Neuro-muscular Apparatus In Human Colon And In Children With Chronic Constipation
Funder
National Health and Medical Research Council
Funding Amount
$195,660.00
Summary
NIDKIDS is a support group for children with chronic constipation. There are 200 patients at the Royal Childrens Hospital in Melbourne who are in this group because their constipation has not responded to any treatments. Movement of food along the intestine requires muscle in the wall of the intestine to contract in a coordinated pattern. Coordination of the muscle contractions is provided by the nervous system. The nervous system controlling the gut has cell bodies located within the gut wall, ....NIDKIDS is a support group for children with chronic constipation. There are 200 patients at the Royal Childrens Hospital in Melbourne who are in this group because their constipation has not responded to any treatments. Movement of food along the intestine requires muscle in the wall of the intestine to contract in a coordinated pattern. Coordination of the muscle contractions is provided by the nervous system. The nervous system controlling the gut has cell bodies located within the gut wall, that send processes to the muscle and lining of the gut. There are sensory neurons, motor neurons and neurons that connect between the other neurons (interneurons). Nerves communicate between each other and cause muscles to contract by releasing chemicals (transmitters). In the last decade, we have discovered that communication between the nerve and muscle cells occurs through a third cell type- interstitial cells of Cajal. These cells also have a role as pacemaker cells for the muscle cells. In a small study, we have found that the muscle can contract in response to transmitters but that activation of the nerves does not result in muscle contraction in NIDKIDs. This result shows that transmission from neurons to muscle is not occuring in large bowel from NIDKIDs. In this study, we will examine a larger group of patients to determine if a functional defect in the muscle, a defect in the nerve chemical transmitters or a lack of the intermediate cells (the interstitial cells of Cajal) is causing the problem in the NIDKIDs. Further treatment of each patient will be easier if the defect causing his-her problem is known. We would then be able to target their problem with drugs that would work specifically at the point of breakdown in their individual gut.Read moreRead less
Motor Patterns Of Colonic Transit And Pathophysiology Of Severe Constipation.
Funder
National Health and Medical Research Council
Funding Amount
$196,018.00
Summary
This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions and flow of content along the colon in these patients. The aim will be to try and identify abnormal patterns responsible for the constipation so that future studies can target appropriate drugs at the responsible defect. A better unde ....This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions and flow of content along the colon in these patients. The aim will be to try and identify abnormal patterns responsible for the constipation so that future studies can target appropriate drugs at the responsible defect. A better understanding of clusters or symptoms and how they might predict such underlying abnormalities is crucial for the safer and more cost effective diagnosis and treatment of affected patients. Pharmacological studies in the human as well as on tissue obtained from affected patients at surgery will be conducted to better understand the presumptive abnormalities affecting the nerves within the colon in constipation.Read moreRead less
Transcutaneous Electrical Stimulation To Relieve Chronic Constipation In Children
Funder
National Health and Medical Research Council
Funding Amount
$82,450.00
Summary
1 in 300 children suffer from chronic constipation that is not fixed by changing their diet or taking laxatives. They continue to suffer the problem into adulthood. They also have fecal incontinence or soiling that causes problems with socialising and schooling. We are testing a method of electrical stimulation through the skin on the belly to increase the movement of the bowel. Initial results are encouraging, showing that the rate of movement of the bowel is increased and soiling is decreased.
