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Book ; Online: Neurogenic Bowel Dysfunction

Krogh, Klaus

2022

Keywords	Medicine ; Neurology & clinical neurophysiology ; laxatives ; constipation ; adults ; prevalence ; utilisation ; gut microbiota ; spina bifida ; transanal irrigation ; urinary tract infection ; SCI ; MENTOR ; NBD ; fecal incontinence ; Parkinson's disease ; autonomic ; gastrointestinal ; alpha-synuclein ; parasympathetic ; neurogenic bowel dysfunction ; low anterior resection syndrome ; faecal incontinence ; chronic constipation ; bowel dysfunction ; quality of life ; spinal cord injury ; multiple sclerosis ; pharmacological ; systematic review ; neurogenic bowel ; treatment assessment ; bowel function ; exoskeletal walking ; difficulty with evacuation ; neostigmine ; glycopyrrolate ; iontophoresis ; autonomic dysfunction ; motility ; investigations ; manometry ; breath test ; imaging ; diabetes mellitus ; postprandial hypotension ; food ingestion ; ambulatory blood pressure measurement ; cohort study ; pediatric ; children ; adolescent ; anorectal malformation ; cerebral palsy ; acute rehabilitation ; opioids ; SCI bowel management
Language	0\|e
Size	1 electronic resource (242 pages)
Publisher	MDPI - Multidisciplinary Digital Publishing Institute
Publishing place	Basel
Document type	Book ; Online
Note	English ; Open Access
HBZ-ID	HT021613005
ISBN	9783036547985 ; 3036547983
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article ; Online: Are local analgesics effective in reducing autonomic dysreflexia in individuals with spinal cord injury? A systematic review.

Gray, Katherine / Sheehan, Whitley / McCracken, Laura / Krogh, Klaus / Sachdeva, Rahul / Krassioukov, Andrei V

Spinal cord

2022 Volume 61, Issue 1, Page(s) 1–7

Abstract: Study design: Systematic review.: Objectives: To systematically review the evidence on the use of local analgesics, specifically lidocaine or bupivacaine, to prevent autonomic dysreflexia (AD) during iatrogenic procedures or bowel and bladder care ... ...

Abstract	Study design: Systematic review. Objectives: To systematically review the evidence on the use of local analgesics, specifically lidocaine or bupivacaine, to prevent autonomic dysreflexia (AD) during iatrogenic procedures or bowel and bladder care routines in individuals with spinal cord injury (SCI). Methods: A keyword search of MEDLINE, CINAHL, CENTRAL, Cochrane Reviews, PsycInfo, Embase, and Web of Science databases identified all English-language studies evaluating the efficacy of local analgesics in reducing AD. Included studies were either randomized controlled trials (RCTs) or quasi-experimental studies. Participants were adults with chronic SCI who received local analgesics prior to AD-triggering procedures or routines. Additionally, studies were required to report blood pressure values as an outcome. The methodology of this review followed the PRISMA checklist and was registered with PROSPERO (CRD42021219506). Results: Four RCTs and two quasi-experimental studies met inclusion criteria. Results were narratively synthesized as meta-analysis was not possible due to heterogeneity across studies included in the review. All six studies administered lidocaine. Lidocaine was found to have a beneficial effect on AD in three studies, no effect in two studies and a detrimental effect in one study. Conclusions: Presently, RCTs and quasi-experimental studies on the use of lidocaine for reducing AD in individuals with SCI had small sample sizes and opposing findings. There is a strong need for definitive, well-monitored clinical trials with adequate sample sizes. Presently there is not enough compelling evidence to support or refute recommendations for the use of lidocaine from the AD management clinical practice guidelines.
MeSH term(s)	Adult ; Humans ; Autonomic Dysreflexia/drug therapy ; Autonomic Dysreflexia/etiology ; Autonomic Dysreflexia/prevention & control ; Spinal Cord Injuries/complications ; Spinal Cord Injuries/drug therapy ; Lidocaine/therapeutic use ; Bupivacaine ; Analgesics/therapeutic use
Chemical Substances	Lidocaine (98PI200987) ; Bupivacaine (Y8335394RO) ; Analgesics
Language	English
Publishing date	2022-08-12
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1316161-1
ISSN	1476-5624 ; 1362-4393
ISSN (online)	1476-5624
ISSN	1362-4393
DOI	10.1038/s41393-022-00840-8
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Article ; Online: Effects of opium tincture on the enteric and central nervous systems: A randomized controlled trial.

