Colon Motility disorders in children with chronicle constipation: electrophysiology
Авторы: Zimnytska T.V. — V.N. Karazin Kharkiv National University
Рубрики: Педиатрия/Неонатология
Разделы: Клинические исследования
Версия для печати
Резюме
The purpose– studies of соlon electric activity in children with chronic constipation.
Patients and methods. The 63 children at the age 7-14 y.o. with chronical constipation (basic group) were observed. The comparative group included 30 healthly children. All patients were investigated by electrocardiography. Endoscopic investigationі were performed in all children.
Results. The 4 types colon motility disorders was founded. The most spread disorders characterized with increasing pre-prandial and decreasing postprandial colon summary electric potential compare to control group. The comparative characteristic of parameters of the colon electrical activity in children with comorbidic chronic inflammatory diseases of the digestive tract is made. The pre-prandial colon electric motility in children with inflammatory changing of intestinal mucous membrane is more higher than in children without inflammation, that leader to worsening of propulsive colon motility.
Conclusions The different character of colon motility disorders need to differential treatment. The ways of correction of colon motor dysfunction in children with chronic constipation were suggested.
Ключевые слова
chronic constipation, electric activity, colon, children
Chronic constipation is one of the most common among disorders of function gastro-intestinal tract in children. According to literature date the constipation is spread among children from 3 till 49% [6,10]. About 4% of children with constipation of preschool period and 1-2% of school period suffers on encores [1]. However, true frequency of this pathology is difficult to determine in pediatric practice due to variability of optimal frequency defecation in children, absence of exact criterions to make diagnosis and because the parents rarely bring children to the doctors.
The most of authors consider that dyscordination of propulsive and antyperistaltic colon contractility is on basic of slower intestinal movement. It causes by electrophysiologic disorders [5, 3].
Some areas of digestive system acts as pacemakers. The wave of depolarization spread on the other cells with speed, which depends from pacemakers [10]. Automatic spontaneous activity of smooth muscle cells is the slow waves. It is the rhythmic oscillation of membrane potential (depolarization with following repolarization). Ions of Ca++ are accumulated in cells during phase of depolarization. As result of this process the kalium canals that depends from calcium are activated, K+ goes away from cells and repolarization occurs. The frequency of slow waves is specific for every part of digestive tract and forms its basal electric rhythm. According to date of the electrophysiological investigation the frequency of stomach basal electric rhythm of human organism is 0,05 Hz, colon - 0,017-0,03 Hz [3].
The act potential appears on peak slow wave at certainly critical level of depolarization of smooth muscle cells membrane. It is provided with increasing intracellular concentration of free Са++ ions. It comes into the cell from interstitial space or intracellular deposit. All experimental researches indicate the slow waves are not connecting with contraction of smooth muscles [4].
The contraction of smooth muscles cells of digestive tract is coursed with acts potentials, which appearances on peak slow waves. The contractility force depends from quantity its per minute. The act potential is spread along smooth muscles. In this way the force of muscle contraction depends from intensity of generation potential. The slow waves synchronized and coordinate them [3,4].
The generation of electric impulses and following spreading on smooth muscles tissue are regulated by neuro and humoral systems [4]. According to authors abnormal colon summary electric activity is based on colon motility dysfunctions, which leads to manifestation gastroenterological symptoms [3, 4, 5, 14].
The purpose – studies of colon electric activity in children with chronic constipation.
Patients and methods
The 63 children at the age 7-14 y.o. with chronic constipation (basic group) and 30 healthy children (the same age) of control group were studied.
The chronic constipation was diagnosed in children with frequency of defecation less than 3 time per week. The children with such symptoms as feeling of incomplete evacuation, straining during bowel movements, changing of feces consistency were included in this group.
Chronic colitis was diagnosed in 37 children (51%), irritable bowel syndrome – in 9 children (14,3 %), functional constipation – 17 patients (27%). In 25,4% case stool retentions forms on background congenital pathology: dolichosygma, transversoptos. The most of children had comorbidic pathology of digestive tract. The 49 children (77,7 %) had chronic gastroduodenitis, 19 children (30,1%) – chronic cholecistytis. The functional biliar disorders were diagnosed in 34 children (54%). For confirming of clinical diagnosis the endoscopic, echosonographic, laboratory investigations were performed.
The colon mucous condition was studied by using rectoscope which revealed the following changing: hyperemia and edema, unclear vessels paint, light mucus that covers intestinal wall. It is corresponds to catarrhal proctosygmoiditis. This endoscopic picture was founded in 28 children (44,4%). The intensity hyperemia with significant edema, the lot of follicles, yellow mucus on intestinal wall, absence of vessels paint due to edema were founded at catarrhal-follicular proctosygmoiditis in 9 children (14,3%). The inflammatory changing of colon mucus wasn’t founded in 26 children (41,3%).