Transcutaneous Electrical Stimulation To Relieve Chronic Constipation In Children
Funder
National Health and Medical Research Council
Funding Amount
$346,995.00
Summary
We have over 300 children with chronic treatment-resistant constipation at Royal Children's Hospital Melbourne. We have a new physiotherapy technique that may overcome constipation and stop soiling in many of these children. In 2003-4, we ran a pilot study to test a technique used by physiotherapists to treat urinary incontinence. We have called the method TESIC (transcutaneous electrical stimulation using interferential current). TESIC uses suction electrodes placed on the belly and back at the ....We have over 300 children with chronic treatment-resistant constipation at Royal Children's Hospital Melbourne. We have a new physiotherapy technique that may overcome constipation and stop soiling in many of these children. In 2003-4, we ran a pilot study to test a technique used by physiotherapists to treat urinary incontinence. We have called the method TESIC (transcutaneous electrical stimulation using interferential current). TESIC uses suction electrodes placed on the belly and back at the level of the belly button. The electrical stimulation is applied using a current (interferential current) that stimulates deep into the abdomen. We tested 8 children and had very encouraging results with improved constipatio in 5-8 and all with soiling stopped. Parents and children are keen to use this technique but first we need to establish that the results are reproducible in a larger group of 70 children. We also need to know if the effect was just a placebo response (due to time spent with the physiotherapists), and how long the effect lasts. We will also measure changes in soiling. Faecal soiling is smelly and antisocial. Relief of soiling has a big impact on a child's ability to fit in at school and to attend normal schooling. We will measure outcomes using daily diaries kept by children, questionnaires, how quickly food moves through the bowel and pressures within the bowel. We have a multidiciplinary team of experienced clinicians and scientists with expertise in these techniques and in constipation and incontinence in children (paediatric surgeon, gastroenterologist, manometry nurse, incontinence paediatrician and physiotherapist, expert in electrical stimulation and gut nervous system scientist). This technique could revolutionise treatment of chronic constipation. Most physiotherapists have TESIC machines, allowing delivery Australia wide. It is non-invasive and should also be able to be used by adults, including the elderly in nursing homes.Read moreRead less
Mechanisms Of Action Of Neurochemicals And Modulators In Human Intestine: Changes In Disease
Funder
National Health and Medical Research Council
Funding Amount
$442,500.00
Summary
Inflammatory bowel disease (IBD) and idiopathic chronic constipation (ICC) are two serious gastrointestinal disorders, for which no effective medical treatment is known. We will investigate the hypothesis that abnormalities in the nerve chemicals found in the gut contribute to the aetiology of these diseases. Our studies will examine the sites of action (receptors) for these chemicals (neurotensin and acetylcholine) in the small and large intestine. The mechanisms governing motility changes in r ....Inflammatory bowel disease (IBD) and idiopathic chronic constipation (ICC) are two serious gastrointestinal disorders, for which no effective medical treatment is known. We will investigate the hypothesis that abnormalities in the nerve chemicals found in the gut contribute to the aetiology of these diseases. Our studies will examine the sites of action (receptors) for these chemicals (neurotensin and acetylcholine) in the small and large intestine. The mechanisms governing motility changes in response to these chemicals have been well studied in animal intestine, but there is little detailed information from the human intestine. This study will provide insight into the mechanisms operating in the normal bowel, providing a base for comparing bowel obtained from patients with IBD or ICC. We will also study bowel removed at surgery for acute diverticular disease (DD), representing another type of inflammation. Studies on isolated segments of colon from ICC patients will determine whether the contractility of the muscle is abnormal in general or only with respect to the chemicals under investigation. Other studies will investigate the inflammatory processes occurring in the bowel and whether this differs in IBD. Our work will facilitate understanding of the function of the bowel in health and in gastrointestinal disorders and may lead to new medical treatments for IBD and ICC.Read moreRead less
Defining The Colonic Abnormality Underlying Severe Constipation And Evaluating The Efficacy Of A Novel Treatment Therapy
Funder
National Health and Medical Research Council
Funding Amount
$487,990.00
Summary
This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions along the colon in these patients. Furthermore by examining the in vivo colonic motor response to electrical stimulation of pelvic floor nerves, we will help to determine the potential of this new form of treatment for constipation. T ....This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions along the colon in these patients. Furthermore by examining the in vivo colonic motor response to electrical stimulation of pelvic floor nerves, we will help to determine the potential of this new form of treatment for constipation. The aims of these projects will be to try and identify abnormal motor patterns responsible for constipation as well as determining a possible inductor of normal colonic motility so that future studies can target appropriate treatment at the responsible defect.Read moreRead less
A Novel Mechanism For Intestinal Propulsion: Transit Without Neurons Or Pacemakers
Funder
National Health and Medical Research Council
Funding Amount
$256,973.00
Summary
A significant complication of premature births is that the mechanisms that regulate normal intestinal movements have not yet fully developed. We have recently identified a novel pattern of contraction that is seen predominantly in the colon of mice that have not yet developed either the normal nerve circuits that control gut movement and also lack the pacemaker cells that are intrinsic to the muscle coat. This motor pattern appears to be responsible for the movement of gut content during the dev ....A significant complication of premature births is that the mechanisms that regulate normal intestinal movements have not yet fully developed. We have recently identified a novel pattern of contraction that is seen predominantly in the colon of mice that have not yet developed either the normal nerve circuits that control gut movement and also lack the pacemaker cells that are intrinsic to the muscle coat. This motor pattern appears to be responsible for the movement of gut content during the development and maturation of the nerve circuits that regulate this process in more adult animals. However, the mechanisms responsible for this process have not been identified. This project is directed at identifying these mechanismsRead moreRead less
A Multi-site Randomised Controlled Trial Comparing The Severity Of Constipation Symptoms Experienced By Palliative Care Patients Receiving Usual Care Compared To Those Diagnosed And Managed According To The Underlying Pathophysiology.
Funder
National Health and Medical Research Council
Funding Amount
$498,795.00
Summary
This research aims to consider whether the problems of constipation in palliative care are less severe when the physical changes that underlie the problem are explored.