Constipation
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Constipation is usually due to analgesics, but is also common in many neurological conditions. Constipation tends to worsen as the illness progresses, but eases in the last days of life. It is more common with old age, and is a high risk in those with severe neurological or intellectual disabilities. Opioid-induced constipation does not usually respond to changes in diet; luids, and laxatives are nearly always needed. Switching to alternative opioids may help and both fentanyl and methadone have been claimed to have a lower incidence of causing constipation. Constipating drugs include those that reduce forward peristalsis and increase muscle tone; those that reduce secretions into the gut and drugs that reduce all bowel contractions. Oral naloxone has been used to reverse opioid-induced constipation, but the incidence of analgesic reversal is uncertain.
Constipation
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson in Care of the Cancer Patient, 2018
This chapter discusses the medical condition of constipation. Constipation is the term used to describe difficult or painful defaecation which is less frequent than what is normal for the individual patient, and which is associated with harder and smaller stools. It distresses the patient and should be treated promptly or avoided by the appropriate prescription of laxatives, especially when opioids are prescribed. The best remedy for constipation is anticipation and appropriate laxative prescribing, especially when prescribing opioids or other drugs that are known to increase the likelihood of constipation and reduced gut motility. The faecal softeners drugs are usually given in combination with a stimulant laxative to overcome the effect of opioids on gut motility. Constipation makes the patient miserable, and everything should be done to improve their comfort while medications and other interventions are taking effect. Anticholinergic drugs cause constipation by a direct action on the gut wall, slowing down peristalsis.
Diarrhea
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Diarrhea occurs in up to 10% of cancer patients, but up to 38% in acquired immune deficiency syndrome (AIDS). It is distressing for both patients and carers and causes dehydration, electrolyte disturbances and loss of comfort and dignity. A wide range of drugs can cause diarrhea and the drugs usually need to be stopped. Previous surgery can cause diarrhea through a number of mechanisms. Gastrectomy patients can sufer from food being 'dumped' into the bowel, causing nausea, bloating and diarrhea. Loperamide increases water absorption by slowing forward peristalsis. Caution is necessary with infective diarrhea since slowing peristalsis can cause overgrowth of dangerous pathogens and increased absorption of bacterial toxins. Octreotide has been used in AIDS-related diarrhea, cancer, in postgastrectomy dumping, and may also have a role to play in other causes of severe refractory diarrhea, although more evidence of eicacy is needed.
Effects of mosapride on secondary peristalsis in patients with ineffective esophageal motility
Published in Scandinavian Journal of Gastroenterology, 2013
Chien-Lin Chen, Chih-Hsun Yi, Tso-Tsai Liu, William C. Orr
Objective. Ineffective esophageal motility is frequently found in patients with gastroesophageal reflux diseases. Secondary peristalsis contributes to esophageal acid clearance. Mosapride improves gastrointestinal (GI) motility by acting on 5-hydroxytrypatamine4 receptors. The authors aimed to evaluate the effect of mosapride on secondary peristalsis in patients with ineffective esophageal motility. Material and methods. After recording primary peristalsis baseline, secondary peristalsis was stimulated by slowly and rapidly injecting mid-esophageal air in 18 patients. Two separate experiments were randomly performed with 40 mg oral mosapride or placebo. Results. Mosapride had no effect on the threshold volume of secondary peristalsis during slow air distension (9.8 ± 0.97 vs. 10.2 ± 1.0 mL; p = 0.84), but decreased the threshold volume during rapid air distension (4.1 ± 0.2 vs. 4.6 ± 0.3 mL; p = 0.001). The efficiency of secondary peristalsis during rapid air distension increased with mosapride (70% [40–95%]) compared with placebo (60% [10–85%]; p = 0.0003). Mosapride had no effect on the amplitudes of distal pressure wave of secondary peristalsis during slow (94.3 ± 9 vs. 101.9 ± 9.1 mmHg; p = 0.63) or rapid air distension (89.3 ± 9 vs. 95.2 ± 8.3 mmHg; p = 0.24). Conclusions. Mosapride improves esophageal sensitivity of secondary peristalsis by abrupt air distension but has limited effect on the motor properties of secondary peristalsis in ineffective esophageal motility patients. Despite its well-known prokinetic effect, mosapride enhances the efficiency of secondary peristalsis in patients with ineffective esophageal motility through augmenting esophageal sensitivity instead of motility.
Acid Gastro-Oesophageal Reflux Episodes as Related to the Quality of Preceding Peristalsis: A Study in Normal Subjects
Published in Scandinavian Journal of Gastroenterology, 1986
S. Kruse-Andersen, L. Wallin, T. Madsen
It has earlier been demonstrated after long-term monitoring of pH and peristalsis in the oesophagus that episodes of acid gastro-oesophageal reflux occur in normal volunteers. to determine whether there is a connection between gastro-oesophageal reflux and prior peristalsis, pH and peristalsis were monitored for 12 h in 26 asymptomatic subjects. The recorded peristalsis was divided into brief bursts of peristaltic contractions (≤60sec) and more prolonged continuous activity. Peristaltic periods were limited to prior and subsequent peristalsis by a non-peristaltic course of ≥ 30 sec. Continuous peristalsis was defined as a sequence of peristaltic contractions with a mutual distance between individual peristaltic waves of ≤ 30 sec. A total of 81 episodes of reflux were recorded, of which 67 were preceded by peristaltic activity. Brief bursts of peristalsis, unrelated to reflux episodes, were frequently terminated by boslus-transporting peristaltic waves (p < 0.001). When the last contraction before reflux was considered, an increased frequency of non-propagating peristalsis was found (p < 0.01). In addition, a closer time relationship was observed between peristalsis and reflux if the last contraction was of the upper segmentary type, as compared with propagating activity (p < 0.001). In conclusion, reflectory sphincter relaxation producing reflux may possibly be triggered by contractions in the upper part of the oseophagus, not followed by a bolus-transporting peristaltic wave.
Hearing peristalsis: theory, interpretation and practice in biodynamic psychotherapy
Published in Body, Movement and Dance in Psychotherapy, 2017
This article explores the factors affecting how practitioners of biodynamic psychotherapy, body psychotherapy and biodynamic massage understand and interpret peristaltic gut sounds – what psychotherapist Gerda Boyesen referred to as ‘psycho-peristalsis’. I present a thematic analysis of 15 semi-structured interviews, identifying 3 themes: ‘Practitioner background’, ‘Understanding peristalsis’ and ‘Peristalsis in practice’. Practitioners drew upon diverse past experiences, yet reached similar perceptions of mind-body connectivity. Practitioners made use of scientific and psychotherapeutic theory when understanding peristalsis, but found experiential learning and intuition more significant. Finally, practitioners used peristalsis clinically for self-use, building client narratives, practical guidance, evoking images to guide treatment and representing physical and emotional processing. This article shows how the biodynamic bodymind ontology shapes clinical reasoning and the epistemology of peristalsis, advancing understanding and clinical practice to the benefit of clients and therapists.