The studies of electric activity performed in all children by using non-invasive electroenterography method, which is based on registration summary colon electric potential from surface of patient’s body (UА А61B/04 77724). The studies were carried out before and after meal. The degree of postprandial increasing summary colon electric potential corresponded to intensity of gastrocolitic reflex (the part of common colon propulsive activity); (UА A61B5/05 5099).
The mean value of pre-prandial colon electric activity in children of control group is 0,05 ± 0,004 mV, coefficient of postprandial growth of electric potential is 1,65 ± 0,04. The parameters of electric activity of children with chronic constipation (56 persons; 88,9 %) differed (р<0,001) from control group (tabl. 1).
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Some types of disorders of colon electric activity were founded. The decreasing (p<0,01) of mean value of pre-prandial and increasing of postprandial (p<0,001) colon electric activity compare to control group (1st type) were determined in 14 children with constipation (22,2%).
The second type of colon electric activity (9 persons; 14,2%) was characterized with elevations (p <0,001) of mean value pre-prandial summary colon electric potential and its growth in postprandial period (p <0,001) compare to control group.
Significant part of children (28 persons; 44,4%) had increasing colon electric activity before meal (p<0,001) compare to control group. Paradoxical decreasing of summary colon electric potential after meal was determined in this part of children with constipation (p<0,001), (III type).
The excessive decreasing of pre-prandial (p<0,001) and postprandial (p<0,001) colon electric activity compare to control group was registered in 5 children with constipation (7,9% )(ІV type).
The lot of factors influence on value of pre-prandial colon electric potential. Among them the genetically features of smooth muscles cells receptors, intracellular metabolic disorders, permeability of membrane [4].
Inflammation of colon mucous membrane accompanied with more excessive degranulation of must cells. The realizing of mediator from must cells (histaminase, triptase, prostoglandins) influences on smooth muscles contractility [8,12]. The date of literature shows, that cytokines (interferons, TNFs) directly damages of Kachl’s cells (pacemakers) [9]. Ultrastructural changing leads to asyncronic colon electric activity and abnormal motility [13]. Especially attention gave to study influence of interleukins IL-6, IL-1β on generation of colon electric activity [8,9].
The studies of colon electric activity in children with inflammatory changing of intestinal mucous membrane were carried out. In this group the mean value of summary pre-prandial colon potential was 0,09± 0,005 мВ. It was differed (p<0,001) from similar parameter in group of children without inflammatory (0,059 ± 0,004 мВ). In children with catarrhal or catarrhal – follicular proctosygmoiditis the growth of colon electric activity was 0,63 ± 0,03. This coefficient was less (p<0,001) than in children with normal mucous membrane (1,02 ±0,03). These patients had more excessive reducing of propulsive colon activity after meal. The directly correlation (r=0,6) was founded between degree of intestinal inflammatory and value pre-prandial summary colon electric activity. Clinically it also corresponds to degree of constipation in children.
The most of patients had comorbidic gastro-intestinal diseases. The studies of parameters of colon electric activity in children with chronic gastroduodenitis were carried out. The results of investigations showed, that in this group mean value of pre-prandial colon activity more higher (0,11 ± 0,005 mV; p<0,001) than in children without chronic gastroduodenitis (0,048 ± 0,004 mV). It is explained by more higher production of proinflamatory cytokines and other biology active substances. So the result of investigation confirmed guess about influence inflammation of upper digestive tract on intensity of formation colon electric potentials by smooth muscular cells, that leads to disorders of colon peristaltic activity .
Different character of colon electric activity disorders corresponding clinically to prolong constipation in children is needed different therapy. The most important condition for normalization of electrophysiological process is treatment inflammation. Sedative drugs, relax gymnastic, the drugs decreasing viscerally hypersensitivity was suggested for children with hypersensitivity reaction on food’s stimulation (I and II type of disorders of colon electric activity) for correction intestinal motor dysfunction. Selective spasmolitic (mebeverin) can be used for normalization of parameters of colon electric activity. Our previous investigations showed it [2]. The children with lower colon electric activity (IV type) needed in the treatment directed on increasing of colon peristaltic. Massage of abdomen, amplipuls is recommended for it. The procedure which stimulates colon peristaltic activity can be used after previous course of selective spasmolytic for children with more higher pre-prandial and lower postprandial electric potential (III type).
Conclusions
1. The children with chronic constipation have different character of colon pre-prandial and postprandial electric activity.
2. The elevation of pre-prandial and reducing of postprandial summary colon electric potentials are the most common type in children with constipation.
3. The degree of colon electric activity depends from mucous membrane condition.
The degree of elevation of pre-prandial colon electric potential is higher in children with inflammatory changing of colon mucous membrane. The postprandial growth of electric activity is less in these children, than in children with normal intestinal mucous membrane.
4. The correction of colon motility dysfunction in children with chronic constipation depends on parameters of colon electric activity.
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