Abstract
Assessment of colonic motor dysfunction is rarely done because of inadequate methodology and lack of knowledge about normal motor patterns. Here we report on elucidation of intraluminal pressure patterns using High Resolution Colonic Manometry during a baseline period and in response to a meal, in 15 patients with constipation, chronically dependent on laxatives, 5 healthy volunteers and 9 patients with minor, transient, IBS-like symptoms but no sign of constipation. Simultaneous pressure waves (SPWs) were the most prominent propulsive motor pattern, associated with gas expulsion and anal sphincter relaxation, inferred to be associated with fast propagating contractions. Isolated pressure transients occurred in most sensors, ranging in amplitude from 5–230 mmHg. Rhythmic haustral boundary pressure transients occurred at sensors about 4–5 cm apart. Synchronized haustral pressure waves, covering 3–5 cm of the colon occurred to create a characteristic intrahaustral cyclic motor pattern at 3–6 cycles/min, propagating in mixed direction. This activity abruptly alternated with erratic patterns resembling the segmentation motor pattern of the small intestine. High amplitude propagating pressure waves (HAPWs) were too rare to contribute to function assessment in most subjects. Most patients, dependent on laxatives for defecation, were able to generate normal motor patterns in response to a meal.
Highlights
IntroductionIn order to evaluate if High Resolution Colonic Manometry (HRCM) can help diagnose motor dysfunction in these patients and help make better decisions about individual management, first a full understanding of colonic motor activities is needed
Another group consisted of 9 patients who presented with minor transient IBS-like symptoms without pain; this patient control group consisted of 9 males, age ranging from 25–50 years
In most studies comparing a cohort of patients with a cohort of controls, statements are made whether or not, on average, a particular motor pattern is increased or decreased, mostly only High amplitude pressure waves (HAPWs) are evaluated and sometimes a statement is made whether or not overall activity was increased after a meal
Summary
In order to evaluate if High Resolution Colonic Manometry (HRCM) can help diagnose motor dysfunction in these patients and help make better decisions about individual management, first a full understanding of colonic motor activities is needed. Our objectives were to identify and characterize all motor patterns in patients with chronic constipation and control subjects, to identify potentially unique motor patterns in our patients, and to design management based on the HRCM results. We extensively analyzed all pressure patterns with a focus on simultaneous pressure waves and isolated pressure transients. These motor patterns have far received little attention, we predict that they will become important for understanding normal colon motility, and for diagnosis and management of colonic motor dysfunction
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