal cord injury (SCI) has been found to affect the physiology of the gastrointestinal tract. Changes in gastric motility occur in tetraplegia because of dissociation of antral and duodenal motility. Among individuals with high-level tetraplegia, antral quiescence has been hypothesized as a manifestation of autonomic dysreflexia after surgery. This case series shows the issues with gastric hypomotility after gastrointestinal surgery in tetraplegic patients with tetraplegia, including management strategies. Objective: To report 3 patients with complete high cervical SCI who developed gastroparesis after abdominal surgery and discuss the effect of autonomic dysfunction on gastric motility. Methods: Retrospective chart review of 3 cases. Results: Gastroparesis occurred after abdominal surgery in 3 patients with C4 American Spinal Injury Association (ASIA) A tetraplegia and seemed to be a sign of autonomic hyperreflexia caused by postoperative pain. Management was challenging because it consisted of balancing of appropriate pain medication and dealing with absorption issues and dysmotility. Often gastric motility agents were not effective in improving gastric emptying. However, increased use of pain medication improved gastric emptying, which supports the hypothesis that this issue represents gastric dysfunction from autonomic hyperreflexia. Conclusions: In persons with complete cervical SCI who have undergone abdominal surgery, postoperative gastroparesis can be a manifestation of pain. This may occur as the excessive sympathetic response from autonomic hyperreflexia inhibits distal antral activity. Thus, treatment of postoperative gastroparesis should focus on improved pain control to decrease excessive splanchnic sympathetic output and circulating norepinephrine.

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Section: Introductionmentioning

confidence: 96%

Gastric Dysmotility After Abdominal Surgery in Persons With Cervical Spinal Cord Injury: A Case Series

Pacheco

Garstang

2007

The Journal of Spinal Cord Medicine

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“…For example, acute and often chronic psychological stress is expected because of the sudden and dramatic life changes experienced by someone with an SCI (Boekamp et al, 1996; Elliott and Frank, 1996). Neurogenic bladder and bowel develop after SCI as a result of damage to spinal autonomic circuitry (Chung and Emmanuel, 2006; Enck et al, 2006; Karlsson, 2006; Riegger et al, 2007, 2009). SCI-induced dysautonomia also impairs immune function, increasing the need for repeat dosing with antibiotics to fight infections (Evans et al, 2011, 2013; Failli et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Gut dysbiosis impairs recovery after spinal cord injury

Kigerl

Hall

Wang

et al. 2016

Journal of Experimental Medicine

255

259

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“…The bowel dysfunction in SCI may be caused by motor and sensory deficits that affect the peripheral and autonomic nervous system 8 . The varied presentation of bowel symptoms could be a consequence of complex interactions between the neural injury, gut innervation and pelvic viscera.…”

Section: Introductionmentioning

confidence: 99%

Translumbar and Transsacral Motor-Evoked Potentials: A Novel Test for Spino-Anorectal Neuropathy in Spinal Cord Injury

Tantiphlachiva

Attaluri

Valestin

et al. 2011

American Journal of Gastroenterology

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Introduction Spinal cord injury (SCI) causes anorectal problems, whose pathophysiology remains poorly characterized. A comprehensive method of evaluating spino-anorectal function is lacking. Aim To investigate the neuropathophysiology of bowel dysfunction in SCI by evaluating motor evoked potentials (MEP) of anus and rectum following trans-spinal magnetic stimulation and anorectal physiology. Methods Translumbar and transsacral magnetic stimulations, anorectal manometry and pudendal nerve latency (PNTML) were performed in 39 subjects with SCI and anorectal problems and 14 healthy controls and data were compared. MEPs were recorded with an anorectal probe containing bipolar ring electrodes. Results The MEPs were significantly prolonged (p<0.05) bilaterally, and at lumbar and sacral levels, and at rectal and anal sites in SCI subjects compared to controls. 95% of SCI subjects had abnormal MEPs; 53% had abnormal PNTML. All subjects with abnormal PNTML also demonstrated abnormal MEP, but 16/17 subjects with normal PNTML had abnormal MEP. Overall SCI patients had weaker anal sphincters (p<0.05), higher prevalence of dyssynergia (85%) and altered rectal sensation (82%). Conclusions Translumbar and transsacral MEPs revealed significant and hitherto undetected lumbo-sacral neuropathy in 90% of SCI subjects. Test was safe and provided neuropathophysiological information that could explain bowel dysfunction in SCI subjects.

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Upper and lower gastrointestinal motor and sensory dysfunction after human spinal cord injury

Cited by 26 publications

References 39 publications

Gastric Dysmotility After Abdominal Surgery in Persons With Cervical Spinal Cord Injury: A Case Series

Gastric Dysmotility After Abdominal Surgery in Persons With Cervical Spinal Cord Injury: A Case Series

Gut dysbiosis impairs recovery after spinal cord injury

Translumbar and Transsacral Motor-Evoked Potentials: A Novel Test for Spino-Anorectal Neuropathy in Spinal Cord Injury

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