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Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options

Post-operative ileus (POI) is the transient cessation of coordinated gastrointestinal motility after abdominal surgical intervention. It decreases quality of life, prolongs length of hospital stay, and increases socioeconomic costs. The mechanism of POI is complex and multifactorial, and has been br...

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Detalles Bibliográficos
Autores principales: Hussain, Zahid, Park, Hyojin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Neurogastroenterology and Motility 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577567/
https://www.ncbi.nlm.nih.gov/pubmed/36250359
http://dx.doi.org/10.5056/jnm22100
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author Hussain, Zahid
Park, Hyojin
author_facet Hussain, Zahid
Park, Hyojin
author_sort Hussain, Zahid
collection PubMed
description Post-operative ileus (POI) is the transient cessation of coordinated gastrointestinal motility after abdominal surgical intervention. It decreases quality of life, prolongs length of hospital stay, and increases socioeconomic costs. The mechanism of POI is complex and multifactorial, and has been broadly categorized into neurogenic and inflammatory phase. Neurogenic phase mediated release of corticotropin-releasing factor (CRF) plays a central role in neuroinflammation, and affects both central autonomic response as well hypothalamic-pituitary-adrenal (HPA) axis. HPA-stress axis associated cortisol release adversely affects gut microbiota and permeability. Peripheral CRF (pCRF) is a key player in stress induced gastric emptying and colonic transit. It functions as a local effector and interacts with the CRF receptors on the mast cell to release chemical mediators of inflammation. Mast cells proteases disrupt epithelial barrier via protease activated receptor-2 (PAR-2). PAR-2 facilitates cytoskeleton contraction to reorient tight junction proteins such as occludin, claudins, junctional adhesion molecule, and zonula occludens-1 to open epithelial barrier junctions. Barrier opening affects the selectivity, and hence permeation of luminal antigens and solutes in the gastrointestinal tract. Translocation of luminal antigens perturbs mucosal immune system to further exacerbate inflammation. Stress induced dysbiosis and decrease in production of short chain fatty acids add to the inflammatory response and barrier disintegration. This review discusses potential mechanisms and factors involved in the pathophysiology of POI with special reference to inflammation and interlinked events such as epithelial barrier dysfunction and dysbiosis. Based on this review, we recommend CRF, mast cells, macrophages, and microbiota could be targeted concurrently for efficient POI management.
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spelling pubmed-95775672022-10-30 Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options Hussain, Zahid Park, Hyojin J Neurogastroenterol Motil Review Post-operative ileus (POI) is the transient cessation of coordinated gastrointestinal motility after abdominal surgical intervention. It decreases quality of life, prolongs length of hospital stay, and increases socioeconomic costs. The mechanism of POI is complex and multifactorial, and has been broadly categorized into neurogenic and inflammatory phase. Neurogenic phase mediated release of corticotropin-releasing factor (CRF) plays a central role in neuroinflammation, and affects both central autonomic response as well hypothalamic-pituitary-adrenal (HPA) axis. HPA-stress axis associated cortisol release adversely affects gut microbiota and permeability. Peripheral CRF (pCRF) is a key player in stress induced gastric emptying and colonic transit. It functions as a local effector and interacts with the CRF receptors on the mast cell to release chemical mediators of inflammation. Mast cells proteases disrupt epithelial barrier via protease activated receptor-2 (PAR-2). PAR-2 facilitates cytoskeleton contraction to reorient tight junction proteins such as occludin, claudins, junctional adhesion molecule, and zonula occludens-1 to open epithelial barrier junctions. Barrier opening affects the selectivity, and hence permeation of luminal antigens and solutes in the gastrointestinal tract. Translocation of luminal antigens perturbs mucosal immune system to further exacerbate inflammation. Stress induced dysbiosis and decrease in production of short chain fatty acids add to the inflammatory response and barrier disintegration. This review discusses potential mechanisms and factors involved in the pathophysiology of POI with special reference to inflammation and interlinked events such as epithelial barrier dysfunction and dysbiosis. Based on this review, we recommend CRF, mast cells, macrophages, and microbiota could be targeted concurrently for efficient POI management. The Korean Society of Neurogastroenterology and Motility 2022-10-30 2022-10-30 /pmc/articles/PMC9577567/ /pubmed/36250359 http://dx.doi.org/10.5056/jnm22100 Text en © 2022 The Korean Society of Neurogastroenterology and Motility https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Hussain, Zahid
Park, Hyojin
Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title_full Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title_fullStr Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title_full_unstemmed Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title_short Inflammation and Impaired Gut Physiology in Post-operative Ileus: Mechanisms and the Treatment Options
title_sort inflammation and impaired gut physiology in post-operative ileus: mechanisms and the treatment options
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577567/
https://www.ncbi.nlm.nih.gov/pubmed/36250359
http://dx.doi.org/10.5056/jnm22100
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