Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry.

Abstract

The manometric diagnosis of severe intestinal dysmotility is performed at most institutions using catheters with 2-8 sensors 5-10cm apart. The recent application of high-resolution manometry catheters with closely spaced sensors to other gut segments has been highly successful. The objective of the present study was to determine the feasibility of a jejunal high-resolution manometry method and to carry out a descriptive analysis of normal jejunal motor function. A 36-channel high-resolution water-perfused manometry catheter (MMS-Laborie, Enschede, The Netherlands) was orally placed in the jejunum of 18 healthy subjects (10 men, eight women; 21-38 age range). Intestinal motility was recorded during 5h, 3 during fasting, and 2 after a 450kcal solid-liquid meal. Analysis of motility patterns was supported by computerized tools. All healthy subjects except one showed at least one complete migrating motor complex during the 3h fasting period. Phase III activity lasted 5±1min and migrated aborally at a velocity of 7±3cm/min. High-resolution spatial analysis showed that during phase III each individual contraction propagated rapidly (75±37cm/min) over a 32±10cm segment of the jejunum. During phase II, most contractile activity corresponded to propagated contractile events which increased in frequency from early to late phase II (0.5±0.9 vs 2.5±1.3 events/10min, respectively; p<0.001). After meal ingestion, non-propagated activity increased, whereas propagated events were less frequent than during late phase II. Jejunal motility analysis with high-resolution manometry identifies propagated contractile patterns which are not apparent with conventional manometric catheters.