Okdahl, Tina / Mark, Esben Bolvig / Nedergaard, Rasmus Bach / Knoph, Cecilie Siggaard / Cook, Mathias Ellgaard / Krogh, Klaus / Drewes, Asbjørn Mohr

Basic & clinical pharmacology & toxicology

2023 Volume 132, Issue 5, Page(s) 434–448

Abstract: Opioids change gut motility, and opium tincture has been used for treatment of chronic diarrhoea for centuries. However, the effects have never been documented in controlled trials. We aimed to investigate the effects of opium tincture on ... ...

Abstract	Opioids change gut motility, and opium tincture has been used for treatment of chronic diarrhoea for centuries. However, the effects have never been documented in controlled trials. We aimed to investigate the effects of opium tincture on gastrointestinal transit and motility, frequency of bowel movements, stool consistency, gastrointestinal symptoms and sedation. Twenty healthy subjects were included in this randomized controlled trial. Opium tincture or placebo was each applied for 9 days. Gastrointestinal transit and motility were investigated with the 3D-transit system. Bowel movements and gastrointestinal symptoms were recorded daily. General cognition, reaction time, memory and electroencephalography were used to assess effects on the central nervous system. Opium tincture doubled colonic transit (49 vs. 23 h, p < 0.001), decreased antegrade colonic movements (p < 0.05), reduced daily bowel movements (0.7 vs. 1.2, p < 0.001) and increased stool consistency (Type 3 vs. Type 4, p < 0.001). No changes in general cognition, reaction time or memory were observed, and minor changes of power observed by electroencephalography did not indicate sedation. This study is the first to show that opium tincture has anti-propulsive properties in the healthy gut, while no sedative effects were seen. This indicates that opium tincture is a relevant and safe treatment option in chronic diarrhoea.
MeSH term(s)	Humans ; Opium ; Gastrointestinal Transit ; Gastrointestinal Motility/physiology ; Diarrhea/drug therapy ; Central Nervous System
Chemical Substances	Opium (8008-60-4)
Language	English
Publishing date	2023-03-08
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2134679-3
ISSN	1742-7843 ; 1742-7835
ISSN (online)	1742-7843
ISSN	1742-7835
DOI	10.1111/bcpt.13850
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Article: Opioids in the Treatment of Chronic Idiopathic Diarrhea in Humans-A Systematic Review and Treatment Guideline.

Graven-Nielsen, Christoffer S / Knoph, Cecilie S / Okdahl, Tina / Høyer, Katrine L / Krogh, Klaus / Hellström, Per M / Drewes, Asbjørn M

Journal of clinical medicine

2023 Volume 12, Issue 7

Abstract: In patients with chronic idiopathic diarrhea resistant to standard treatment, opioids are often used as rescue therapy. This systematic review investigated opioid effects on gut function in chronic diarrhea. PubMed and Embase were searched regarding ... ...

Abstract	In patients with chronic idiopathic diarrhea resistant to standard treatment, opioids are often used as rescue therapy. This systematic review investigated opioid effects on gut function in chronic diarrhea. PubMed and Embase were searched regarding effects of opioid agonists on the gastrointestinal tract in humans with chronic or experimentally induced diarrhea. A total of 1472 relevant articles were identified and, after thorough evaluation, 11 clinical trials were included. Generally, studies reported a reduction in stool frequency and an increase in transit time during treatment with the opioid receptor agonists loperamide, asimadoline, casokefamide, and codeine compared with placebo. Loperamide and diphenoxylate significantly improved stool consistency compared with placebo, whereas asimadoline showed no such effects. Compared with placebo, loperamide treatment caused less abdominal pain and urgency. Asimadoline showed no significant subjective improvements, but fedotozine was superior to placebo in reducing abdominal pain and bloating in selected patients. Only two relevant studies were published within the last 20 years, and standardized endpoint measures are lacking. Most trials included few participants, and further evidence is needed from larger, prospective studies. Likewise, consensus is needed to standardize endpoints for stool frequency, transit time, and consistency to conduct future meta-analyses on opioids in management of chronic idiopathic diarrhea.
Language	English
Publishing date	2023-03-24
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12072488
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Article ; Online: Mapping the Iceberg of Autonomic Recovery: Mechanistic Underpinnings of Neuromodulation following Spinal Cord Injury.

