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Aryeetey L, Hinkle AJ, Huerta S, Sambandam S. The Impact of Colostomy on Inpatient Outcomes Following Primary Total Knee Arthroplasty. Cureus 2024; 16:e65900. [PMID: 39092377 PMCID: PMC11292088 DOI: 10.7759/cureus.65900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The inpatient postoperative outcomes of patients with colostomies following primary total knee arthroplasty (TKA) have not been well studied in the literature. The purpose of this study was to analyze how colostomy impacts the immediate postoperative outcomes of TKA. Our null hypothesis is that after correcting for common variables, a colostomy does not predispose patients undergoing TKA to surgical site infections (SSIs) and periprosthetic infections. Methods The National Inpatient Sample database was used to retrieve information on colostomy patients and patients without a colostomy who had undergone primary TKA from 2016 to 2019. Patients with colostomies were matched to a cohort of non-colostomy control groups in a 1:1 propensity score algorithm by age, sex, race, and pertinent comorbidities. Patient demographic characteristics, comorbidities, length of hospital stay (LOS), total hospital charges, and inpatient complications were compared. Results Following propensity score matching, 399 patients with colostomies were compared to 385 patients without a colostomy (control). The colostomy group had a prolonged LOS (3.15 ± 2.67 vs 2.44 ± 3.15 days, p<0.001) compared to the control group. Also, the colostomy group had significantly higher incidences of acute kidney injury (AKI) (6.02% vs 1.56%, odds ratio (OR): 4.04, 95% confidence interval (CI): 1.63-10.00, p<0.001), blood loss anemia (20.55% vs 13.25%, OR: 1.69, 95% CI: 1.16-2.48, p=0.008), and blood transfusions (4.01% vs 0.26%, OR: 16.04, 95% CI: 2.12-121.56, p<0.001). There was no difference in periprosthetic infection, superficial SSI, or deep SSI. Conclusion Patients with colostomies face a notably higher risk of experiencing AKI, blood loss anemia, and blood transfusion requirements during the immediate postoperative period following primary TKA. Despite the perceived risk of postoperative infection in colostomy patients, this patient population is not at an increased risk of developing periprosthetic infection, superficial SSI, or deep SSI following TKA.
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Affiliation(s)
- Lemuelson Aryeetey
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Andrew J Hinkle
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sergio Huerta
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Senthil Sambandam
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
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2
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Evangelista RR, Silva Lopes B, Coutinho D, Moreira E, Silva A, Almeida PL, Ermida V, Caldas J, Gomes A, Carmezim I, Barreira V, Pinheiro-Guedes L. Subacute stroke: new-onset poststroke bladder and bowel dysfunctions and possible associated factors. Disabil Rehabil 2024; 46:1073-1081. [PMID: 36960634 DOI: 10.1080/09638288.2023.2189317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Bladder and bowel poststroke dysfunctions negatively impact patients' health. Stroke-related characteristics associated to these dysfunctions are poorly known. This study aims to estimate the prevalence of new-onset poststroke bladder and bowel dysfunctions, characterize their associated factors, and describe the dysfunctions' clinical approach. MATERIALS AND METHODS Cross-sectional study including 157 patients admitted to a single hospital's stroke unit with a first-ever stroke, during 3 months. An 18-item questionnaire was applied to assess dysfunctions pre and poststroke. The McNemar test was used to compare pre and poststroke prevalence. A logistic regression was used to estimate associations (OR, 95% CI) between individual characteristics and new-onset dysfunctions. RESULTS We had 113 (72%) respondents. There was a significant increase in the prevalence of bladder and bowel dysfunctions poststroke (p < 0.001). Higher stroke severity was significantly associated with both new-onset poststroke bladder and bowel dysfunctions (OR = 15.00, 95% CI [4.92,45.76] and OR = 5.87,95%CI [2.14,16.12], respectively). Total anterior circulation strokes, cardioembolic strokes, and lower functionality at discharge were also significantly associated with both dysfunctions. Thirteen patients (11.5%) reported that health professionals addressed these dysfunctions. CONCLUSIONS Poststroke bladder and bowel dysfunctions are highly prevalent. Being aware of their epidemiology helps draw attention to patients at higher risk of developing these dysfunctions, enhancing the rehabilitation process.IMPLICATIONS FOR REHABILITATIONPoststroke bladder and bowel dysfunctions are highly prevalent and under-recognised consequences of stroke.Being aware of their epidemiology and associated factors may help identify patients at higher risk of developing these dysfunctions.It is necessary to raise clinical awareness to ensure a more efficient diagnostic and therapeutic approach, enhancing patients' rehabilitation process, quality of life and lowering collateral societal burden.
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Affiliation(s)
| | - Bruno Silva Lopes
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - David Coutinho
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elisa Moreira
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Andreia Silva
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Leonel Almeida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Vera Ermida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Jorge Caldas
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ana Gomes
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ilídia Carmezim
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Viviana Barreira
- General Practice and Family Medicine, USF Horizonte, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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3
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Bokova E, Prasade N, Rosen JM, Lim IIP, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1558. [PMID: 37761519 PMCID: PMC10529947 DOI: 10.3390/children10091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. METHODS To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. RESULTS Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion. CONCLUSION Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - John M. Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Irene Isabel P. Lim
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20010, USA
| | - Rebecca M. Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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4
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Montanari M, Imbriani P, Bonsi P, Martella G, Peppe A. Beyond the Microbiota: Understanding the Role of the Enteric Nervous System in Parkinson's Disease from Mice to Human. Biomedicines 2023; 11:1560. [PMID: 37371655 DOI: 10.3390/biomedicines11061560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The enteric nervous system (ENS) is a nerve network composed of neurons and glial cells that regulates the motor and secretory functions of the gastrointestinal (GI) tract. There is abundant evidence of mutual communication between the brain and the GI tract. Dysfunction of these connections appears to be involved in the pathophysiology of Parkinson's disease (PD). Alterations in the ENS have been shown to occur very early in PD, even before central nervous system (CNS) involvement. Post-mortem studies of PD patients have shown aggregation of α-synuclein (αS) in specific subtypes of neurons in the ENS. Subsequently, αS spreads retrogradely in the CNS through preganglionic vagal fibers to this nerve's dorsal motor nucleus (DMV) and other central nervous structures. Here, we highlight the role of the ENS in PD pathogenesis based on evidence observed in animal models and using a translational perspective. While acknowledging the putative role of the microbiome in the gut-brain axis (GBA), this review provides a comprehensive view of the ENS not only as a "second brain", but also as a window into the "first brain", a potentially crucial element in the search for new therapeutic approaches that can delay and even cure the disease.
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Affiliation(s)
- Martina Montanari
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, 00143 Rome, Italy
- Department of Systems Neuroscience, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paola Imbriani
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, 00143 Rome, Italy
- Clinical Neuroscience, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Paola Bonsi
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, 00143 Rome, Italy
| | - Giuseppina Martella
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, 00143 Rome, Italy
| | - Antonella Peppe
- Clinical Neuroscience, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
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5
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Trzpis M, Sun G, Chen JH, Huizinga JD, Broens P. Novel insights into physiological mechanisms underlying fecal continence. Am J Physiol Gastrointest Liver Physiol 2023; 324:G1-G9. [PMID: 36283962 DOI: 10.1152/ajpgi.00313.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The machinery maintaining fecal continence prevents involuntary loss of stool and is based on the synchronized interplay of multiple voluntary and involuntary mechanisms, dependent on cooperation between motor responses of the musculature of the colon, pelvic floor, and anorectum, and sensory and motor neural pathways. Knowledge of the physiology of fecal continence is key toward understanding the pathophysiology of fecal incontinence. The idea that involuntary contraction of the internal anal sphincter is the primary mechanism of continence and that the external anal sphincter supports continence only by voluntary contraction is outdated. Other mechanisms have come to the forefront, and they have significantly changed viewpoints on the mechanisms of continence and incontinence. For instance, involuntary contractions of the external anal sphincter, the puborectal muscle, and the sphincter of O'Beirne have been proven to play a role in fecal continence. Also, retrograde propagating cyclic motor patterns in the sigmoid and rectum promote retrograde transit to prevent the continuous flow of content into the anal canal. With this review, we aim to give an overview of primary and secondary mechanisms controlling fecal continence and evaluate the strength of evidence.
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Affiliation(s)
- Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ge Sun
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ji-Hong Chen
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Canada
| | - Jan D Huizinga
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Canada
| | - Paul Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands.,Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
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6
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Miget G, Tan E, Pericolini M, Chesnel C, Haddad R, Turmel N, Amarenco G, Hentzen C. The Neurogenic Bowel Dysfunction score (NBD) is not suitable for patients with multiple sclerosis. Spinal Cord 2022; 60:1130-1135. [PMID: 35859189 DOI: 10.1038/s41393-022-00837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Bowel and anorectal dysfunctions are common in patients with multiple sclerosis (pwMS). The use of validated questionnaires is recommended in the initial assessment and patient's follow-up. The Neurogenic Bowel Dysfunction (NBD) score is the most used questionnaire but has been developed in spinal cord injured patients and has never been validated in other neurological diseases. We aimed to assess NBD's relevance in pwMS. SETTINGS Monocentric study in a tertiary neuro-urology department. METHODS A retrospective study in pwMS consulting for the first time in our department, that fulfilled the NBD questionnaire between 2010 and 2021 was performed. Qualitative and quantitative answers for each question were analyzed. Content validity and internal consistency were evaluated. RESULTS One hundred thirty-five pwMS (mean age 47.1, 58% of women) fulfilled the NBD questionnaire. Mean NBD score was 6.0 (SD 6.1) and 75% of patients had a score <9. Content validity analysis revealed 4 items not appropriate, 1 item with irrelevant calibration, and omission of some treatment widely used in pwMS. Internal consistency was appreciated with Cronbach's alpha = 0.48 IC 95% [0.31; 0.6]. CONCLUSION NBD questionnaire lacks content validity and presents a weak internal consistency in pwMS. A specific questionnaire is therefore required in pwMS to optimize bowel management and follow-up.
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Affiliation(s)
- Gabriel Miget
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.
| | - Eliane Tan
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Martina Pericolini
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.,Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", 00133, Rome, Italy
| | - Camille Chesnel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Rebecca Haddad
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Nicolas Turmel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Gérard Amarenco
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Claire Hentzen
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
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7
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Rodriguez GM, Gater DR. Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071141. [PMID: 35887638 PMCID: PMC9324073 DOI: 10.3390/jpm12071141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/02/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
People with spinal cord injury (SCI) suffer from the sequela of neurogenic bowel and its disabling complications primarily constipation, fecal incontinence, and gastrointestinal (GI) symptoms. Neurogenic bowel is a functional bowel disorder with a spectrum of defecatory disorders as well as colonic and gastrointestinal motility dysfunction. This manuscript will review the anatomy and physiology of gastrointestinal innervation, as well as the pathophysiology associated with SCI. It will provide essential information on the recent guidelines for neurogenic bowel assessment and medical management. This will allow medical providers to partner with their patients to develop an individualized bowel plan utilizing a combination of various pharmacological, mechanical and surgical interventions that prevent complications and ensure successful management and compliance. For people with SCI and neurogenic bowel dysfunction, the fundamental goal is to maintain health and well-being, promote a good quality of life and support active, fulfilled lives in their homes and communities.
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Affiliation(s)
- Gianna M. Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan College of Medicine, Ann Arbor, MI 48108, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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8
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Neurogenic Bowel Dysfunction Changes after Osteopathic Care in Individuals with Spinal Cord Injuries: A Preliminary Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10020210. [PMID: 35206825 PMCID: PMC8871877 DOI: 10.3390/healthcare10020210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Neurogenic bowel dysfunction (NBD) indicates bowel dysfunction due to a lack of nervous control after a central nervous system lesion. Bowel symptoms, such as difficulties with evacuation, constipation, abdominal pain and swelling, are experienced commonly among individuals with spinal cord injury (SCI). Consequentially, individuals with SCI experience a general dissatisfaction with the lower perceived quality of life (QoL). Several studies have demonstrated the positive effects of manual therapies on NBD, including Osteopathic Manipulative Treatment (OMT). This study aimed to explore OMT effects on NBD in individuals with SCI compared with Manual Placebo Treatment (MPT). Methods: The study was a double-blind randomized controlled trial composed of three phases, each one lasting 30 days (i: NBD/drugs monitoring; ii: four OMT/MPT sessions; iii: NBD/drug monitoring and follow-up evaluation). Results: the NBD scale, the QoL on worries and concerns sub-questionnaire, and the perception of abdominal swelling and constipation significantly improved after treatments compared to baseline only for individuals who underwent OMT. Conclusion: These preliminary results showed positive effects of OMT on bowel function and QoL in individuals with SCI, but further studies are needed to confirm our results.
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9
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Kovari M, Stovicek J, Novak J, Havlickova M, Mala S, Busch A, Kolar P, Kobesova A. Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach. NeuroRehabilitation 2021; 50:89-99. [PMID: 34776431 PMCID: PMC8925101 DOI: 10.3233/nre-210226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.
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Affiliation(s)
- Martina Kovari
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Stovicek
- Department of Internal Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jakub Novak
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michaela Havlickova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Sarka Mala
- Department of Internal Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
| | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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10
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Ivan IF, Irincu VL, Diaconu Ș, Falup-Pecurariu O, Ciopleiaș B, Falup-Pecurariu C. Gastro-intestinal dysfunctions in Parkinson's disease (Review). Exp Ther Med 2021; 22:1083. [PMID: 34447476 DOI: 10.3892/etm.2021.10517] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
In patients with Parkinson's disease (PD), gastrointestinal dysfunction occurs from the early stages of the disease and even in the pre-motor phase. This condition can include the entire digestive tract, with symptoms ranging from delays in gastric emptying to dysphagia, constipation and even malnutrition. Excess saliva accumulates in the mouth due to the low frequency of swallowing. Dysphagia develops in about 50% of patients and may be a reflection of both central nervous system and enteric nervous system disorder. Gastroparesis can cause a variety of symptoms, including nausea, and also may be responsible for some of the motor fluctuations observed with levodopa therapy. Intestinal dysfunction in PD may be the result of both delayed colon transit and impaired anorectal muscle coordination. In addition, recent studies have demonstrated the role of Helicobacter pylori infection in the pathogenesis of diseases but also the occurrence of motor fluctuations by affecting the absorption of anti-parkinsonian medication. In this review, the main gastrointestinal dysfunctions associated with PD are presented.
