Transcutaneous Electrical Stimulation To Relieve Chronic Constipation In Children
Funder
National Health and Medical Research Council
Funding Amount
$82,450.00
Summary
1 in 300 children suffer from chronic constipation that is not fixed by changing their diet or taking laxatives. They continue to suffer the problem into adulthood. They also have fecal incontinence or soiling that causes problems with socialising and schooling. We are testing a method of electrical stimulation through the skin on the belly to increase the movement of the bowel. Initial results are encouraging, showing that the rate of movement of the bowel is increased and soiling is decreased.
Transcutaneous Electrical Stimulation To Relieve Chronic Constipation In Children
Funder
National Health and Medical Research Council
Funding Amount
$346,995.00
Summary
We have over 300 children with chronic treatment-resistant constipation at Royal Children's Hospital Melbourne. We have a new physiotherapy technique that may overcome constipation and stop soiling in many of these children. In 2003-4, we ran a pilot study to test a technique used by physiotherapists to treat urinary incontinence. We have called the method TESIC (transcutaneous electrical stimulation using interferential current). TESIC uses suction electrodes placed on the belly and back at the ....We have over 300 children with chronic treatment-resistant constipation at Royal Children's Hospital Melbourne. We have a new physiotherapy technique that may overcome constipation and stop soiling in many of these children. In 2003-4, we ran a pilot study to test a technique used by physiotherapists to treat urinary incontinence. We have called the method TESIC (transcutaneous electrical stimulation using interferential current). TESIC uses suction electrodes placed on the belly and back at the level of the belly button. The electrical stimulation is applied using a current (interferential current) that stimulates deep into the abdomen. We tested 8 children and had very encouraging results with improved constipatio in 5-8 and all with soiling stopped. Parents and children are keen to use this technique but first we need to establish that the results are reproducible in a larger group of 70 children. We also need to know if the effect was just a placebo response (due to time spent with the physiotherapists), and how long the effect lasts. We will also measure changes in soiling. Faecal soiling is smelly and antisocial. Relief of soiling has a big impact on a child's ability to fit in at school and to attend normal schooling. We will measure outcomes using daily diaries kept by children, questionnaires, how quickly food moves through the bowel and pressures within the bowel. We have a multidiciplinary team of experienced clinicians and scientists with expertise in these techniques and in constipation and incontinence in children (paediatric surgeon, gastroenterologist, manometry nurse, incontinence paediatrician and physiotherapist, expert in electrical stimulation and gut nervous system scientist). This technique could revolutionise treatment of chronic constipation. Most physiotherapists have TESIC machines, allowing delivery Australia wide. It is non-invasive and should also be able to be used by adults, including the elderly in nursing homes.Read moreRead less
Neuro-muscular Apparatus In Human Colon And In Children With Chronic Constipation
Funder
National Health and Medical Research Council
Funding Amount
$195,660.00
Summary
NIDKIDS is a support group for children with chronic constipation. There are 200 patients at the Royal Childrens Hospital in Melbourne who are in this group because their constipation has not responded to any treatments. Movement of food along the intestine requires muscle in the wall of the intestine to contract in a coordinated pattern. Coordination of the muscle contractions is provided by the nervous system. The nervous system controlling the gut has cell bodies located within the gut wall, ....NIDKIDS is a support group for children with chronic constipation. There are 200 patients at the Royal Childrens Hospital in Melbourne who are in this group because their constipation has not responded to any treatments. Movement of food along the intestine requires muscle in the wall of the intestine to contract in a coordinated pattern. Coordination of the muscle contractions is provided by the nervous system. The nervous system controlling the gut has cell bodies located within the gut wall, that send processes to the muscle and lining of the gut. There are sensory neurons, motor neurons and neurons that connect between the other neurons (interneurons). Nerves communicate between each other and cause muscles to contract by releasing chemicals (transmitters). In the last decade, we have discovered that communication between the nerve and muscle cells occurs through a third cell type- interstitial cells of Cajal. These cells also have a role as pacemaker cells for the muscle cells. In a small study, we have found that the muscle can contract in response to transmitters but that activation of the nerves does not result in muscle contraction in NIDKIDs. This result shows that transmission from neurons to muscle is not occuring in large bowel from NIDKIDs. In this study, we will examine a larger group of patients to determine if a functional defect in the muscle, a defect in the nerve chemical transmitters or a lack of the intermediate cells (the interstitial cells of Cajal) is causing the problem in the NIDKIDs. Further treatment of each patient will be easier if the defect causing his-her problem is known. We would then be able to target their problem with drugs that would work specifically at the point of breakdown in their individual gut.Read moreRead less
Mechanisms By Which Aging Induces Constipation In The Elderly
Funder
National Health and Medical Research Council
Funding Amount
$369,717.00
Summary
Chronic constipation is one of the most common reasons why the elderly community seek medical attention. There is now strong evidence to suggest that the high prevalence of constipation in the elderly is likely due to a dramatic loss of specific nerves that lie in the wall of the colon. This project will use latest imaging technologies to identify the mechanisms by which these nerves are impaired with age that lead to constipation in the elderly.
Motor Patterns Of Colonic Transit And Pathophysiology Of Severe Constipation.
