Abstract
Characterization of high-amplitude propagating pressure waves (HAPWs or HAPCs) plays a key role in diagnosis of colon dysmotility using any type of colonic manometry. With the introduction of high-resolution manometry, more insight is gained into this most prominent propulsive motor pattern. Here, we use a water-perfused catheter with 84 sensors with intervals between measuring points of 1 cm throughout the colon, for 6-8 h, in 19 healthy subjects. The catheter contained a balloon to evoke distention. We explored as stimuli a meal, balloon distention, oral prucalopride, and bisacodyl injection, with a goal to optimally evoke HAPWs. We developed a quantitative measure of HAPW activity, the "HAPW Index." Our protocol elicited 290 HAPWs. 21% of HAPWs were confined to the proximal colon with an average amplitude of 75.3 ± 3.3 mmHg and an average HAPW Index of 440 ± 58 mmHg·m·s. 29% of HAPWs started in the proximal colon and ended in the transverse or descending colon, with an average amplitude of 87.9 ± 3.1 mmHg and an average HAPW Index of 3,344 ± 356 mmHg·m·s. Forty-nine percent of HAPWs started and ended in the transverse or descending colon with an average amplitude of 109.3 ± 3.3 mmHg and an average HAPW Index of 2,071 ± 195 mmHg·m·s. HAPWs with and without simultaneous pressure waves (SPWs) initiated the colo-anal reflex, often abolishing 100% of anal sphincter pressure. Rectal bisacodyl and proximal balloon distention were the most optimal stimuli to evoke HAPWs. These measures now allow for a confident diagnosis of abnormal motility in patients with colonic motor dysfunction.NEW & NOTEWORTHY High-amplitude propagating pressure waves (HAPWs) were characterized using 84 sensors throughout the entire colon in healthy subjects, taking note of site of origin, site of termination, amplitude, and velocity, and to identify optimal stimuli to evoke HAPWs. Three categories of HAPWs were identified, including the associated colo-anal reflex. Proximal balloon distention and rectal bisacodyl were recognized as reliable stimuli for evoking HAPWs, and a HAPW Index was devised to quantify this essential colonic motor pattern.
Highlights
Chronic colonic motility disorders are treated or undergo surgical intervention, most often without proper diagnosis of motor dysfunction, yet all consensus reports indicate that colonic manometry is essential for diagnosis of colon motor dysfunction [11, 19, 43, 47]
The High-amplitude propagating pressure waves (HAPWs) were classified into three different categories based on their origin and termination in the colon, starting with activities that were initiated in the proximal colon
The average anal sphincter relaxation for this group was 47.5 Ϯ 3.1%. 89% of the HAPWs in this category were associated with relaxation of the anal sphincter of Ͼ20%. 64% of the HAPWs in this category transformed into SPWs; 88% of these were associated with anal sphincter relaxation
Summary
Chronic colonic motility disorders are treated or undergo surgical intervention, most often without proper diagnosis of motor dysfunction, yet all consensus reports indicate that colonic manometry is essential for diagnosis of colon motor dysfunction [11, 19, 43, 47]. Guidelines for colonic manometry indicate that the most important feature that should be achieved is the ability to conclude that a patient’s motor function is normal [11]. There have been indications in the pediatric literature that HAPWs are not normal unless they span the entire colon [47], which makes it important to study regional HAPWs. the first objective of this study was to characterize HAPWs in healthy subjects using 84 sensors throughout the colon based on the site of origin and site of termination and quantify their features, so as to assess in future studies potential regional
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