Neuroimmune mechanisms in postoperative ileus

Boeckxstaens, Guy E.; Jonge, Wouter J. de

doi:10.1136/gut.2008.169250

Cited by 294 publications

(413 citation statements)

References 107 publications

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“…These resident macrophages play an important role in diabetic-induced gastroparesis, 42 43 postoperative ileus (POI), [44][45][46] LPS-induced septic ileus, [47][48][49][50] and seem to represent the gatekeepers of the enteric nervous system, or the 'little brain of the gut'. VN stimulation prevents muscular inflammation and ileus following intestinal manipulation, 51 suggesting that this subpopulation of macrophages is also under cholinergic control.…”

Section: The Intestinal Immune System and The Cholinergic Anti-inflammentioning

confidence: 99%

“…As this inflammatory response has a major impact on neuromuscular function, compounds or interventions hampering this process may be instrumental in reducing POI. 46 Several lines of preclinical evidence indicate that activation of the cholinergic anti-inflammatory pathway may be an efficient strategy to prevent POI ( figure 3). 83 VN stimulation via electrical current, 51 high-fat enteral feeding 84 or central application of semapimod, 85 as well as peripheral α7nAChR activation via AR-R17779 83 all resulted in reduction of influx of immune cells into the muscularis, dampened cytokine production and improved gastrointestinal transit.…”

Section: Postoperative and Endotoxin-induced Ileusmentioning

confidence: 99%

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The vagal innervation of the gut and immune homeostasis

Matteoli

Gomez‐Pinilla

Giovangiulio

et al. 2015

Autonomic Neuroscience

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The central nervous system interacts dynamically with the immune system to modulate inflammation through humoral and neural pathways. Recently, in animal models of sepsis, the vagus nerve (VN) has been proposed to play a crucial role in the regulation of the immune response, also referred to as the cholinergic anti-inflammatory pathway. The VN, through release of acetylcholine, dampens immune cell activation by interacting with α-7 nicotinic acetylcholine receptors. Recent evidence suggests that the vagal innervation of the gastrointestinal tract also plays a major role controlling intestinal immune activation. Indeed, VN electrical stimulation potently reduces intestinal inflammation restoring intestinal homeostasis, whereas vagotomy has the reverse effect. In this review, we will discuss the current understanding concerning the mechanisms and effects involved in the cholinergic anti-inflammatory pathway in the gastrointestinal tract. Deeper investigation on this counter-regulatory neuroimmune mechanism will provide new insights in the cross-talk between the nervous and immune system leading to the identification of new therapeutic targets to treat intestinal immune disease.

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Section: The Intestinal Immune System and The Cholinergic Anti-inflammentioning

confidence: 99%

Section: Postoperative and Endotoxin-induced Ileusmentioning

confidence: 99%

The vagal innervation of the gut and immune homeostasis

Matteoli

Gomez‐Pinilla

Giovangiulio

et al. 2015

Autonomic Neuroscience

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“…The activated mast cells briefly increase intestinal permeability resulting in translocation of bacteria and consequently activation of resident macrophages in the muscularis externa. An inhibitory adrenergic neural pathway is also activated which impairs the neuromuscular function of the distant part of intestine, explaining the generalised features of ileus (Boeckxstaens and de Jonge 2009). Studies have demostrated that mast cell stabilizers improve gastric emptying and reduce inflammatory response (de Jonge, et al 2003).…”

Section: "The Intestinal Inflammation In Response To Bowel Manipulatimentioning

confidence: 99%

“…Although, the enteric nervous system has the ability to function independently, for normal digestive process it links with the central (extrinsic) nervous system. Due to these cross connections gut provides sensory information to the central nervous system and therefore it may recieve efferent signals from it (Boeckxstaens and de Jonge 2009;Luckey, et al 2003;Wood 2008). In addition, various hormones and enzymes play an important role in gut function and its motility.…”

Section: Normal Physiologymentioning

confidence: 99%

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Postoperative Ileus in Elective Colorectal Surgery: Management Strategies

Ahmed¹,

Mehmood²,

MacFie³

2012

Contemporary Issues in Colorectal Surgical Practice

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Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer

et al. 2023

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ImportanceDespite the adoption of the optimized Enhanced Recovery After Surgery (ERAS) protocol, postoperative ileus (POI) severely impairs recovery after colorectal resection and increases the burden on the health care system.ObjectiveTo assess the efficacy of electroacupuncture (EA) in reducing the duration of POI with the ERAS protocol.Design, Setting, and ParticipantsThis multicenter, randomized, sham-controlled trial was conducted in China from October 12, 2020, through October 17, 2021. There was a 1:1 allocation using the dynamic block random method, and analyses were by intention to treat. Patients 18 years or older undergoing laparoscopic resection of colorectal cancer for the first time were randomly assigned to treatment group by a central system.InterventionsPatients were randomly assigned to 4 sessions of EA or sham electroacupuncture (SA) after surgery. All patients were treated within the ERAS protocol.Main Outcomes and MeasuresThe primary outcome was the time to first defecation. Secondary outcomes included other patient-reported outcome measures, length of postoperative hospital stay, readmission rate within 30 days, and incidence of postoperative complications and adverse events.ResultsA total of 249 patients were randomly assigned to treatment groups. After the exclusion of 1 patient because of a diagnosis of intestinal tuberculosis, 248 patients (mean [SD] age, 60.2 [11.4] years; 153 men [61.7%]) were included in the analyses. The median (IQR) time to first defecation was 76.4 (67.6-96.8) hours in the EA group and 90.0 (73.6-100.3) hours in the SA group (mean difference, −8.76; 95% CI, −15.80 to −1.73; P = .003). In the EA group compared with the SA group, the time to first flatus (median [IQR], 44.3 [37.0-58.2] hours vs 58.9 [48.2-67.4] hours; P &lt; .001) and the tolerability of semiliquid diet (median [IQR], 105.8 [87.0-120.3] hours vs 116.5 [92.0-137.0] hours; P = .01) and solid food (median [IQR], 181.8 [149.5-211.4] hours vs 190.3 [165.0-228.5] hours; P = .01) were significantly decreased. Prolonged POI occurred in 13 of 125 patients (10%) in the EA group vs 25 of 123 patients (20%) in the SA group (risk ratio [RR], 0.51; 95% CI, 0.27-0.95; P = .03). Other secondary outcomes were not different between groups. There were no severe adverse events.Conclusions and RelevanceResults of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000038444

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Neuroimmune mechanisms in postoperative ileus

Cited by 294 publications

References 107 publications

The vagal innervation of the gut and immune homeostasis

The vagal innervation of the gut and immune homeostasis

Postoperative Ileus in Elective Colorectal Surgery: Management Strategies

Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer

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