Motility Recordings Research Articles

Combining optical and electrical impedance techniques for quantitative measurement of confluence in MDCK-I cell cultures.

A new method combining optical and electrical impedance measurements is described that enables submicroscopic cell movements to be monitored. The cells are grown on small gold electrodes that are transparent to light. This modified electrical cell-substrate impedance sensor (ECIS) allows simultaneous microscopic recording of both growth and motility, thus enabling cell confluence on the electrodes to be systematically correlated to the impedance in regular time intervals of seconds and for extended periods of time. Furthermore, the technique provides an independent measure of monolayer cell densities that we compare to calculated values from a theoretical model. We have followed the attachment and spreading behavior of epithelial Madin-Darby canine kidney strain I (MDCK-I) cell cultures on microelectrodes for up to 40 h. The studies reveal a high degree of correlation between the measured resistance at 4 kHz and the corresponding cell confluence in 4- to 6-h intervals with typical linear cross-correlation factors of r equaling approximately 0.9. In summary, the impedance measured with the ECIS technique provides a good quantitative measure of cell confluence.

Duodenogastric Bile Reflux Is Common in Cystic Fibrosis

ABSTRACTBackgroundPatients with cystic fibrosis (CF) have a high incidence of gastroesophageal reflux disease, but few cases of mucosal injury are reported. Duodenogastric reflux has not been studied in CF but has been suggested to have a pathogenic role in producing alkaline injury to the esophageal mucosa. The aim of this study was to analyze the presence of duodenogastric reflux in patients with CF.Patients and MethodsTen patients with CF and 7 healthy volunteers participated in the study. Gastroduodenal manometry and intragastric perfusion were performed in all subjects. Gastric perfusate was analyzed for bilirubin and bile acids. Only patients and controls exhibiting normal migrating motor complexes were evaluated.ResultsEight patients with CF had normal motility recordings and had significantly higher gastric bilirubin levels compared with healthy subjects (P = 0.003). The bilirubin concentration was associated with bile acid regurgitation in five patients with CF. All bile acids were conjugated with a high glycine/taurine ratio and low levels of secondary bile acids. Small amounts of keto bile acids were found in two patients.ConclusionThe patients with CF had an increased incidence of duodenogastric reflux compared with healthy subjects. The bile acid composition was typical for CF with low levels of secondary bile acids. