Intestine motility, secretion, and constipation treatment principles

Introduction. Constipation is a derangement of the motor, secretory and/or evacuation function of the colon. The same symptoms are recorded in at least 20% of the population in the developed countries – as those occurring sporadically or for a long period.

Basic content. The secretory function of the colon significantly affects stool consistency and its free movement. The secretion increases by 8–10 times in the presence of local mechanical irritation.  Intestinal mucus is produced by colonic goblet cells. The frequency, time of defecation and stool consistency is in large part determined by the motor function of the colon. The relation of various types of contraction varies depending on the main function – propulsion or mixing. Rhythmic phasic contractions in the colon generate a pendular movement with slow propulsion of the contents and absorption of water. The tonic contractions enhance the mixing effect of weak rhythmic contractions. The propulsive contractions are specifically attributed to the lower gastrointestinal tract and occur spontaneously. They occur quite regularly, from 2 to 10 times a day, and ensure the propulsion of intestinal contents over great distances in the colon. When reaching the sphincter area, such wave causes its relaxation by mechanisms of descending inhibition. The dietary regime and adequate intake of carbohydrates with various chain lengths, including dietary fiber, as well as flavonoids and other components that modify peristaltic activity and secretion, play an important role in the regulation of intestinal secretion and peristalsis. The drugs enhancing intestinal secretion and peristalsis, such as bisacodyl and sodium picosulfate, are also used to treat constipation. These substances hydrolyse into bis-(p-hydroxyphenyl)-pyridyl-2-methane in the intestine, which, upon contact with the receptors in colonic mucosa, stimulates propulsive activity and increases intestinal secretion. The selective action of sodium picosulfate is confined to the colon.

Conclusion. Pharmacological and non-pharmacological treatments for constipation are aimed at maintaining and enhancing the natural propulsive contractions of the colon and intestinal secretion.

1. Kojima M., Wakai K., Tokudome S. et al. Bowel movement frequency and risk of colorectal cancer in a large cohort study of Japanese men and women. Br J Cancer. 2004;90(7):1397–1401. doi: 10.1038/sj.bjc.6601735.

2. Watanabe T., Nakaya N., Kurashima K., Kuriyama S., Tsubono Y., Tsuji I. Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study. Eur J Cancer. 2004;40(14):2109–2115. doi: 10.1016/j.ejca.2004.06.014.

3. Johansson M.E., Larsson J.M., Hansson G.C. The two mucus layers of colon are organized by the MUC2 mucin, whereas the outer layer is a legislator of host-microbial interactions. Proc Natl Acad Sci U S A. 2011;108(1):4659– 4665. doi: 10.1073/pnas.1006451107.

4. Sarna S.K. Colonic Motility: From Bench Side to Bedside. San Rafael (CA): Morgan & Claypool Life Sciences; 2010. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21452445.

5. Ueno T., Uemura K., Harris M.B., Pappas T.N., Takahashi T. Role of vagus nerve in postprandial antropyloric coordination in conscious dogs. Am J Physiol Gastrointest Liver Physiol. 2005;288(3):487–495. doi: 10.1152/ajpgi.00195.2004.

6. Bharucha A.E. High amplitude propagated contractions. Neurogastroenterol Motil. 2012;24(11):977–982. doi: 10.1111/nmo.12019.

7. Auwerda J.J., Bac D.J., Schouten W.R. Circadian rhythm of rectal motor complexes. Dis Colon Rectum. 2001;44(9):1328–32. doi: 10.1007/bf02234793.

8. Guyton A.C. Textbook of Medical Physiology. 8th ed. Philadelphia: W.B. Saunders; 1991.

9. Jun J.Y. The Excitatory Effect of Cholecystokinin on Colonic Motor Function via Cholecystokinin Receptor. J Neurogastroenterol Motil. 2011;17(1):4–5. doi: 10.5056/jnm.2011.17.1.4.

10. Chen J.H., Parsons S.P., Shokrollahi M. et al. Characterization of Simultaneous Pressure Waves as Biomarkers for Colonic Motility Assessed by High-Resolution Colonic Manometry. Front Physiol. 2018;9:1248. doi: 10.3389/fphys.2018.01248.

11. Arhipov V.Yu. Inulin and oligofructose: efficiency as a prebiotic fiber for the confectionery industry. Fundamental’nye issledovaniya = Fundamental research. 2014;9(6):1216–1219. (In Russ.) Available at: http://www.fundamental-research.ru/ru/article/view?id=35041.

12. Hwang N., Eom Т., Gupta S.K., Jeong S.Y., Jeong D.Y., Kim Y.S. et al. Genes and Gut Bacteria Involved in Luminal Butyrate Reduction Caused by Diet and Loperamide. Genes (Basel). 2017;8(12):pii: E350. doi: 10.3390/genes8120350.

13. Damiano S., Sasso A., De Felice B., Di Gregorio I., La Rosa G., Lupoli G.A. et al. Quercetin Increases MUC2 and MUC5AC Gene Expression and Secretion in Intestinal Goblet Cell-Like LS174T via PLC/PKCα/ERK1-2 Pathway. Front Physiol. 2018;9:357. doi: 10.3389/fphys.2018.00357.

14. Briguglio M., Dell’Osso B., Panzica G., Malgaroli A., Banfi G., Zanaboni D.C. et al.. Dietary Neurotransmitters: A Narrative Review on Current Knowledge. Nutrients. 2018;10(5):pii: E591. doi: 10.3390/nu10050591.

15. Łowicka E., Bełtowski J. Hydrogen sulfide (H2S) – the third gas of interest for pharmacologists. Pharmacol Rep. 2007;59(1):4–24. Available at: http://www.if-pan.krakow.pl/pjp/pdf/2007/1_4.pdf.

16. Ivashkin V.T., Mayev I.V., Sheptulin A.A., Trukhmanov A.S., Poluektova Y.A., Baranskaya Y.K. et al. Diagnostics and treatment of chronic constipation in adults: clinical guidelines of the Russian gastroenterological association. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(3):75–83. (In Russ.) doi: 10.22416/1382-4376-2017-27-3-75-83.

17. Talley N.J. Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol. 2003;98(4):750–758. doi: 10.1111/j.1572-0241.2003.07306.x.