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Does Total Colectomy Alter Motor Inhibitory Effect of Ileal Brake?
MUNENORI NAGAO, Chikashi Shibata, Yuji Funayama, Kouhei Fukushima, Ken-ichi Takahashi, Fumito Saijo, Sho Haneda, Kazuhiro Watanabe, Katsuyoshi Kudoh, Atsushi Kohyama, Iwao Sasaki, Department of surgery, Tohoku university school of medicine, Sendai, Miyagi, Japan
Phenomenon that infusion of nutrients into the ileum inhibits upper gastrointestinal motility via the release of peptides such as PYY has been referred to as ‘ileal brake.' Stimulation of ileal afferent nerves with capsaicin inhibited upper gastrointestinal motility without the increase of PYY. Symptoms associated with the disorder of gastrointestinal motility such as abdominal bloating occur after total colectomy. Abnormal ileal brake after total colectomy might cause the disorder of upper gastrointestinal motility. The aim of the present study was to study if total colectomy alters motor inhibitory effect of ileal brake. [Method] Four beagle dogs were equipped with 8 strain gauge force transducers on the stomach and small intestine. Infusion of nutrients (saline as placebo control, 0.2M oleic acid, 0.4M butyrate, and 20% glucose) was started 90 minutes after feeding and continued for 30 minutes with 1.7 ml/min speed via a silicone tube placed in the ileal lumen. Capsaicin (10 mg) was injected into the ileum as a bolus. After these studies as control, all dogs underwent re-laparotomy and total colectomy, and the same experiments were performed 2 weeks postoperatively. As total colectomy, the distal ileum and the distal colon were transected, and the intestinal continuity was restored by an end-to-end ileoproctostomy. Area under the contractile curves for 30 minutes after intraileal administration were measured and expressed as motility index. [Results] In control dogs, oleic acid, glucose, and capsaicin inhibited postprandial gastrointestinal motility in the gastric antrum, duodenum, and proximal jejunum for 30-90 minutes, and motility indices at these sites after these stimuli were reduced compared to control (p<0.05). Butyrate did not have inhibitory effect on upper gastrointestinal motility. In dogs after total colectomy, inhibition of motility were observed in the gastric antrum, duodenum, and proximal jejunum after intraileal infusion of oleic acid, glucose, and capsaicin. The motility index in these sites after these intraileal stimuli was decreased compared to placebo control (p<0.05), and the degree of reduction in motility index was not different between control dogs and dogs with total colectomy. [Conclusion] Motor inhibitory effect of intraileal oleic acid, glucose, and capsaicin on upper gastrointestinal motility was similarly observed in control dogs and dogs after total colectomy, suggesting that total colectomy does not alter ileal brake.
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