Journal article
Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols
Frontiers in pharmacology, Vol.11, pp.583422-583422
11/24/2020
DOI: 10.3389/fphar.2020.583422
PMCID: PMC7774512
PMID: 33390950
Abstract
Postoperative ileus (POI) and postoperative gastrointestinal tract dysfunction (POGD) are well-known complications affecting patients undergoing intestinal surgery. GI symptoms include nausea, vomiting, pain, abdominal distention, bloating, and constipation. These iatrogenic disorders are associated with extended hospitalizations, increased morbidity, and health care costs into the billions and current therapeutic strategies are limited. This is a narrative review focused on recent concepts in the pathogenesis of POI and POGD, pipeline drugs or approaches to treatment. Mechanisms, cellular targets and pathways implicated in the pathogenesis include gut surgical manipulation and surgical trauma, neuroinflammation, reactive enteric glia, macrophages, mast cells, monocytes, neutrophils and ICC’s. The precise interactions between immune, inflammatory, neural and glial cells are not well understood. Reactive enteric glial cells are an emerging therapeutic target that is under intense investigation for enteric neuropathies, GI dysmotility and POI. Our review emphasizes current therapeutic strategies, starting with the implementation of colorectal enhanced recovery after surgery protocols to protect against POI and POGD. However, despite colorectal enhanced recovery after surgery, it remains a significant medical problem and burden on the healthcare system. Over 100 pipeline drugs or treatments are listed in
Clin.Trials.gov
. These include 5HT
4
R agonists (Prucalopride and TAK 954), vagus nerve stimulation of the ENS—macrophage nAChR cholinergic pathway, acupuncture, herbal medications, peripheral acting opioid antagonists (Alvimopen, Methlnaltexone, Naldemedine), anti-bloating/flatulence drugs (Simethiocone), a ghreline prokinetic agonist (Ulimovelin), drinking coffee, and nicotine chewing gum. A better understanding of the pathogenic mechanisms for short and long-term outcomes is necessary before we can develop better prophylactic and treatment strategies.
Details
- Title: Subtitle
- Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols
- Creators
- Elvio Mazzotta - The Ohio State University Wexner Medical CenterEgina Criseida Villalobos-Hernandez - The Ohio State University Wexner Medical CenterJuan Fiorda-Diaz - The Ohio State University Wexner Medical CenterAlan Harzman - The Ohio State University Wexner Medical CenterFievos L. Christofi - The Ohio State University Wexner Medical Center
- Resource Type
- Journal article
- Publication Details
- Frontiers in pharmacology, Vol.11, pp.583422-583422
- Publisher
- Frontiers Media S.A
- DOI
- 10.3389/fphar.2020.583422
- PMID
- 33390950
- PMCID
- PMC7774512
- ISSN
- 1663-9812
- eISSN
- 1663-9812
- Alternative title
- Mazzotta et al
- Language
- English
- Date published
- 11/24/2020
- Academic Unit
- Anesthesia
- Record Identifier
- 9984656609302771
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