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Affiliation(s)
- Irina-Florina Ivan
- Department of Neurology, County Emergency Clinic Hospital, 500365 Brașov, Romania
| | | | - Ștefania Diaconu
- Faculty of Medicine, Transilvania University, 500036 Brașov, Romania
| | | | - Bogdan Ciopleiaș
- Department of Neurology, County Emergency Clinic Hospital, 500365 Brașov, Romania
| | - Cristian Falup-Pecurariu
- Department of Neurology, County Emergency Clinic Hospital, 500365 Brașov, Romania.,Faculty of Medicine, Transilvania University, 500036 Brașov, Romania
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11
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Neurogenic bowel dysfunction score in spinal cord-injured patients: translation and validation of the Dutch-language NBD score. Spinal Cord 2021; 60:223-227. [PMID: 34349233 DOI: 10.1038/s41393-021-00668-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN This is a prospective validation study. OBJECTIVES The neurogenic bowel dysfunction (NBD) score is a widely used symptom-based questionnaire evaluating bowel dysfunction and its impact on quality of life (QoL) in spinal cord-injured patients. This study aimed to translate and validate a Dutch-language NBD score in patients with SCI. SETTING Patients with SCI visiting the urology department or general practitioner (GP) in Rotterdam, the Netherlands. METHODS Standardized guidelines were followed for the translation and validation process of the NBD score. Adult patients with SCI visiting our urology department were asked to participate by filling in a set of questionnaires: the NBD score, the Fecal Incontinence Quality of Life scale (FIQL), the Fecal Incontinence Severity Index (FISI), and the European Quality of life 5-Dimension 3-Level questionnaire (EQ-5D-3L) at baseline and 1-2 weeks afterward. A control group recruited at a GP office completed the questionnaires once. The following measurement properties were evaluated: content validity, internal consistency, reproducibility, criterion-, and construct validity. RESULTS Fifty-eight patients and 50 references were included. Content validity was adequate, internal consistency was moderate (Cronbach's alpha 0.56 and 0.30) and reproducibility was adequate (ICC 0.87). Criterion validity was confirmed; NBD score correlated significantly with the FIQL, FISI, and EQ-5D-3L. NBD scores in the patient group were significantly higher than in references, demonstrating good construct validity. CONCLUSIONS The Dutch-language version of the NBD score showed moderate to good measurement properties, and therefore is a reliable tool to measure bowel dysfunction in patients with SCI. We recommend standardized usage of this questionnaire for clinical evaluation and research purposes.
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Chen W, Zhao J, Li X, Wang X, Chen J, Zhang T, Ma L, Li D. Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage. Cerebrovasc Dis 2021; 50:535-542. [PMID: 34148034 DOI: 10.1159/000515706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/25/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Constipation is one of the common poststroke complications that directly affect the patients' quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. OBJECTIVE This study investigates constipation's clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. METHODS This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. RESULTS Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44-0.88; p = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37-5.89, p < 0.001), enteral nutrition (OR 2.82, 95% CI 1.85-4.30, p < 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40-3.16; p < 0.001), opioid analgesics (OR 1.86, 95% CI 1.32-2.62; p < 0.001), sedation (OR 1.83, 95% CI 1.20-2.77; p = 0.005), and vasopressors (OR 1.81, 95% CI 1.26-2.61; p = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43-3.05, p < 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58-1.90, p = 0.871). CONCLUSIONS Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.
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Affiliation(s)
- Wei Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jieyi Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangkui Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Li
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
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13
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Bazzocchi G, Turroni S, Bulzamini MC, D'Amico F, Bava A, Castiglioni M, Cagnetta V, Losavio E, Cazzaniga M, Terenghi L, De Palma L, Frasca G, Aiachini B, Cremascoli S, Massone A, Oggerino C, Onesta MP, Rapisarda L, Pagliacci MC, Biscotto S, Scarazzato M, Giovannini T, Balloni M, Candela M, Brigidi P, Kiekens C. Changes in gut microbiota in the acute phase after spinal cord injury correlate with severity of the lesion. Sci Rep 2021; 11:12743. [PMID: 34140572 PMCID: PMC8211659 DOI: 10.1038/s41598-021-92027-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SCI patients, months after a traumatic injury. Here we characterized the gut microbiota in a large Italian SCI population, within a short time from a not only traumatic injury. Feces were collected within the first week at the rehabilitation center (no later than 60 days after SCI), and profiled by 16S rRNA gene-based next-generation sequencing. Microbial profiles were compared to those publicly available of healthy age- and gender-matched Italians, and correlated to patient metadata, including type of SCI, spinal unit location, nutrition and concomitant antibiotic therapies. The gut microbiota of SCI patients shows distinct dysbiotic signatures, i.e. increase in potentially pathogenic, pro-inflammatory and mucus-degrading bacteria, and depletion of short-chain fatty acid producers. While robust to most host variables, such dysbiosis varies by lesion level and completeness, with the most neurologically impaired patients showing an even more unbalanced microbial profile. The SCI-related gut microbiome dysbiosis is very likely secondary to injury and closely related to the degree of completeness and severity of the lesion, regardless of etiology and time interval. This microbial layout could variously contribute to increased gut permeability and inflammation, potentially predisposing patients to the onset of severe comorbidities.
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Affiliation(s)
- Gabriele Bazzocchi
- Neurogastroenterology Unit, Montecatone Rehabilitation Institute, via Montecatone 37, 40026, Imola, Bologna, Italy.
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | - Federica D'Amico
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mimosa Balloni
- Neurogastroenterology Unit, Montecatone Rehabilitation Institute, via Montecatone 37, 40026, Imola, Bologna, Italy
| | - Marco Candela
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Bologna, Italy
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14
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van Doorn T, Groenendijk IM, Scheepe JR, Blok BF. Validation of the Dutch-Language Version of the Neurogenic Bowel Dysfunction Score in Patients with Multiple Sclerosis. Int J MS Care 2021; 24:67-73. [DOI: 10.7224/1537-2073.2020-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background: Neurogenic bowel dysfunction (NBD), like fecal incontinence and constipation, is a common symptom of disease in patients with multiple sclerosis (MS). The NBD score is a validated symptom-based questionnaire consisting of ten multiple-choice questions. The aim of this study was to validate the Dutch version of the NBD score in patients with MS, creating an objective measuring tool of bowel dysfunction.
Methods: Translation and validation of the NBD score was performed according to standardized guidelines. Adult patients with MS visiting a urology department completed a set of questionnaires (test): the NBD score, the Fecal Incontinence Quality of Life scale (FIQL), the Fecal Incontinence Severity Index (FISI), and the EQ-5D 3-Level questionnaire (EQ-5D-3L). After 1 to 2 weeks, the questionnaires were completed again (retest). A control group recruited at a general practitioner’s practice completed the questionnaires once. Data were analyzed for measurement properties.
Results: Sixty-one patients and 50 controls were included. Content validity was adequate, internal consistency was moderate (Cronbach α = 0.57 and 0.41), and reproducibility was excellent (interclass correlation coefficient = 0.78). Criterion validity was confirmed; the NBD score correlated moderately/strongly with the FIQL, FISI, and EQ-5D-3L. The NBD scores in the patient group were significantly higher than those in the control group, demonstrating good construct validity.
Conclusions: The Dutch version of the NBD score showed moderate-to-good validity and good reliability for assessment of NBD in patients with MS.