Funder
National Health and Medical Research Council
Funding Amount
$196,018.00
Summary
This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions and flow of content along the colon in these patients. The aim will be to try and identify abnormal patterns responsible for the constipation so that future studies can target appropriate drugs at the responsible defect. A better unde ....This project aims to clarify the contractile patterns of the human colon which underlie the very common and distressing condition of constipation. We will be relating symptoms of constipation from a large number of sufferers with actual measurements of contractions and flow of content along the colon in these patients. The aim will be to try and identify abnormal patterns responsible for the constipation so that future studies can target appropriate drugs at the responsible defect. A better understanding of clusters or symptoms and how they might predict such underlying abnormalities is crucial for the safer and more cost effective diagnosis and treatment of affected patients. Pharmacological studies in the human as well as on tissue obtained from affected patients at surgery will be conducted to better understand the presumptive abnormalities affecting the nerves within the colon in constipation.Read moreRead less
Properties And Electro-Physiology Of The Intrinsic Nervous System
Funder
National Health and Medical Research Council
Funding Amount
$419,214.00
Summary
The gut contains a very large number of nerve cells which fall into several functionally distinct groups. We have identified virtually all these functional groups in the guinea-pig small intestine and have begun an analysis of the ways the different groups communicate with each other. We have developed methods to identify the functions of any nerve cell from which we record and have also developed novel methods for specifically stimulating individual functional classes of nerve cells that contac ....The gut contains a very large number of nerve cells which fall into several functionally distinct groups. We have identified virtually all these functional groups in the guinea-pig small intestine and have begun an analysis of the ways the different groups communicate with each other. We have developed methods to identify the functions of any nerve cell from which we record and have also developed novel methods for specifically stimulating individual functional classes of nerve cells that contact them. The aim of the proposed research is to exploit these methods to identify the chemicals used by specifc types of nerve cell in transmission of information to other nerve cells during the normal behaviour of the intestine. We will record the behaviour of individual nerve cells in the gut wall while stimulating specific nerve pathways that contact them. We will then use drugs that block the activity of the chemicals of interest (small proteins called tachykinins, and certain amine compounds) to try and block the transmission of information between the nerve cells involved. Identification of the nature of the chemicals used at specific connections between different functional groups of nerve cells in the gut will allow the design of drugs for treatment of gastrointestinal disorders that will have minimal side effects. Further because the chemicals that are used for communication in the gut are also found in the brain, the results will provide evidence about the functions of these chemicals elsewhere in the nervous system.Read moreRead less
A Novel Mechanism For Intestinal Propulsion: Transit Without Neurons Or Pacemakers
Funder
National Health and Medical Research Council
Funding Amount
$256,973.00
Summary
A significant complication of premature births is that the mechanisms that regulate normal intestinal movements have not yet fully developed. We have recently identified a novel pattern of contraction that is seen predominantly in the colon of mice that have not yet developed either the normal nerve circuits that control gut movement and also lack the pacemaker cells that are intrinsic to the muscle coat. This motor pattern appears to be responsible for the movement of gut content during the dev ....A significant complication of premature births is that the mechanisms that regulate normal intestinal movements have not yet fully developed. We have recently identified a novel pattern of contraction that is seen predominantly in the colon of mice that have not yet developed either the normal nerve circuits that control gut movement and also lack the pacemaker cells that are intrinsic to the muscle coat. This motor pattern appears to be responsible for the movement of gut content during the development and maturation of the nerve circuits that regulate this process in more adult animals. However, the mechanisms responsible for this process have not been identified. This project is directed at identifying these mechanismsRead moreRead less
Sacral Parasympathetic Innervation Of Distal Bowel
Funder
National Health and Medical Research Council
Funding Amount
$314,983.00
Summary
Not a topic for polite conversation, normal movements of the colon and rectum are essential for good health and a sense of wellbeing. Constipation, diarrhoea, incontinence and pain result from disordered motility. One major control mechanism is the parasympathetic innervation. While we know of its importance, how it works in health and diseases is poorly understood. This project will use state-of-the-art techniques to study this pathway in order to understand its role in health and disease
Antidepressants In Irritable Bowel: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$227,546.00
Summary
Irritable bowel syndrome is a common costly disorder in Australia; one in six Australians suffer with the condition. IBS can cause very substantial disability; some become housebound because of the need to have toilet facilities nearby. The currently available treatments for irritable bowel syndrome only provide at best partial relief or are completely ineffective. The literature suggests that individuals who suffer from an irritable bowel may benefit from the use of an antidepressant medication ....Irritable bowel syndrome is a common costly disorder in Australia; one in six Australians suffer with the condition. IBS can cause very substantial disability; some become housebound because of the need to have toilet facilities nearby. The currently available treatments for irritable bowel syndrome only provide at best partial relief or are completely ineffective. The literature suggests that individuals who suffer from an irritable bowel may benefit from the use of an antidepressant medication. Antidepressant medications have been shown to affect the function of the gastrointestinal system, in addition to relieving some of the psychological symptoms, such as depression and anxiety that are common in individuals with irritable bowel syndrome. To date, there have been no proper controlled trials of antidepressant medications in IBS, and there have been no studies at all into the new class of antidepressant medications, the selective serotonin reuptake inhibitors, in treating IBS. In this study we aim to investigate whether antidepressant medications are effective in treating irritable bowel syndrome by directly comparing a tricyclic (older class of antidepressant) with a selective serotonin reuptake inhibitor (new class of antidepressant) and with a placebo. All study participants will be closely monitored during the study. Patients will have their gastrointestinal symptoms, psychological symptoms, disability, quality of life and tolerance to the medication assessed. This will be the first comprehensive study of antidepressant medications assessed and the irritable bowel syndrome to be undertaken. The study will be conducted at the Nepean Hospital and the Royal North Shore Hospital; both of these centres have a well established treatment and research programs into the irritable bowel syndrome.Read moreRead less