Imaging Review of Gastrointestinal Motility Disorders

Imaging following endoscopic and surgical treatment of achalasia

Achalasia is an esophageal motility disorder characterized by absent esophageal peristalsis associated with failure of relaxation of the lower esophageal sphincter (LES). Patients with achalasia may present with long-standing and slowly progressive dysphagia to solids and liquids, heartburn, regurgitation, refractory reflux symptoms and noncardiac chest pain. The esophagram and the timed barium swallow are useful imaging studies that may contribute to the diagnosis of achalasia and may be used to determine improvement after treatment. Esophagography is also ideally suited to evaluate potential post treatment complications. Treatment options for achalasia aim to disrupt the high-pressure LES to improve esophageal emptying, improve symptoms and prevent further dilatation of the esophagus. The most common treatment options currently include esophageal botulinum toxin (Botox) injections, pneumatic dilatation, Heller myotomy (often performed in conjunction with a fundoplication) and peroral endoscopic myotomy. Potential complications of these procedures may include intramural dissection, leak, scarring and fibrosis of the lower esophagus, strictures and problems related to gastroesophageal reflux and its associated complications. Radiologists must be aware of expected findings and potential complications following these procedures for timely and accurate diagnoses. The purpose of this paper is to describe treatment options for achalasia, illustrate expected imaging findings as well as imaging findings of potential early and long-term complications following treatment for achalasia.

A review of the traditional uses, pharmacology, and toxicology of areca nut

BACKGROUND

Areca nut, the fruit of A. catechu, is an important Chinese herbal medicine and is the first of China's "four southern medicines". The main chemical components are alkaloids, phenols, polysaccharides, amino acids, and terpenoids. The flowers, leaves, fruits and seeds of A. catechu contain high medicinal value. However, with the emergence of adverse reactions in people who chew areca nut, people have doubts about the safety of the use of areca nut.

PURPOSE

In view of the two sides of pharmacology and toxicology of areca nut, this study comprehensively reviewed the components of different parts of A. catechu, the mechanism of pharmacology and toxicology, and the relationship between dosage and pharmacology and toxicology, in order to provide a new reference for the safe application of areca nut.

METHODS

We used "Areca nut", "Betel nut", and known biologically active ingredients in areca nut, combined with "natural active ingredients", "pharmacological activity", and "toxicological effect" as keywords to search in PubMed, Web of Science, Science Direct and CNKI up to March 2024.

RESULTS

A large number of studies have shown that low-dose areca nut has pharmacological effects such as deworming, anti-inflammatory, improving gastrointestinal function, lowering blood lipids, preventing atherosclerosis, anti-depression properties. The important mechanism involved in these effects is to reduce the generation of ROS, inhibit the activation of NADPH oxidase, increase the activity of antioxidant enzymes, affect MAPK, AKT, TLR, NF-κB, Nrf-2, PI3 K, STAT3 signaling pathway, reduce COX-2, IL-1β m RNA, MCP-1 and ICAM-1 mRNA gene expression, reduce IL-6, IL-8, IGE levels, activate AMPK signaling pathway, change the ion level in cells, and increase Bax/Bcl-2 ratio. It interferes with the biochemical metabolic process of bacteria. Long-term consumption of areca nut in large quantities will cause some adverse reactions or related malignant diseases to the human body.

CONCLUSION

We reviewed the pharmacological and toxicological effects and related mechanisms of areca nut, revealed the relationship between dose and pharmacological and toxicological effects, and discussed how to reduce the toxicity of areca nut and improve the comprehensive utilization of areca nut. It provides a reference for the study of the relationship between areca nut and human health, as well as the safe and rational use and full development and utilization of areca nut.

Got the Munchies for an Egg Sandwich? The Effects of Cannabis on Bowel Motility and Beyond

The use of medicinal cannabis has a long history dating back thousands of years. Recent discoveries have shed light on its mechanism of action with the identification of cannabinoid receptors and endocannabinoids, which make up the body's endocannabinoid system. Cannabinoid receptors, particularly the cannabinoid 1 and 2 receptors, play a crucial role in modulating the gut-brain axis and serve as potential therapeutic targets for gastrointestinal motility and inflammatory disorders. With increasing legalization of cannabis and a rising number of users, understanding the effects of cannabis on gut motility is essential for nuclear medicine providers. Although tetrahydrocannabinol, the principal psychoactive constituent of cannabis, may decrease gut motility in experimental settings, it appears to paradoxically improve symptoms in gastroparesis. Treatment effects are difficult to measure given the large number of variables that could significantly alter outcomes, such as cannabinoid type, potency, and route of intake. Another consideration is the highly personalized gut microbiome, which directly interacts with the endocannabinoid system. Further research is required to delineate these multifaceted, complex cannabinoid interactions. The goal of this article is to explore the knowns and unknowns of the impact of cannabis on the alimentary system.