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Affiliation(s)
- Tess van Doorn
- From the Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands (TvD, IMG, JRS, BFMB)
| | - Ilse M. Groenendijk
- From the Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands (TvD, IMG, JRS, BFMB)
| | - Jeroen R. Scheepe
- From the Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands (TvD, IMG, JRS, BFMB)
| | - Bertil F.M. Blok
- From the Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands (TvD, IMG, JRS, BFMB)
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15
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Schaffernicht G, Shang Q, Stievenard A, Bötzel K, Dening Y, Kempe R, Toussaint M, Gündel D, Kranz M, Reichmann H, Vanbesien-Mailliot C, Brust P, Dieterich M, Funk RHW, Ravens U, Pan-Montojo F. Pathophysiological Changes in the Enteric Nervous System of Rotenone-Exposed Mice as Early Radiological Markers for Parkinson's Disease. Front Neurol 2021; 12:642604. [PMID: 33841309 PMCID: PMC8030242 DOI: 10.3389/fneur.2021.642604] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Parkinson's disease (PD) is known to involve the peripheral nervous system (PNS) and the enteric nervous system (ENS). Functional changes in PNS and ENS appear early in the course of the disease and are responsible for some of the non-motor symptoms observed in PD patients like constipation, that can precede the appearance of motor symptoms by years. Here we analyzed the effect of the pesticide rotenone, a mitochondrial Complex I inhibitor, on the function and neuronal composition of the ENS by measuring intestinal contractility in a tissue bath and by analyzing related protein expression. Our results show that rotenone changes the normal physiological response of the intestine to carbachol, dopamine and electric field stimulation (EFS). Changes in the reaction to EFS seem to be related to the reduction in the cholinergic input but also related to the noradrenergic input, as suggested by the non-adrenergic non-cholinergic (NANC) reaction to the EFS in rotenone-exposed mice. The magnitude and direction of these alterations varies between intestinal regions and exposure times and is associated with an early up-regulation of dopaminergic, cholinergic and adrenergic receptors and an irregular reduction in the amount of enteric neurons in rotenone-exposed mice. The early appearance of these alterations, that start occurring before the substantia nigra is affected in this mouse model, suggests that these alterations could be also observed in patients before the onset of motor symptoms and makes them ideal potential candidates to be used as radiological markers for the detection of Parkinson's disease in its early stages.
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Affiliation(s)
- Gabriela Schaffernicht
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Qi Shang
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Alicia Stievenard
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France
| | - Kai Bötzel
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Yanina Dening
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Romy Kempe
- Department of Pharmacology and Toxicology, TU-Dresden, Dresden, Germany
| | - Magali Toussaint
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Leipzig, Germany
| | - Daniel Gündel
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Leipzig, Germany
| | - Mathias Kranz
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Leipzig, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Christel Vanbesien-Mailliot
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France
| | - Peter Brust
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Leipzig, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Richard H W Funk
- Center for Regenerative Therapies Dresden, Dresden, Germany.,Institute for Anatomy, Technical University (TU)-Dresden, Dresden, Germany
| | - Ursula Ravens
- Department of Pharmacology and Toxicology, TU-Dresden, Dresden, Germany.,Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Francisco Pan-Montojo
- Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
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16
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17
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[Spanish validation of the Autonomic Standards Assessment Form in spinal cord injuries]. Rehabilitacion (Madr) 2018; 53:20-27. [PMID: 30929829 DOI: 10.1016/j.rh.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Autonomic nervous system (ANS) dysfunction in patients with spinal cord injury (SCI) severely impacts morbidity and mortality. However, research initiatives aiming to gain insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are still lacking. Thus, this study had 2main objectives: 1) to translate into Spanish the revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), and 2) to describe the impact of ANS dysfunction in a sample of SCI patients. MATERIAL AND METHODS Cross-sectional observational pilot study in 51 traumatic SCI patients (> 1 year after injury). Demographic, medical and ISAFSCI data were studied. RESULTS The Spanish version of the ISAFSCI showed that the most altered systems in the sample were sweating control (above-lesion hyperhidrosis in 33.3%; below-lesion hyperhidrosis in 17.6%; below-lesion hypohidrosis in 21.6%) and temperature control (hyperthermia in 76.5%). In addition, 74.5% of the sample had complete loss of control of the lower urinary tract, and 82.4% had no control of the bowel. Finally, genital arousal was reflex in 47.1% and orgasm and ejaculation were reduced or altered in most of the patients (92.2% and 84.3%, respectively). CONCLUSION The Spanish version of the ISAFSCI is a useful and practical tool, and can be employed in clinical practice to assess ANS function in patients with SCI. Understanding the role of ANS in persons with SCI is crucial to improve their health status and reduce secondary complications post-SCI, and consequently help to improve the clinical management in these individuals.
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18
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Abstract
Spina bifida is a birth defect that commonly causes bowel and bladder dysfunction in children with a significant negative impact on quality of life and emotional wellbeing. Fecal continence improves satisfaction and the quality of life of both children and their caretakers. Bowel management in children with spina bifida is hampered by limited controlled studies and variable practice within different institutions and subspecialists. The goals of a successful bowel management program in children with spina bifida consist of predictable bowel movements, social continence, and eventual independence. Treatment options range from conservative interventions such as diets and oral laxatives that modify stool consistency and transit, to trans-anal irrigations and antegrade continence enemas that facilitate predictable recto-sigmoid emptying and provide a greater degree of independence. In children, the treatment approach should be implemented in the context of the child's developmental age in order to allow for optimum social integration with their age-appropriate peers. We present a review of a stepwise approach to bowel management in children with spina bifida and the challenges related to the proposed treatment options.
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Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Leonel Rodriguez
- Colorectal and Pelvic Malformations Center, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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19
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Cotterill N, Sullivan A, Norton C, Wilkins A, Weir I, Kilonzo M, Drake MJ. Conservative interventions for urinary or faecal incontinence, or both, in adults with multiple sclerosis. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikki Cotterill
- North Bristol NHS Trust; Bristol Urological Institute; Southmead Hospital Bristol UK BS10 5NB
- CLAHRC West; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; 9th Floor, Whitefriars Lewins Mead Bristol UK BS1 2NT
- University of the West of England; Centre for Health and Clinical Research, Faculty of Health and Applied Sciences; Blackberry Hill Bristol UK BS16 1DD
| | - Amanda Sullivan
- North Bristol NHS Trust; Department of Physiotherapy; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Christine Norton
- King's College London; Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Alastair Wilkins
- North Bristol NHS Trust; Bristol and Avon Multiple Sclerosis Unit/Clinical Neurosciences; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Iain Weir
- University of West of England; Department of Engineering, Design and Mathematics; Coldharbour Lane Bristol UK BS16 1QY
| | - Mary Kilonzo
- University of Aberdeen; Health Economics Research Unit; Aberdeen UK AB25 2ZD
| | - Marcus J Drake
- University of Bristol; School of Clinical Sciences; Bristol UK BS10 5NB
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20
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Zhang Y, Xia X, Zhuang X. Effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. J Clin Nurs 2018; 27:e1146-e1151. [PMID: 29193471 DOI: 10.1111/jocn.14198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Yanyan Zhang
- Rehabilitation Center; Shandong University Qilu Hospital; Jinan China
| | - Xiyan Xia
- Department of Immunology; Jinan Vocational College of Nursing; Jinan China
| | - Xuewei Zhuang
- Department of Clinical Laboratory Medicine; Shandong University Qilu Hospital; Jinan China
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21
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Abstract
Spina bifida is a birth defect that commonly causes bowel and bladder dysfunction in children with a significant negative impact on quality of life and emotional wellbeing. Fecal continence improves satisfaction and the quality of life of both children and their caretakers. Bowel management in children with spina bifida is hampered by limited controlled studies and variable practice within different institutions and subspecialists. The goals of a successful bowel management program in children with spina bifida consist of predictable bowel movements, social continence, and eventual independence. Treatment options range from conservative interventions such as diets and oral laxatives that modify stool consistency and transit, to trans-anal irrigations and antegrade continence enemas that facilitate predictable recto-sigmoid emptying and provide a greater degree of independence. In children, the treatment approach should be implemented in the context of the child's developmental age in order to allow for optimum social integration with their age-appropriate peers. We present a review of a stepwise approach to bowel management in children with spina bifida and the challenges related to the proposed treatment options.
