Kumaran Thiruppathy

Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease

Objectives Bowel and bladder symptoms are highly prevalent in patients with multiple sclerosis (MS). Bladder dysfunction (affecting 75% of these patients) is caused by disease in the spinal cord, whilst the pathophysiology of bowel dysfunction is unknown. Pathways regulating both the organs lie in close proximity to the spinal cord, and coexistence of their dysfunction might be the result of a common pathophysiology. If so, the prevalence of bladder symptoms should be greater in patients with MS and bowel symptoms. This hypothesis is tested in the study. We also evaluated how patient-reported symptoms quantify bowel dysfunction. Patients and methods The Neurogenic Bowel Dysfunction questionnaire and the presence of bladder symptoms were recorded in 71 patients with MS and bowel symptoms. Disability, a surrogate clinical measure of spinal cord disease, was assessed using the Expanded Disability Status Scale. Bowel and bladder symptoms were quantified by patient-reported frequency, expressed in time percentage (0, 25, 50, 75 or 100% of the time the symptom was perceived), and patient-reported severity on a visual analogue scale between 0 and 100. Results The prevalence of bladder symptoms was 85%, which is higher than that expected in an unselected population of patients with MS. Neurogenic Bowel Dysfunction score was significantly correlated with both patient-reported frequency (r=0.860, P<0.0001) and severity of bowel symptoms (r=0.659, P=<0.0001), as well as with the Expanded Disability Status Scale (r=0.526, P<0.0001). Conclusion Our findings suggest that gut dysfunction in patients with MS is secondary to spinal cord disease. Patient-reported bowel symptoms quantify bowel dysfunction well.

Congenital asplenia and group B streptococcus sepsis in the adult : case report and review of the literature

Asplenia is associated with an increased incidence of fatal and life-threatening sepsis caused by encapsulated pathogens. Isolated congenital asplenia is a very rare condition, with only 33 cases reported in the literature. The authors report another case of this condition complicated by overwhelming Group B streptococcus sepsis secondary to paronychia that was managed successfully.

Effect of rectal distension on voluntary external anal sphincter function in healthy subjects

Aim  Quantification of the anorectal reflex function is critical for explaining the physiological control of continence. Reflex external anal sphincter activity increases with rectal distension in a dynamic response. We hypothesized that rectal distension would similarly augment voluntary external anal sphincter function, quantified by measuring the anal maximum squeeze pressure.

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, ClinicalManifestation and Management

Bowel dysfunction amongst multiple sclerosis (MS) patients often manifests as faecal incontinence (FI), constipation, or a combination of the two. Its pathophysiology is poorly understood and can be multifactorial. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice. Due to the varied and fluctuant nature of the symptoms, these patients can be a management challenge. This review aims to give an overview of the pathophysiology, clinical manifestations and the principles of management of multiple sclerosis patients with bowel dysfunction

The utility of conditioning sequences in barostat protocols for the measurement of rectal compliance

A barostat can be used to measure rectal sensitivity, compliance and elastance all of which are potentially important physiological parameters in the pathophysiology of faecal incontinence. Current practice recommends a conditioning distension sequence be performed prior to index distensions. We questioned the validity of this by comparing values for rectal compliance during sequential conditioning (CD) and index (ID) distensions in physiologically normal subjects.

Colonic Motility and Physiology

Although the colon is not an organ essential for survival, it contributes in a major fashion to physical well-being. It plays an important role in three key homeostatic functions: (1) absorption of water and electrolytes, (2) absorption of nutrients and (3) storage and controlled evacuation of faecal material. Approximately 90% of the whole gut transit time is accounted for by colonic transit time. This prolonged transit is essential in permitting the colon to fulfil these functions. The colon can be divided functionally into two portions, the right and left colon. The right colon (caecum and ascending colon) plays a major role in water and electrolyte absorption and fermentation of undigested sugars, and the left colon (descending colon, sigmoid colon and rectum) is predominantly involved in storage and evacuation of stool.