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Over the last decade there is substantial evidence that abdominal surgery triggers two different phases of POI, each with its own time course and underlying pathophysiology.
Gut 2009;58:1300-1311
laparotomy
intestinal manipulation
Gut 2009;58:1300-1311
Gut 2009;58:1300-1311
Mechanisms underlying the impaired contractility of the intestine following abdominal surgery.
1. activated resident macrophages release inflammatory cytokines & chemokines; 2. inflammatory mediators activate endothelial cells which upregulate adhesion molecule expression; 3. circulating leukocytes invade (diapedesis) the muscularis externa of the intestine; 4. these leukocytes and resident macrophages produce large amounts of NO and prostaglandins (PGs) which inhibit the contractile activity of intestinal smooth muscle cells. PGs also activate and increase the sensitivity of spinal afferents contributing to the generalized POI.
Gut 2009;58:1300-1311
Potential therapeutic strategies to inhibit activation of resident macrophages and prevent POI.
1. activated resident macrophages release inflammatory cytokines & chemokines; 2. inflammatory mediators activate endothelial cells which upregulate adhesion molecule expression; 3. circulating leukocytes invade the muscularis externa of the intestine; 4. these leukocytes and resident macrophages produce large amounts of NO and prostaglandins (PGs) which inhibit the contractile activity of intestinal smooth muscle cells. PGs also activate and increase the sensitivity of spinal afferents contributing to the generalized POI.
Gut 2009;58:1300-1311
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Pharmacologic methods for preventing or treating POI are modestly effective at best; Chewing gum is a clinically proven, cost-effective means of treating POI and decreasing LOS; Additional preclinical and clinical research is warranted.
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