1
|
Yao YB, Xiao CF, Wu JW, Meng LY, Liu W, Lu JG, Wang C. Yiqi Kaimi prescription regulates protein phosphorylation to promote intestinal motility in slow transit constipation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 329:118118. [PMID: 38614261 DOI: 10.1016/j.jep.2024.118118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The clinical efficacy of the Yiqi Kaimi prescription has been confirmed in slow transit constipation. However, the effects and biological mechanism of Yiqi Kaimi prescription are still unclear. AIMS OF THE STUDY To identify the effects of Yiqi Kaimi prescription on intestinal motility; To reveal the potential key targets and pathways of Yiqi Kaimi prescription for the treatment of slow transit constipation. MATERIALS AND METHODS The effects of Yiqi Kaimi prescription on slow transit constipation were investigated in a mouse model. The terminal ink propulsion experiment and fecal indocyanine green imaging was used to measure the intestinal transit time. Protein phosphorylation changes in colon tissues treated with Yiqi Kaimi prescription were detected using a Phospho Explorer antibody microarray. Bioinformatic analyses were performed using the Database for Annotation Visualization and Integrated Discovery (DAVID) and the Search Tool for the Retrieval of Interacting Genes (STRING). Western blot analysis and immunohistochemistry confirmed the observed changes in phosphorylation. RESULT s: Yiqi Kaimi prescription significantly increased the intestinal transit rate (P < 0.05 vs. model) and reduced the time to first discharge of feces containing fecal indocyanine green imaging in mice (P < 0.05 vs. model). The administration of Yiqi Kaimi prescription induced phosphorylation changes in 41 proteins, with 9 upregulated proteins and 32 downregulated proteins. Functional classification of the phosphorylated proteins with DAVID revealed that the critical biological processes included tyrosine protein kinases, positive regulation of calcium-mediated signaling and response to muscle stretch. The phosphorylation of the spleen tyrosine kinase (SYK) at Tyr348 increased 2.19-fold, which was the most significant change. The phosphorylation level of the transcription factor p65 (RELA) at Thr505 was decreased 0.57-fold. SYK was a hub protein in the protein-protein interaction network and SYK and RELA formed the core of the secondary subnetwork. The key protein phosphorylation after treatment with Yiqi Kaimi prescription were verified by Western blot analysis and immunohistochemistry. CONCLUSION Yiqi Kaimi prescription significantly enhanced intestinal motility. This effect was attributed to alterations in the phosphorylation levels of various target proteins. The observed changes in protein phosphorylation, including SYK and RELA, may serve as crucial factors in the treatment of slow transit constipation.
Collapse
Affiliation(s)
- Yi-Bo Yao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
| | - Chang-Fang Xiao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Jing-Wen Wu
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Ling-Yun Meng
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Wei Liu
- Department of Pharmacy, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jin-Gen Lu
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
| |
Collapse
|
2
|
Awan EJ, Plunk KW, Washington AN, Buedo MG, Messieh J, Contardi AB, MpanuMpanu R, Sobhan AM, Shemesh E, O'Neill AM, Othman F. Chronic Constipation Unmasked: A Comprehensive Case Study of Colonic Inertia and Its Future Implications. Cureus 2024; 16:e60031. [PMID: 38854170 PMCID: PMC11162815 DOI: 10.7759/cureus.60031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/11/2024] Open
Abstract
Colonic inertia is a gastrointestinal disorder characterized by a significant delay in colon transit, resulting in chronic constipation that impedes an undisclosed percentage of individuals in the United States. This article aims to delve into the intricate mechanisms underlying the hindered transit observed in colonic inertia, focusing on multifactorial etiology and treatment. By gaining a better understanding of the pathophysiology of colonic inertia, we can improve the quality of life for individuals affected by this condition. Our study employs a comprehensive approach, combining clinical observation during pancolectomy, histopathological analyses performed by pathologists, and detailed investigation to unravel the complex interplay of factors affecting colonic motility.
Collapse
Affiliation(s)
- Enaiya J Awan
- Medical School, St. George's University School of Medicine, Great River, USA
| | - Kyle W Plunk
- Medical School, St. George's University School of Medicine, Great River, USA
| | | | - Matias G Buedo
- Medical School, St. George's University School of Medicine, Great River, USA
| | - Jayson Messieh
- Medical School, St. George's University School of Medicine, Great River, USA
| | | | | | - Armaan M Sobhan
- Medical School, St. George's University School of Medicine, Great River, USA
| | - Eliyahu Shemesh
- Colorectal Surgery, Delray Medical Center, Delray Beach, USA
| | - Andrew M O'Neill
- Minimally Invasive Surgery, Delray Medical Center, Delray Beach, USA
| | - Feras Othman
- General Surgery, University of Miami, Coral Gables, USA
| |
Collapse
|
3
|
Bazzocchi G, Corazziari ES, Staiano A, Bassotti G, Bellini M, Chiarioni G, D'Alba L, Scarpato E. Position paper on transanal irrigation in chronic non-organic constipation. Dig Liver Dis 2024; 56:770-777. [PMID: 38461046 DOI: 10.1016/j.dld.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
The practice of recto-colonic water irrigation to treat constipation has been used since ancient times with different, uncontrolled, and variably performing methods which have been considered interchangeably all alike. The use of better-performing devices with a standardized methodology is relatively recent, and the term Trans Anal Irrigation (TAI) defines a methodology performed with devices able to control the timing, volume, and pressure of the water introduced into the rectum and colon utilizing a catheter or a cone through the anus. Such practice has been implemented with favorable responses in patients with refractory chronic constipation secondary to neurological diseases. However, since the role of Trans Anal Irrigation as a therapeutic aid in chronic functional constipation and functional evacuation disorders is not yet fully clarified and standardized, a group of clinical investigators with recognized expertise in these clinical conditions intends to clarify the elements that characterize a TAI procedure that can benefit patients with functional constipation and functional defecation disorders defined according to the lastly updated Rome Diagnostic Criteria. Finally, the paper deals with adherence and practical implementation of TAI.
