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Front Biosci. 2002 Jun 1;7:b6-13.
The motor efficacy of the artificial colonic pacemaker in colonic inertia patients.

Shafik A, El-Sibai O, Shafik AA, Ahmed I.

Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. ashafihmedshafik.org

We have recently demonstrated that the colon possesses at least 4 pacemakers which presumably generate electric waves and that colonic pacing evokes electric activity in colonic inertia. We tested the hypothesis that electric waves produced by artificial colonic pacing in colonic inertia patients may initiate colonic motilitiy and effect evacuation. 17 patients with constipation due to total colonic inertia were divided into 2 groups: 10 (age 45.6 ( 6.3 years, 7 women) in the study group and 7 (age 43.7 ( 5.8 years, 5 women) as controls. 7 healthy volunteers were included in the study. Colonic pacing was tested at 2 sites of pacemakers: mid-transverse colon and colosigmoid junction. A stimulating electrode was hooked to the colonic mucosa at the pacemaker site and 2-3 recording electrodes distally to it. Healthy volunteers showed resting electric waves in the form of pacesetter and action potentials which increased significantly on colonic pacing. Inertia patients exhibited no basal electric activity. Colonic pacing in the study group evoked electric waves and caused expulsion of small volume balloon. Balloon distension at pacemaker site produced mass movement of balloon, while away from pacemaker site step-wise movement. In conclusion, colonic pacing evoked electric waves in colonic inertia patients and effected balloon expulsion. We postulate that the pacemaker generates electric waves which spread along pacemaker branches that are composed of interstitial cells of Cajal and nerve fibers of the enteric nervous plexus and effect colonic mass contraction. Ex-pacemaker stimulation presumably leads to local activation of interstitial cells of Cajal and segmental step-wise contraction.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045022&dopt=Abstract

urahp.yokohama-cu.ac.jp

Many hemodialysis patients suffer from constipation. The frequency of constipation has not been rigorously evaluated in continuous ambulatory peritoneal dialysis (CAPD) patients, however. We conducted a survey on constipation in CAPD patients and compared the findings with those in hemodialysis patients through a questionnaire. Daily dietary fiber and potassium intake were calculated from the patients' dietary records. In the questionnaire, patients were asked about bowel frequency, stool consistency, straining, and use of laxatives and resins. The frequency of constipation was 28.9% in 204 CAPD patients and 63.1% in 268 hemodialysis patients. The hemodialysis patients had a 3.14 times higher relative risk of constipation than the CAPD patients. Only 3.4% of CAPD patients needed resin to avoid hyperkalemia. Of hemodialysis patients, 49% needed resin. Among the 261 hemodialysis patients, 205 (78.5%) suppressed an urge to defecate during hemodialysis therapy. Potassium and total dietary fiber intake per day were 1.8 +/- 0.5 g and 11.0 +/- 4.0 g in CAPD patients, which were higher (P < 0.01) than the values in hemodialysis patients--1.3 +/- 0.5 g and 5.9 +/- 2.7 g. The results suggest that constipation occurs less frequently in CAPD patients than in hemodialysis patients. The low rate of constipating drug administration, dialysis modality-based lifestyle, and higher total dietary fiber intake may cause the lower prevalence of constipation in CAPD patients. 2002 by the National Kidney Foundation, Inc.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12046044&dopt=Abstract

Am J Kidney Dis. 2002 Jun;39(6):E24.
Infantile cystinosis presenting as chronic constipation.

Assadi FK, Sandler RH, Wong PW, Salem M, Simenauer L.

Department of Pediatrics, Rush Presbyterian St. Luke's Medical Center, Rush University Medical College, Chicago, IL, USA. fassadush.edu

An infant presented with persistent constipation as the first clinical symptom of cystinosis before evidence of renal Fanconi's syndrome. The history of muscle weakness, failure to thrive, polydipsia, and polyuria prompted subsequent clinical and laboratory evaluations, leading to the correct diagnosis of cystinosis. Primary and persistent constipation as an initial manifestation of cystinosis has not been reported previously. Although rare, cystinosis should be considered in the differential diagnosis of constipation if other suggestive signs or symptoms are present. 2002 by the National Kidney Foundation, Inc.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12046055&dopt=Abstract

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