Samejima, Soshi / Shackleton, Claire / Miller, Tiev / Moritz, Chet T / Kessler, Thomas M / Krogh, Klaus / Sachdeva, Rahul / Krassioukov, Andrei V

The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry

2023 , Page(s) 10738584221145570

Abstract: Spinal cord injury leads to disruption in autonomic control resulting in cardiovascular, bowel, and lower urinary tract dysfunctions, all of which significantly reduce health-related quality of life. Although spinal cord stimulation shows promise for ... ...

Abstract	Spinal cord injury leads to disruption in autonomic control resulting in cardiovascular, bowel, and lower urinary tract dysfunctions, all of which significantly reduce health-related quality of life. Although spinal cord stimulation shows promise for promoting autonomic recovery, the underlying mechanisms are unclear. Based on current preclinical and clinical evidence, this narrative review provides the most plausible mechanisms underlying the effects of spinal cord stimulation for autonomic recovery, including activation of the somatoautonomic reflex and induction of neuroplastic changes in the spinal cord. Areas where evidence is limited are highlighted in an effort to guide the scientific community to further explore these mechanisms and advance the clinical translation of spinal cord stimulation for autonomic recovery.
Language	English
Publishing date	2023-01-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1233753-5
ISSN	1089-4098 ; 1073-8584
ISSN (online)	1089-4098
ISSN	1073-8584
DOI	10.1177/10738584221145570
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Article: Dietary Intervention Improves Gastrointestinal Symptoms after Treatment of Cancer in the Pelvic Organs.

Borre, Mette / Fassov, Janne / Poulsen, Jakob Lykke / Christensen, Peter / Laurberg, Søren / Drewes, Asbjørn Mohr / Krogh, Klaus

Journal of clinical medicine

2023 Volume 12, Issue 14

Abstract: Gastrointestinal (GI) symptoms are common in patients receiving radiotherapy, chemotherapy, and/or surgery for cancer in the pelvic organs. The aim of the present prospective cohort study was to report the efficacy of dietary intervention in patients ... ...

Abstract	Gastrointestinal (GI) symptoms are common in patients receiving radiotherapy, chemotherapy, and/or surgery for cancer in the pelvic organs. The aim of the present prospective cohort study was to report the efficacy of dietary intervention in patients with chronic GI sequelae to treatment of cancer in pelvic organs and insufficient symptomatic effect of medical treatment. Eighty-eight patients were offered specialist dietitian guidance. Gastrointestinal symptoms and quality of life were assessed before and after intervention by validated questionnaires. The main dietary interventions were low-fat diet (n = 44; 50%), modification of dietary fiber content (n = 19; 33%), dietary restrictions with a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (n = 18; 20%), gluten-free diet (n = 1; 1%), and other dietary advice (n = 6; 7%). Compared to baseline, dietary intervention improved quality of life (EQ5D scale) (
Language	English
Publishing date	2023-07-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12144766
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Article: Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm.

Magnuson, Fredrika S / Christensen, Peter / Krassioukov, Andrei / Rodriguez, Gianna / Emmanuel, Anton / Kirshblum, Steven / Krogh, Klaus

Journal of clinical medicine

2023 Volume 12, Issue 22

Abstract: Neurogenic bowel dysfunction (NBD) is a common condition in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). It usually entails constipation, difficult evacuation of the rectum, and fecal incontinence (FI); often in combination. It ... ...