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Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Leonel Rodriguez
- Colorectal and Pelvic Malformations Center, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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22
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Abstract
Myelomeningocele, commonly known as spina bifida, is a birth defect in which the spinal cord does not develop properly due to incomplete closure of the neural tube at 28 days of gestation. With advances in treatment modalities, technologies, and medical knowledge, people with spina bifida in the United States are living well into adulthood. Myelomeningocele management includes life-long comprehensive neurologic, urologic, musculoskeletal, skin, and habilitation management. We describe approaches to the same, with an emphasis on the signs and symptoms of medical urgencies and emergencies of which every pediatrician must be aware.
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Affiliation(s)
- Leslie A Phillips
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
| | - Justin M Burton
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
| | - Sarah Helen Evans
- Pediatric Rehabilitation Medicine, Children's National Health Systems, Washington, DC
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23
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Li J, Yuan M, Liu Y, Zhao Y, Wang J, Guo W. Incidence of constipation in stroke patients: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7225. [PMID: 28640117 PMCID: PMC5484225 DOI: 10.1097/md.0000000000007225] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported.We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke.After detailed evaluations, 8 studies (n = 1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI] = 33%-63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI = 40-91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI = 27%-75%]). The incidence in the acute stage (45% [95% CI = 36%-54%]) was lower than that in the rehabilitation stage (48% [95% CI = 23%-73%]).Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management.
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Affiliation(s)
- Jianxiang Li
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Mengguo Yuan
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
| | - Yunfang Liu
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
| | - Yang Zhao
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jingqing Wang
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Weifeng Guo
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
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24
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Su A, Gandhy R, Barlow C, Triadafilopoulos G. Utility of high-resolution anorectal manometry and wireless motility capsule in the evaluation of patients with Parkinson's disease and chronic constipation. BMJ Open Gastroenterol 2016; 3:e000118. [PMID: 27843572 PMCID: PMC5093364 DOI: 10.1136/bmjgast-2016-000118] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aetiology of constipation in Parkinson's disease remains poorly understood. Defaecatory dyssynergia, anal sphincter spasticity and slow transit constipation may, individually or collectively, play a role. AIMS In this retrospective cohort analysis of patients with Parkinson's disease and chronic constipation, we determined the utility of high-resolution anorectal manometry, balloon expulsion and wireless motility capsule testing in defining the underlying aetiology for constipation. METHODS In this retrospective cohort study, consecutive patients with Parkinson's disease and chronic constipation underwent clinical assessment, manometry with balloon expulsion and wireless motility capsule testing using standard protocols. RESULTS We studied 66 patients fulfilling Rome IV criteria for functional constipation. Most patients (89%) had abnormal manometry, exhibiting various types of defaecatory dyssynergia (mostly types II and IV), abnormal balloon expulsion, diminished rectal sensation and, in some, lacking rectoanal inhibitory reflex. 62% exhibited colonic transit delay by wireless motility capsule study, while 57% had combined manometric and transit abnormalities, suggesting of overlap constipation. Symptoms of infrequent defaecation, straining and incomplete evacuation were not discriminatory. There was a relationship between constipation scores and colonic transit times (p=0.01); Parkinson's disease scores and duration were not correlated with either the manometric or transit findings. Faecal incontinence was seen in 26% of the patients. CONCLUSIONS Chronic constipation in patients with Parkinson's disease may reflect pelvic floor dyssynergia, slow transit constipation or both, and may be associated with faecal incontinence, suggesting both motor and autonomic dysfunction. Anorectal manometry and wireless motility capsule testing are useful in the assessment of these patients.
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Affiliation(s)
- Andrew Su
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rita Gandhy
- The Parkinson's Institute, Sunnyvale, California, USA
| | | | - George Triadafilopoulos
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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25
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Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson's disease. World J Gastroenterol 2016; 22:5742-5752. [PMID: 27433087 PMCID: PMC4932209 DOI: 10.3748/wjg.v22.i25.5742] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/30/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Early involvement of gut is observed in Parkinson’s disease (PD) and symptoms such as constipation may precede motor symptoms. α-Synuclein pathology is extensively evident in the gut and appears to follow a rostrocaudal gradient. The gut may act as the starting point of PD pathology with spread toward the central nervous system. This spread of the synuclein pathology raises the possibility of prion-like propagation in PD pathogenesis. Recently, the role of gut microbiota in PD pathogenesis has received attention and some phenotypic correlation has also been shown. The extensive involvement of the gut in PD even in its early stages has led to the evaluation of enteric α-synuclein as a possible biomarker of early PD. The clinical manifestations of gastrointestinal dysfunction in PD include malnutrition, oral and dental disorders, sialorrhea, dysphagia, gastroparesis, constipation, and defecatory dysfunction. These conditions are quite distressing for the patients and require relevant investigations and adequate management. Treatment usually involves both pharmacological and non-pharmacological measures. One important aspect of gut dysfunction is its contribution to the clinical fluctuations in PD. Dysphagia and gastroparesis lead to inadequate absorption of oral anti-PD medications. These lead to response fluctuations, particularly delayed-on and no-on, and there is significant relationship between levodopa pharmacokinetics and gastric emptying in patients with PD. Therefore, in such cases, alternative routes of administration or drug delivery systems may be required.
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Pan Y, Liu B, Li R, Zhang Z, Lu L. Bowel dysfunction in spinal cord injury: current perspectives. Cell Biochem Biophys 2015; 69:385-8. [PMID: 24549854 DOI: 10.1007/s12013-014-9842-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Permanent disruptions of gastrointestinal function are very common sequel of spinal cord injury (SCI). When motor and sensory nervous integrity are severely affected, neurogenic gastrointestinal dysfunction is an inevitable consequence. Autonomic nervous system miss function has significantly diminished or lost sensory sensations followed with incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone all of those predisposing to increased risk of fecal incontinence (FI). The FI is, beside paralysis of extremities, one of the symptoms most profoundly affecting quality of life (QOL) in patients with SCI. We are reviewing current perspectives in management of SCI, discussing some pathophysiology mechanisms which could be addressed and pointing toward actual practical concepts in use for evaluation and improvements necessary to sustain SCI patients QOL.
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Affiliation(s)
- Yuehai Pan
- Department of Hand Surgery, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, People's Republic of China
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Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology 2015; 16:265-84. [PMID: 25666896 PMCID: PMC4361768 DOI: 10.1007/s10522-015-9554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/28/2015] [Indexed: 01/18/2023]
Abstract
The prevalence of both urinary and faecal incontinence, and also chronic constipation, increases with ageing and these conditions have a major impact on the quality of life of the elderly. Management of bladder and bowel dysfunction in the elderly is currently far from ideal and also carries a significant financial burden. Understanding how these changes occur is thus a major priority in biogerontology. The functions of the bladder and terminal bowel are regulated by complex neuronal networks. In particular neurons of the spinal cord and peripheral ganglia play a key role in regulating micturition and defaecation reflexes as well as promoting continence. In this review we discuss the evidence for ageing-induced neuronal dysfunction that might predispose to neurogenic forms of incontinence in the elderly.
