Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient

Lee, Sangjee; Na, In-hun; Choi, Eunseok; Jung, Sung‐Hee; Yoon, Jong-soo

doi:10.5535/arm.2012.36.2.278

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…In addition, most of these patients have a serious brain injury such as severe stroke, status epilepticus, traumatic brain injury, or encephalitis, which often leads to excessive parasympathetic suppression, sympathetic stimulation, and impairment of colonic autonomic regulation. 1 11 12 13 14 17 18 Together these factors could disturb gastrointestinal motility and result in the development of ACPO.…”

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal motility problems are common in NeuroICU patients. 11 12 13 14 Both the severity of neurological illnesses and the medications used such as opioids or drugs with strong anticholinergic effects put neurocritically ill patients at risk of developing ACPO. Despite this condition being observed frequently in clinical practice, very little has been published about its treatment.…”

Section: Introductionmentioning

confidence: 99%

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Neostigmine for Treating Acute Colonic Pseudo-Obstruction in Neurocritically Ill Patients

et al. 2021

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Background and Purpose Acute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients. Methods This retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated. Results This study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p <0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment ( p <0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine. Conclusions Neostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neostigmine for Treating Acute Colonic Pseudo-Obstruction in Neurocritically Ill Patients

et al. 2021

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“…It is often misdiagnosed due to sub-occlusive episodes. Some of the neurological causes of pseudo-obstruction are pandysautonomia, pure autonomic failure, stroke, encephalitis, calcification of basal ganglia, myasthenia gravis, and autoimmune neuropathy [ 39 , 40 ]. Underlying processes include reduced ganglion cells, dysregulated stretch receptors, and suppression of parasympathetic action in the colonic smooth muscle [ 41 , 42 ].…”

Section: Methodsmentioning

confidence: 99%

The Impact of Microbiota on the Gut–Brain Axis: Examining the Complex Interplay and Implications

Chaudhry,

Senapati,

Gadam

et al. 2023

JCM

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The association and interaction between the central nervous system (CNS) and enteric nervous system (ENS) is well established. Essentially ENS is the second brain, as we call it. We tried to understand the structure and function, to throw light on the functional aspect of neurons, and address various disease manifestations. We summarized how various neurological disorders influence the gut via the enteric nervous system and/or bring anatomical or physiological changes in the enteric nervous system or the gut and vice versa. It is known that stress has an effect on Gastrointestinal (GI) motility and causes mucosal erosions. In our literature review, we found that stress can also affect sensory perception in the central nervous system. Interestingly, we found that mutations in the neurohormone, serotonin (5-HT), would result in dysfunctional organ development and further affect mood and behavior. We focused on the developmental aspects of neurons and cognition and their relation to nutritional absorption via the gastrointestinal tract, the development of neurodegenerative disorders in relation to the alteration in gut microbiota, and contrariwise associations between CNS disorders and ENS. This paper further summarizes the synergetic relation between gastrointestinal and neuropsychological manifestations and emphasizes the need to include behavioral therapies in management plans.

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“…5,6 Neurological conditions account for 9% of cases, including Parkinson's disease, spinal cord injury, multiple sclerosis and dementia, 5,6 with rare cases attributed to acute stroke. 7 Supportive therapy includes correcting electrolyte imbalances (usually potassium, magnesium and calcium) and reviewing medication. Second-line therapy involves flatus tube insertion, which causes resolution in 70% of cases.…”

Section: Discussionmentioning

confidence: 99%