Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0655, USA.
Neurogastroenterol Motil. 2012 Jul;24(7):670-7, e295-6. doi: 10.1111/j.1365-2982.2012.01918.x. Epub 2012 Apr 10.
In obstructive bowel disorders (OBDs) such as achalasia, pyloric stenosis, and bowel obstruction, the lumen of the affected segments is markedly dilated and the motility function is significantly impaired. We tested the hypothesis that mechanical stress in lumen dilation leads to induction of cyclooxygenase-2 (COX-2) in smooth muscle throughout the gastrointestinal (GI) tract, contributing to motility dysfunction.
Lumen dilation was induced in vivo with obstruction bands (12 × 3 mm) applied over the lower esophageal sphincter (LES), the pyloric sphincter, and the ileum in rats for 48 h. Mechanical stretch in vivo was also emulated by balloon distension of the distal colon. Direct stretch of muscle strips from the esophagus, gastric fundus, and ileum was mimicked in an in vitro tissue culture system.
Partial obstruction in the LES, pylorus, and ileum significantly increased the expression of COX-2 mRNA and protein in the muscularis externae of the dilated segment oral to the occlusions, but not in the aboral segment. Direct stretch of the lumen in vivo or of muscle strips in vitro markedly induced COX-2 expression. The smooth muscle contractility was significantly suppressed in the balloon-distended segments. However, treatment with COX-2 inhibitor NS-398 restored the contractility. Furthermore, in vivo administration of NS-398 in gastric outlet obstruction significantly improved gastric emptying.
CONCLUSIONS & INFERENCES: Mechanical dilation of the gut lumen by occlusion or direct distension induces gene expression of COX-2 throughout the GI tract. Mechanical stress-induced COX-2 contributes to motility dysfunction in conditions with lumen dilation.
在梗阻性肠病(OBD)中,如贲门失弛缓症、幽门狭窄和肠梗阻,受累节段的管腔明显扩张,运动功能显著受损。我们假设管腔扩张导致的机械应力会导致整个胃肠道(GI)中的环氧化酶-2(COX-2)诱导,导致运动功能障碍。
通过在下食管括约肌(LES)、幽门和回肠上施加 12×3mm 的阻塞带,在体内诱导管腔扩张,持续 48 小时。通过球囊扩张远端结肠来模拟体内的机械拉伸。通过体外组织培养系统模拟食管、胃底和回肠的肌肉条的直接拉伸。
LES、幽门和回肠的部分阻塞显著增加了扩张段口侧闭塞处的外肌层 COX-2 mRNA 和蛋白的表达,但在口侧没有。体内管腔的直接拉伸或体外肌肉条的直接拉伸显著诱导了 COX-2 的表达。球囊扩张段的平滑肌收缩明显受到抑制。然而,用 COX-2 抑制剂 NS-398 治疗可恢复收缩性。此外,在胃出口梗阻中体内给予 NS-398 可显著改善胃排空。
阻塞或直接扩张引起的肠道管腔机械扩张会诱导整个胃肠道的 COX-2 基因表达。机械应激诱导的 COX-2 导致管腔扩张时的运动功能障碍。