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Affiliation(s)
- Richard N Ranson
- Department of Applied Sciences (Biomedical Sciences), Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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Abstract
Although it is now generally recognized that the clinical spectrum of Parkinson disease (PD) is broader than its defining motor aspects, its various non-motor symptoms are often not routinely assessed in the clinical setting. As most of these symptoms are amenable to treatment, improved recognition would lead to more comprehensive management of the disease, and ultimately improve the quality of life for PD patients. In an attempt to increase the general awareness of physicians caring for these patients, this article focuses on the clinical manifestations and treatment of the gastrointestinal symptoms most commonly experienced by PD patients, as well as on the gastrointestinal side effects of antiparkinsonian treatments.
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Engler TMNDM, Dourado CC, Amâncio TG, Farage L, de Mello PA, Padula MPC. Stroke: bowel dysfunction in patients admitted for rehabilitation. Open Nurs J 2014; 8:43-7. [PMID: 25419252 PMCID: PMC4238029 DOI: 10.2174/1874434601408010043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/15/2014] [Accepted: 06/20/2014] [Indexed: 11/29/2022] Open
Abstract
Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.
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Affiliation(s)
- Tânia M N de M Engler
- Graduate Program in Health Sciences, Universidade de Brasília (UnB), Brazil ; Neurological rehabilitation program in the SARAH Network of Rehabilitation Hospitals, Brasília (DF), Brazil
| | - Cinthia C Dourado
- Neurological rehabilitation program in the SARAH Network of Rehabilitation Hospitals, Brasília (DF), Brazil
| | - Thais G Amâncio
- Secretaria de Estado de Saúde do Distrito Federal, Brasília (DF), Brazil
| | - Luciano Farage
- Faculty of Medicine, Universidade de Brasília-UnB-Brasília (DF), Brazil
| | - Paulo A de Mello
- Faculty of Medicine, Universidade de Brasília-UnB-Brasília (DF), Brazil
| | - Marcele P C Padula
- Faculty of Medical Sciences of Santa Casa São Paulo-São Paulo (SP), Brazil
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Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F. Gastrointestinal complications after ischemic stroke. J Neurol Sci 2014; 346:20-5. [PMID: 25214444 DOI: 10.1016/j.jns.2014.08.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 01/25/2023]
Abstract
Ischemic stroke is an important cause of morbidity and mortality, and currently the leading cause of adult disability in developed countries. Stroke is associated with various non-neurological medical complications, including infections and thrombosis. Gastrointestinal complications after stroke are also common, with over half of all stroke patients presenting with dysphagia, constipation, fecal incontinence or gastrointestinal bleeding. These complications are associated with increased hospital length of stay, the development of further complications and even increased mortality. In this article we review the epidemiology, pathophysiology, diagnosis, management and prevention of the most common gastrointestinal complications associated with ischemic stroke.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico.
| | - Beatriz E Ibarra-Yruegas
- Departamento de Psiquiatria, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
| | - Fernando Gongora-Rivera
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
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Che C, Wang H, Xu HX. Clinical effect of individualized staged holistic nursing in spinal cord injury patients with neurogenic bowel dysfunction. Shijie Huaren Xiaohua Zazhi 2013; 21:3440-3444. [DOI: 10.11569/wcjd.v21.i31.3440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effect of individualized staged holistic nursing in spinal cord injury (SCI) patients with neurogenic bowel dysfunction.
METHODS: Eighty SCI patients with neurogenic bowel dysfunction were randomly divided into either an experimental or a control group. The control group was given routine nursing care, while the experimental group was given individualized staged holistic nursing. Bowel function and the quality of life were compared between the two groups in different stages, including before treatment, acute phase, rehabilitation phase, and follow-up phase.
RESULTS: In different stages, the bowel function was improved in varying degrees in the two groups. The improvement was more significant in the experimental group than in the control group in the acute phase, rehabilitation phase, and follow-up phase (all P < 0.05). In the follow-up phase, the bowel function had a downward trend in the control group. The scores of quality of life were improved in varying degrees in the two groups; however, in the acute phase and rehabilitation phase, the experimental group was significantly better than the control group in terms of total score of life quality and scores for each of the domains of physiology, psychology, and environment (all P < 0.05), although there was no significant difference in the score for the social domain (P > 0.05). In the follow-up phase, the experimental group was significantly better than the control group with regard to total score of life quality and scores for each of the domains of physiology, psychology, society, and environment (all P < 0.05).
CONCLUSION: Individualized staged holistic nursing can help improve bowel function and quality of life in SCI patients with neurogenic bowel dysfunction.
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Preziosi G, Raptis DA, Raeburn A, Thiruppathy K, Panicker J, Emmanuel A. Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease. Eur J Gastroenterol Hepatol 2013; 25:1044-50. [PMID: 23669324 PMCID: PMC4206376 DOI: 10.1097/meg.0b013e328361eaf8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Bowel and bladder symptoms are highly prevalent in patients with multiple sclerosis (MS). Bladder dysfunction (affecting 75% of these patients) is caused by disease in the spinal cord, whilst the pathophysiology of bowel dysfunction is unknown. Pathways regulating both the organs lie in close proximity to the spinal cord, and coexistence of their dysfunction might be the result of a common pathophysiology. If so, the prevalence of bladder symptoms should be greater in patients with MS and bowel symptoms. This hypothesis is tested in the study. We also evaluated how patient-reported symptoms quantify bowel dysfunction. PATIENTS AND METHODS The Neurogenic Bowel Dysfunction questionnaire and the presence of bladder symptoms were recorded in 71 patients with MS and bowel symptoms. Disability, a surrogate clinical measure of spinal cord disease, was assessed using the Expanded Disability Status Scale. Bowel and bladder symptoms were quantified by patient-reported frequency, expressed in time percentage (0, 25, 50, 75 or 100% of the time the symptom was perceived), and patient-reported severity on a visual analogue scale between 0 and 100. RESULTS The prevalence of bladder symptoms was 85%, which is higher than that expected in an unselected population of patients with MS. Neurogenic Bowel Dysfunction score was significantly correlated with both patient-reported frequency (r=0.860, P<0.0001) and severity of bowel symptoms (r=0.659, P=<0.0001), as well as with the Expanded Disability Status Scale (r=0.526, P<0.0001). CONCLUSION Our findings suggest that gut dysfunction in patients with MS is secondary to spinal cord disease. Patient-reported bowel symptoms quantify bowel dysfunction well.