Collapse
Affiliation(s)
- G Bazzocchi
- Montecatone Rehabilitation Institute, Imola - University of Bologna, Italy
| | - E S Corazziari
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.
| | - A Staiano
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
| | - G Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Chiarioni
- Il Centro Med Healthcare, Verona Center, Verona, Italy & UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L D'Alba
- Gastroenterology and Endoscopy Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - E Scarpato
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
| |
Collapse
|
4
|
Heemskerk SC, Dirksen CD, van Kuijk SM, Benninga MA, Baeten CI, Masclee AA, Melenhorst J, Breukink SO. Sacral Neuromodulation Versus Conservative Treatment for Refractory Idiopathic Slow-transit Constipation: The Randomized Clinical No.2-Trial. Ann Surg 2024; 279:746-754. [PMID: 37991178 PMCID: PMC10997180 DOI: 10.1097/sla.0000000000006158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Assess the effectiveness of sacral neuromodulation (SNM) versus personalized conservative treatment (PCT) in patients with refractory idiopathic slow-transit constipation (STC). BACKGROUND Evidence on SNM for idiopathic STC is conflicting and of suboptimal methodological quality. METHODS The No.2-Trial was a multicenter, open-label, pragmatic, randomized trial performed in 2 Dutch hospitals. Sixty-seven patients with idiopathic STC, a defecation frequency <3 per week and refractory (ie, unresponsive) to maximal conservative (nonoperative) treatment were included. Exclusion criteria included outlet obstruction, rectal prolapse, and previous colon surgery. Patients were randomized (3:2) to SNM (n=41) or PCT (n=26) with randomization minimization between February 21, 2017 and March 12, 2020. In SNM patients, an implantable pulse generator was implanted after a successful 4-week test stimulation. PCT patients received conservative treatment such as laxatives or retrograde colonic irrigation. The primary outcome was treatment success (defined as average defecation frequency ≥3 per week) after 6 months. Secondary outcomes included constipation severity, fatigue, quality of life, and adverse events. Analysis was according to intention-to-treat. RESULTS After 6 months, 22 (53.7%) patients were successfully treated with SNM versus 1 (3.8%) patient with PCT (odds ratio 36.4, 95% CI 3.4-387.5, P =0.003). At 6 months, SNM patients reported lower constipation severity and fatigue scores ( P <0.001) and improved quality of life compared with PCT ( P <0.001). Eight serious adverse events (6 SNM, 2 PCT) and 78 adverse events (68 SNM, 10 PCT) were reported. CONCLUSIONS SNM is a promising surgical treatment option in a homogeneous group of adults and adolescents with refractory idiopathic STC. No.2-Trial registered at ClinicalTrials.gov NCT02961582.
Collapse
Affiliation(s)
- Stella C.M. Heemskerk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Carmen D. Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Coen I.M. Baeten
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
| | - Ad A.M. Masclee
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Division of Hepatology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jarno Melenhorst
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, the Netherlands
| | - Stéphanie O. Breukink
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
5
|
Bharucha AE, Knowles CH. Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era. Neurogastroenterol Motil 2022; 34:e14453. [PMID: 36102693 PMCID: PMC9887546 DOI: 10.1111/nmo.14453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2-4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. PURPOSE We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%-78%), symptoms of difficult defecation improved (30%-50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.
Collapse
Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles H Knowles
- Blizard Institute (Knowles), Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| |
Collapse
|
6
|
Liu K, Yan F. Advances in surgical treatment of dolichocolon. Shijie Huaren Xiaohua Zazhi 2022; 30:743-747. [DOI: 10.11569/wcjd.v30.i17.743] [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: 02/07/2023] Open
Abstract
Slow transit constipation (STC) is a common disease with an increasing incidence in recent years. Studies have shown that dolichocolon is the most common cause of STC. For patients with severe symptoms, the effect of medical treatment is unsatisfactory, and most patients need surgical treatment. Through comparison, our team found that subtotal colon colectomy is an ideal surgical method for the treatment of STC caused by dolichocolon, and the operation can significantly improve the patient's defecation. In addition, the application of laparoscopic natural orifice specimen extraction surgery to subtotal colon colectomy effectively reduces postoperative complications, shortens hospital stay, and improves patient satisfaction. Future deep clinical research of STC can promote the improvement of the overall level of its diagnosis and treatment.
Collapse
Affiliation(s)
- Kai Liu
- Department of Gastrointestinal Surgery, The Affiliated Zhongshan Hospital, Xiamen University, Xiamen 361004, Fujian Province, China
| | - Feng Yan
- Department of Gastrointestinal Surgery, The Affiliated Zhongshan Hospital, Xiamen University, Xiamen 361004, Fujian Province, China
| |
Collapse
|
7
|
Fikree A, Vollebregt PF, Choudhary A, Aziz Q, Scott SM. Editorial: rectal hyposensitivity in patients with hypermobile Ehlers-Danlos syndrome and constipation-authors' reply. Aliment Pharmacol Ther 2022; 56:907-908. [PMID: 35934864 DOI: 10.1111/apt.17163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Asma Fikree
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul F Vollebregt
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,GI Physiology Unit, Barts Health NHS Trust, London, UK
| | - Anisa Choudhary
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,GI Physiology Unit, Barts Health NHS Trust, London, UK
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,The Princess Grace Hospital, HCA Healthcare, London, UK
| | - S Mark Scott
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,GI Physiology Unit, Barts Health NHS Trust, London, UK
| |
Collapse
|