The Sphincter of O'Beirne - Part 1: Study of 18 Normal Subjects.

Abstract

Gastroenterologists have ignored or emphasized the importance of the rectosigmoid junction in continence or constipation on and off for 200years. Here, we revisit its significance using high-resolution colonic manometry. Manometry, using an 84-channel water-perfused catheter, was performed in 18 healthy volunteers. The rectosigmoid junction registers as an intermittent pressure band of 26.2 ± 7.2mmHg, or intermittent phasic transient pressure increases at a dominant frequency of 3cpm and an amplitude of 28.6 ± 8.6mmHg; or a combination of tone and transient pressures, at a single sensor, 10-17cm above the anal verge. Features are its relaxation or contraction in concert with relaxation or contraction of the anal sphincters when a motor pattern such as a high-amplitude propagating pressure wave or a simultaneous pressure wave comes down, indicating that such pressure increases or decreases at the rectosigmoid junction are part of neurally driven programs. We show that the junction is a site where motor patterns end, or where they start; e.g. retrogradely propagating cyclic motor patterns emerge from the junction. The rectosigmoid junction is a functional sphincter that should be referred to as the sphincter of O'Beirne; it is part of the "braking mechanism," contributing to continence by keeping content away from the rectum. In an accompanying case report, we show that its excessive presence in a patient with severe constipation can be a primary pathophysiology.