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Affiliation(s)
- Giuseppe Preziosi
- GI Physiology Unit, Department of Uro-Neurology, Division of General Surgery, National Hospital for Neurology and Neurosurgery
| | - Dimitri A. Raptis
- GI Physiology Unit, Department of Uro-Neurology, Division of General Surgery, National Hospital for Neurology and Neurosurgery
| | - Amanda Raeburn
- GI Physiology Unit, Division of General Surgery, University College London
| | | | - Jalesh Panicker
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Anton Emmanuel
- GI Physiology Unit, Department of Uro-Neurology, Division of General Surgery, National Hospital for Neurology and Neurosurgery
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Krassioukov A, Biering-Sorensen CF, Donovan W, Kennelly M, Kirshblum S, Krogh K, Alexander MS, Vogel L, And Wecht J. International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012. Top Spinal Cord Inj Rehabil 2013; 18:282-96. [PMID: 23460763 DOI: 10.1310/sci1803-282] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rasmussen MM, Krogh K, Clemmensen D, Bluhme H, Rawashdeh Y, Christensen P. Colorectal transport during defecation in subjects with supraconal spinal cord injury. Spinal Cord 2013; 51:683-7. [PMID: 23774126 DOI: 10.1038/sc.2013.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/17/2013] [Accepted: 05/08/2013] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Clinical study. OBJECTIVES To explore how supraconal spinal cord injury (SCI) affects colorectal emptying at defecation. Further, to relate findings to subject symptomatology expressed by bowel function scores and gastrointestinal transit time (GITT). SETTING Aarhus University Hospital, Denmark. METHODS Colorectal contents were marked by oral intake of (111)In-coated resin pellets. Movement of stools at defecation was assessed by comparing scintigrams performed before and just after defecation. Results from 15 subjects with SCI (14 males, median age=47 years (range: 22-74 years), SCI level: C5-Th9) were compared with those from 16 healthy volunteers (12 males, median age=31 years (range: 24-42 years)). Bowel symptoms were described from standard symptom scores, and GITT was assessed by radiopaque markers. RESULTS Median emptying at defecation was 31% of the rectosigmoid (range: 0% to complete emptying of the rectosigmoid and 49% of the descending colon) in subjects with SCI and 89% of the rectosigmoid (range: 53% to complete emptying of the rectosigmoid and the descending colon, and 3% of the transverse colon) in the control group (P<0.01). Colorectal emptying at defecation was associated with the St Mark's fecal incontinence score (P=0.02) but not with the Cleveland constipation score (P=0.17), the neurogenic bowel dysfunction score (P=0.12) or GITT (P=0.99). CONCLUSION Supraconal SCI results in significantly reduced emptying of stools at defecation. This is independent of changes in GITT.
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Affiliation(s)
- M M Rasmussen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Yue YS, Xie B, Cheng J, Zhang WY, Zhu Y. Electrical stimulation therapy for neurogenic bowel dysfunction after spinal injury. Shijie Huaren Xiaohua Zazhi 2013; 21:633-640. [DOI: 10.11569/wcjd.v21.i7.633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy of electrical stimulation therapy in the treatment of neurogenic bowel dysfunction after spinal injury.
METHODS: PubMed, MEDLINE, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Knowledge, OVID, CNKI, VIP, and Wanfang Data were searched for clinical studies that evaluated electrical stimulation therapy for neurogenic bowel dysfunction after spinal injury from the date of creation of databases to October 2012. The bibliographies of the retrieved studies were also searched. Researchers read included studies carefully and extracted data strictly.
RESULTS: A total of 11 studies were included. Electrical stimulation therapies mainly included transcutaneous electrical stimulation, transrectal electrostimulation, intravesical electrical stimulation, and sacral nerve modulation. Electrical stimulation could adjust gut innervation, increase the local blood flow of the gastrointestinal tract, promote protein synthesis, and improve bowel control of bowel and symptoms of fecal incontinence or constipation in patients with spinal injury.
CONCLUSION: The current evidence shows that to some extent, electrical stimulation therapy could improve neurogenic bowel dysfunction after spinal injury. However, the number of clinical studies that have been reported on this direction was small, especially the number of randomized controlled trials. In addition, the number of subjects included in the retrieved studies was small, and the intensity, outcomes and follow-up cycles were inconsistent. More large-sample and high-quality clinical studies need to be done to evaluate the efficacy of electrical stimulation therapy in the management of bowel function in patients with spinal injury.
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Gras-Miralles B, Cremonini F. A critical appraisal of lubiprostone in the treatment of chronic constipation in the elderly. Clin Interv Aging 2013; 8:191-200. [PMID: 23439964 PMCID: PMC3578442 DOI: 10.2147/cia.s30729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Indexed: 12/20/2022] Open
Abstract
Chronic constipation is a common disorder in the general population, with higher prevalence in the elderly, and is associated with worse quality of life and with greater health care utilization. Lubiprostone is an intestinal type-2 chloride channel activator that increases intestinal fluid secretion, small intestinal transit, and stool passage. Lubiprostone is currently approved by the US Food and Drug Administration for the treatment of chronic idiopathic constipation and of irritable bowel syndrome with predominant constipation. This review outlines current approaches and limitations in the treatment of chronic constipation in the elderly and discusses the results, limitations, and applicability of randomized, controlled trials of lubiprostone that have been conducted in the general and elderly population, with additional focus on the use of lubiprostone in constipation in Parkinson's disease and in opioid-induced constipation, two clinical entities that can be comorbid in elderly patients.
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Affiliation(s)
- Beatriz Gras-Miralles
- Gastroenterology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Filippo Cremonini
- Gastroenterology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Southern Nevada VA Healthcare System, Las Vegas, NV, USA
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Faaborg PM, Finnerup NB, Christensen P, Krogh K. Abdominal Pain: A Comparison between Neurogenic Bowel Dysfunction and Chronic Idiopathic Constipation. Gastroenterol Res Pract 2013; 2013:365037. [PMID: 24159329 PMCID: PMC3789481 DOI: 10.1155/2013/365037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/12/2013] [Indexed: 01/02/2023] Open
Abstract
Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominal pain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT) were measured by radiopaque markers. Results. Seventeen (81%) SCI and 14 (93%) CIC patients reported abdominal pain or discomfort within the last month (P = 0.38). Pain was considered more intense by CIC than by SCI patients (P < 0.05). Only minor differences were found in patient's qualitative description of abdominal pain or in the location of pain. In neither SCI nor CIC was pain associated with GITT. Conclusion. Most characteristics of abdominal pain among SCI patients resemble those of CIC. This indicates that constipation is a major cause of pain after SCI.
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Affiliation(s)
- Pia Møller Faaborg
- 1Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Dk-8000 Aarhus, Denmark
- 2Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Dk-8000 Aarhus, Denmark
- *Pia Møller Faaborg:
| | - Nanna Brix Finnerup
- 3Danish Pain Research Centre, Aarhus University Hospital, Dk-8000 Aarhus, Denmark
| | - Peter Christensen
- 2Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Dk-8000 Aarhus, Denmark
| | - Klaus Krogh
- 1Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Dk-8000 Aarhus, Denmark
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Dourado CC, Engler TMNDM, Oliveira SBD. Disfunção intestinal em pacientes com lesão cerebral decorrente de acidente vascular cerebral e traumatismo craniencefálico: estudo retrospectivo de uma série de casos. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000400022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A disfunção intestinal é uma queixa comum entre pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico. Este estudo objetivou pesquisar a prevalência da disfunção intestinal (incontinência anal e constipação intestinal) em pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico, admitidos para reabilitação. Trata-se de um estudo retrospectivo de uma série de casos, a partir da análise dos dados de 138 prontuários de pacientes internados no primeiro semestre de 2009. A prevalência de disfunção intestinal foi 41%, sendo 33 (24%) incontinência anal e 37 (27%) constipação intestinal. Comprometimento motor, auxílio locomoção, alterações de memória e comunicação estiveram associados à presença de incontinência anal. A prevalência de disfunção intestinal é alta nessa população, identificá-la precocemente, bem como os fatores relacionados, e promover a reeducação intestinal, poderá contribuir para melhora na qualidade de vida dessas pessoas.