Abstract	Neurogenic bowel dysfunction (NBD) is a common condition in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). It usually entails constipation, difficult evacuation of the rectum, and fecal incontinence (FI); often in combination. It is highly burdensome for affected patients and is correlated with poor quality of life. The current treatment algorithm, or treatment pyramid, does not completely correspond to actual clinical practice, and the known and classical pyramid contains both treatments still in their experimental stage as well as several treatments which are not available at all treatment centers. Thus, an updated treatment algorithm is called upon, and the authors of this paper therefore propose a simplified version of the treatment pyramid, aiming to guide clinicians in treating NBD.
Language	English
Publishing date	2023-11-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12226971
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Article ; Online: Pan-alimentary assessment of motility, luminal content, and structures: an MRI-based framework.

Bertoli, Davide / Mark, Esben B / Liao, Donghua / Brock, Christina / Brock, Birgitte / Knop, Filip K / Krogh, Klaus / Frøkjær, Jens B / Drewes, Asbjorn M

Scandinavian journal of gastroenterology

2023 Volume 58, Issue 12, Page(s) 1378–1390

Abstract: Background: Gastrointestinal symptoms originating from different segments overlap and complicate diagnosis and treatment. In this study, we aimed to develop and test a pan-alimentary framework for the evaluation of gastrointestinal (GI) motility and ... ...

Abstract	Background: Gastrointestinal symptoms originating from different segments overlap and complicate diagnosis and treatment. In this study, we aimed to develop and test a pan-alimentary framework for the evaluation of gastrointestinal (GI) motility and different static endpoints based on magnetic resonance imaging (MRI) without contrast agents or bowel preparation. Methods: Twenty healthy volunteers (55.6 ± 10.9 years, BMI 30.8 ± 9.2 kg/m Key results: We observed an increase in stomach and small bowel volume immediately after meal intake from baseline values ( Conclusion & inferences: We developed a framework for a pan-alimentary assessment of GI endpoints and observed how different dynamic and static physiological endpoints responded to meal intake. All endpoints aligned with the current literature for individual gut segments, showing that a comprehensive model may unravel complex and incoherent gastrointestinal symptoms in patients.
MeSH term(s)	Humans ; Gastric Emptying/physiology ; Stomach/diagnostic imaging ; Gastrointestinal Motility ; Gastrointestinal Diseases/etiology ; Magnetic Resonance Imaging/adverse effects ; Magnetic Resonance Imaging/methods ; Meals ; Water
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2023-07-10
Publishing country	England
Document type	Journal Article
ZDB-ID	82042-8
ISSN	1502-7708 ; 0036-5521
ISSN (online)	1502-7708
ISSN	0036-5521
DOI	10.1080/00365521.2023.2233036
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Article ; Online: Sacral nerve modulation for irritable bowel syndrome: A randomized, double-blinded, placebo-controlled crossover study.

Fassov, Janne / Lundby, Lilli / Laurberg, Søren / Krogh, Klaus

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

2019 Volume 31, Issue 6, Page(s) e13570

Abstract: Background: Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders, and a substantial proportion of patients have an insufficient response to treatment. In a single-blinded study, sacral nerve modulation (SNM) significantly ... ...

Abstract	Background: Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders, and a substantial proportion of patients have an insufficient response to treatment. In a single-blinded study, sacral nerve modulation (SNM) significantly reduced symptoms of IBS. The aim of the present double-blinded, randomized, placebo-controlled study was to evaluate the effect of SNM for IBS. Methods: We included patients with diarrhea-predominant or mixed IBS and a minimum baseline IBS-specific symptom score of 40 points (Gastrointestinal Symptom Rating Scale-IBS version). Patients underwent a 6-week period of SNM. In the first 4 weeks, the patients were randomized 1:1 to have the neurostimulator set subsensory or OFF for 2 weeks and then the opposite for another 2 weeks. Patients and investigators were blinded to settings. In the remaining 2 weeks, the stimulation was set suprasensory. IBS-specific symptoms and quality of life were assessed with validated questionnaires and bowel diaries. Key results: Twenty-one patients were randomized and eligible for analysis. The IBS-specific symptom score was reduced with borderline significance during stimulation (subsensory-OFF median change -1 (-26, 9), OFF-subsensory median change 8 (-11, 36); P = 0.0572). Pain was significantly reduced during stimulation (subsensory-OFF median change -1.5 (-4, 1), OFF-subsensory median change 1 (-4, 3); P = 0.0188), along with the number of daily bowel movements (subsensory-OFF median change 0 (-1.8, 0.2), OFF-subsensory median change 0.2 (-0.5, 1.1); P = 0.0373). The median placebo effect was 14% (0, 55). Conclusion and inferences: Sacral nerve modulation for IBS seems promising but should be considered experimental until larger multicenter studies have been performed.
MeSH term(s)	Adult ; Cross-Over Studies ; Double-Blind Method ; Electric Stimulation Therapy/methods ; Female ; Humans ; Irritable Bowel Syndrome/therapy ; Lumbosacral Plexus ; Male ; Middle Aged ; Treatment Outcome
Language	English
Publishing date	2019-02-21
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.13570
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Article ; Online: Transcutaneous vagal nerve stimulation for treating gastrointestinal symptoms in individuals with diabetes: a randomised, double-blind, sham-controlled, multicentre trial.

