Autophagy Can Prevent Adhesions: The Most Common Cause Of Bowel Obstruction

Bowel obstruction is when the intestinal contents cannot pass thru a segment of the intestines. It is a surgical emergency.

In bowel obstruction, the air and intestinal contents proximal to the obstruction accumulate and distend the intestines.

Symptoms include obstipation, the absence of bowel movement, abdominal bloating, pain and nausea, and vomiting.

Gross alert: In severe cases, the smell of the emesis is described as “fecaloid.”

The complications include bowel rupture, sepsis, dehydration, and fluid and electrolyte imbalances.

The cause of bowel obstruction can be a tumor, volvulus where the bowel twists like a pretzel, incarcerated hernias, stool impaction, and foreign bodies.

The most common is intestinal adhesions. It is the most common because it results from previous abdominal surgery.

Contact of the bowels with the surgical instruments, drying of the organs during surgery, and retained intraabdominal blood clots can cause adhesions.

Cancer radiation therapy and gynecological infections are other causes. Sometimes, there may be no identifiable cause.

With that in mind, surgeons take the proper precautions to prevent adhesion formation after the surgery.

The treatment of bowel obstruction is no fun either. The patient is not allowed to eat, intravenous fluids are started, and a long plastic nasogastric tube is inserted in the nose and passes down the throat and esophagus to settle in the stomach.

Then the tube is hooked to a suction machine at low pressure to remove accumulated gas and intestinal contents. I have seen situations where two to three liters of fluid were evacuated from a patient.

That tube can last inside for several days.

Most of the time, suctioning works, and the bowels open up and work again. If not, surgery is recommended, an additional procedure that increases the risk of more adhesion formation. Plus, surgery is not a guarantee that adhesions will not happen again.

Is there anything that someone can do to prevent adhesions? There are a lot of people who had their appendix, gallbladder, and uterus removed out there.

Autophagy Can Prevent Adhesions: The Most Common Cause Of Bowel Obstruction — Image Of Adhesion After Appendectomy. Source: Hic Et Nunc

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1 Autophagy

2 What induces autophagy?

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2.3 Related

Autophagy

Autophagy is when the body recycles cells that are not useful. Dysfunctional, previously infected, and precancerous proteins are broken into amino acids and reused to make new cells.

Collagen that is present in the adhesions is one of those proteins. The collagen functions like glue and makes the intestines stick together. Collagen can form a band and contract after it crosses the intestines to cause the obstruction.

There are no medicines to remove adhesions, and no surgeon I know will remove adhesions electively. Surgery for adhesions is only done on an emergency basis.

A study from Japan showed that autophagy might play a role in removing adhesions. The research, Autophagy promotes degradation of internalized collagen and regulates distribution of focal adhesions to suppress cell adhesion, was published in Biology Open in October 2017.[1]

One mechanism of autophagy is for the extracellular collagen to be absorbed inside the cell. Inside the cell, an organelle called the lysosome degrades parts of the cells that are past their usefulness.

The collagen gets inside the lysosome to form an autophagosome, but you need the Atg5 and Atg7 genes for autophagosome formation.

In the experiment, the researchers used cells that did not have the Atg5 and Atg7 genes. The result is more adhesions and the spread of more cells.

Thus they conclude that the absence of autophagy promotes adhesion formation. In reverse, the presence of autophagy prevents adhesions.

In their discussion, they discussed the utility of autophagy in preventing cancer metastasis.

And that makes me wonder, could poor appetite in people with cancer be the body’s defense mechanism against cancer spread? A review by Mowers et al. showed that autophagy modulates cancer metastases on several levels.[2]

To me, the results of this laboratory experiment can be used to prevent bowel obstruction due to adhesions. Adhesions do not have any useful function in the abdomen. Thus, their protein content is a viable target during autophagy.

What induces autophagy?

In the absence of caloric intake during intermittent fasting, the body looks within for energy sources, fatty acids, and amino acids to continue the body functions.

Autophagy breaks down and recycles excess and useless proteins like collagen in adhesions. The released sugars and fatty acids are used as fuel, and the amino acids become new proteins.

Another way to stimulate autophagy is physical exercise which will be the subject of a future article.

The other benefits of autophagy and intermittent fasting

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References:

Kawano S, Torisu T, Esaki M, Torisu K, Matsuno Y, Kitazono T. Autophagy promotes degradation of internalized collagen and regulates distribution of focal adhesions to suppress cell adhesion. Biol Open. 2017 Nov 15;6(11):1644-1653. doi: 10.1242/bio.027458. PMID: 28970230; PMCID: PMC5703610.
Mowers EE, Sharifi MN, Macleod KF. Autophagy in cancer metastasis. Oncogene. 2017 Mar 23;36(12):1619-1630. doi: 10.1038/onc.2016.333. Epub 2016 Sep 5. PMID: 27593926; PMCID: PMC5337449.

Image credit: Adhesions by By Hic et nunc – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5993892

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