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Krassioukov A, Biering-Sørensen F, Donovan W, Kennelly M, Kirshblum S, Krogh K, Alexander MS, Vogel L, Wecht J. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med 2012; 35:201-10. [PMID: 22925746 PMCID: PMC3425875 DOI: 10.1179/1079026812z.00000000053] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This is the first guideline describing the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI). This guideline should be used as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) including the ASIA Impairment Scale (AIS), which documents the neurological examination of individuals with SCI. The Autonomic Standards Assessment Form is recommended to be completed during the evaluation of individuals with SCI, but is not a part of the ISNCSCI. A web-based training course (Autonomic Standards Training E Program (ASTeP)) is available to assist clinicians with understanding autonomic dysfunctions following SCI and with completion of the Autonomic Standards Assessment Form (www.ASIAlearningcenter.com).
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Affiliation(s)
- Andrei Krassioukov
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Salat-Foix D, Suchowersky O. The management of gastrointestinal symptoms in Parkinson's disease. Expert Rev Neurother 2012; 12:239-48. [PMID: 22288679 DOI: 10.1586/ern.11.192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The involvement of the autonomic nervous system in Parkinson's disease causes many non-motor symptoms, among which gastrointestinal complaints are prominent. Drooling, dyspepsia, constipation, abdominal pain and fecal incontinence are frequently a source of patient distress. Dysphagia is recognized as causing both discomfort and increased risk of serious complications. Although a diagnosis can often be established based on the reports of patients and/or caregivers, and additional testing is seldom required, these diagnoses are clearly under recognized in clinical practice. These symptoms respond to the same treatment measures used in the general population, although certain drugs with a potential to increase parkinsonian symptoms should be avoided. Increased and early identification of these symptoms can result in a significant improvement in the quality of life of Parkinson's disease patients.
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Affiliation(s)
- David Salat-Foix
- Movement Disorders Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Sigurdsen E, Tørhaug T. [Spinal cord injury and bowel function]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1107-10. [PMID: 22614313 DOI: 10.4045/tidsskr.10.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) often causes permanent disruptions of gastrointestinal function, which exacerbates functional disablement. MATERIAL AND METHOD The article is based on the authors' own clinical experience at tertiary level in the specialist health service and literature searches in PubMed. RESULTS Neurogenic gastrointestinal dysfunction is a common sequela of injury to the spinal cord. Obstipation and faecal incontinence entail treatment that is often time- and resource-consuming. It is not yet possible to treat the cause of the condition. New treatment methods with retrograde and antegrade irrigation of the rectocolon, transanally or by means of appendicostomy, result in a greater degree of self-sufficiency and faster evacuation procedures. INTERPRETATION Neurogenic gastrointestinal dysfunction following a spinal cord injury should be assessed and treated in a tertiary level rehabilitation department. The function loss is permanent, and the treatment must be systematically tested and regularly evaluated. The decision as to which treatment is appropriate has to be taken by the patient and the healthcare system. Individual and personal factors must be taken into account. The newly established international consensus, with standardised data sets for evaluating function loss due to spinal cord injuries, paves the way for new and greater possibilities for multi-centre cooperation on quality assurance and research.
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Affiliation(s)
- Erik Sigurdsen
- Avdeling for ryggmargsskader, Klinikk for fysikalsk medisin og rehabilitering, St. Olavs hospital.
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Finnerup NB, Baastrup C. Spinal Cord Injury Pain: Mechanisms and Management. Curr Pain Headache Rep 2012; 16:207-16. [PMID: 22392531 DOI: 10.1007/s11916-012-0259-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Petronic I, Nikolic D, Cirovic D, Cvjeticanin S, Knezevic T, Raicevic M, Brdar R, Dzamic D, Janic N, Golubovic Z. Distribution of affected muscles and degree of neurogenic lesion in patients with spina bifida. Arch Med Sci 2011; 7:1049-54. [PMID: 22328890 PMCID: PMC3264999 DOI: 10.5114/aoms.2011.26619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 02/10/2011] [Accepted: 03/13/2011] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Patients with spina bifida in the lumbosacral region usually have various degrees of motor and sensory dysfunctions of the lower extremities and anal sphincter. The aim of our study was to evaluate the distribution and differences in frequencies of affected muscles, number of affected muscles and degree of neurogenic lesion between patients with spina bifida occulta (SBO) and spina bifida aperta (SBA). MATERIAL AND METHODS In 100 patients with SB, 6 muscles in the lower limbs were separately analysed. Due to the number of affected muscles, we evaluated 5 groups of patients: with 1 affected muscle, 2 affected muscles, 3 affected muscles, 4 affected muscles and 5 affected muscles. Three degrees of neurogenic lesions were assessed: mild, moderate and severe. RESULTS The tibialis anterior muscle was most frequently affected in SB patients. The outer anal sphincter was frequently affected in the group of SBA patients. Single muscle affection is frequent in the group of patients with SBO, while in the group of patients with SBA, 4 muscles were significantly frequently affected. The great majority of patients (45.46%) with affected outer anal sphincter (OAS) in the group of SBO were without affection of other muscles, while for the SBA group it was for every third patient. Mild neurogenic lesion was significantly frequent in SBO patients, while severe form was significantly frequent in SBA patients. CONCLUSIONS Patients with SBO usually present with mild to moderate clinical presentation, while multiple root involvement and severe degree of neurogenic lesion is associated more frequently with SBA.
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Affiliation(s)
- Ivana Petronic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Dejan Nikolic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
| | - Dragana Cirovic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Suzana Cvjeticanin
- Faculty of Medicine, University of Belgrade, Serbia
- Institute for Human Genetics, School of Medicine, Belgrade, Serbia
| | - Tatjana Knezevic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Raicevic
- Pediatric Surgery Department, University Children's Hospital, Belgrade, Serbia
| | - Radivoj Brdar
- Faculty of Medicine, University of Belgrade, Serbia
- Pediatric Surgery Department, University Children's Hospital, Belgrade, Serbia
| | - Dragana Dzamic
- Physical Medicine and Rehabilitation Department, University Children's Hospital, Belgrade, Serbia
| | - Nenad Janic
- Faculty of Medicine, University of Belgrade, Serbia
- Pediatric Surgery Department, University Children's Hospital, Belgrade, Serbia
| | - Zoran Golubovic
- Faculty of Medicine, University of Belgrade, Serbia
- Pediatric Surgery Department, University Children's Hospital, Belgrade, Serbia
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Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease. World J Gastroenterol 2011; 17:5035-48. [PMID: 22171138 PMCID: PMC3235587 DOI: 10.3748/wjg.v17.i46.5035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/06/2023] Open
Abstract
Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.
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45
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Quigley EMM, O'Mahony S, Heetun Z. Motility disorders in the patient with neurologic disease. Gastroenterol Clin North Am 2011; 40:741-64. [PMID: 22100115 DOI: 10.1016/j.gtc.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Gastrointestinal symptoms are common in the patient with chronic neurologic disease and may loom large in terms of impact on quality of life and on nutrition and mobility. A knowledge of the range of gastrointestinal disorders associated with a given neurologic disease, together with an understanding of the risks and benefits of various therapeutic options and approaches, should aid gastroenterologists in their efforts to contribute to the care of these patients. In most instances a multidisciplinary team (neurologist/neurosurgeon, gastroenterologist, nutritionist, therapist, specialist nurse) aware of the wishes and needs of the family and their carers and mindful of the nature and the natural history of the underlying disease process are best placed to assess and manage these problems.
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Affiliation(s)
- Eamonn M M Quigley
- Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
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46
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Abstract
This article reviews the developmental considerations involved in helping the family of a child with spina bifida who needs to achieve bowel continence. Strategies for success based on an algorithm are interwoven throughout the discussion. The current medications and techniques used at the developmentally appropriate times designed for optimal success are presented.
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