Kornum, Ditte S / Bertoli, Davide / Kufaishi, Huda / Wegeberg, Anne-Marie / Okdahl, Tina / Mark, Esben B / Høyer, Katrine L / Frøkjær, Jens B / Brock, Birgitte / Krogh, Klaus / Hansen, Christian S / Knop, Filip K / Brock, Christina / Drewes, Asbjørn M

Diabetologia

2024

Abstract: Aims/hypothesis: Diabetic gastroenteropathy frequently causes debilitating gastrointestinal symptoms. Previous uncontrolled studies have shown that transcutaneous vagal nerve stimulation (tVNS) may improve gastrointestinal symptoms. To investigate the ... ...

Abstract	Aims/hypothesis: Diabetic gastroenteropathy frequently causes debilitating gastrointestinal symptoms. Previous uncontrolled studies have shown that transcutaneous vagal nerve stimulation (tVNS) may improve gastrointestinal symptoms. To investigate the effect of cervical tVNS in individuals with diabetes suffering from autonomic neuropathy and gastrointestinal symptoms, we conducted a randomised, sham-controlled, double-blind (participants and investigators were blinded to the allocated treatment) study. Methods: This study included adults (aged 20-86) with type 1 or 2 diabetes, gastrointestinal symptoms and autonomic neuropathy recruited from three Steno Diabetes Centres in Denmark. Participants were randomly allocated 1:1 to receive active or sham stimulation. Active cervical tVNS or sham stimulation was self-administered over two successive study periods: 1 week of four daily stimulations and 8 weeks of two daily stimulations. The primary outcome measures were gastrointestinal symptom changes as measured using the gastroparesis cardinal symptom index (GCSI) and the gastrointestinal symptom rating scale (GSRS). Secondary outcomes included gastrointestinal transit times and cardiovascular autonomic function. Results: Sixty-eight participants were randomised to the active group, while 77 were randomised to the sham group. Sixty-three in the active and 68 in the sham group remained for analysis in study period 1, while 62 in each group were analysed in study period 2. In study period 1, active and sham tVNS resulted in similar symptom reductions (GCSI: -0.26 ± 0.64 vs -0.17 ± 0.62, p=0.44; GSRS: -0.35 ± 0.62 vs -0.32 ± 0.59, p=0.77; mean ± SD). In study period 2, active stimulation also caused a mean symptom decrease that was comparable to that observed after sham stimulation (GCSI: -0.47 ± 0.78 vs -0.33 ± 0.75, p=0.34; GSRS: -0.46 ± 0.90 vs -0.35 ± 0.79, p=0.50). Gastric emptying time was increased in the active group compared with sham (23 min vs -19 min, p=0.04). Segmental intestinal transit times and cardiovascular autonomic measurements did not differ between treatment groups (all p>0.05). The tVNS was well-tolerated. Conclusions/interpretation: Cervical tVNS, compared with sham stimulation, does not improve gastrointestinal symptoms among individuals with diabetes and autonomic neuropathy. Trial registration: ClinicalTrials.gov NCT04143269 FUNDING: The study was funded by the Novo Nordisk Foundation (grant number NNF180C0052045).
Language	English
Publishing date	2024-03-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1694-9
ISSN	1432-0428 ; 0012-186X
ISSN (online)	1432-0428
ISSN	0012-186X
DOI	10.1007/s00125-024-06129-0
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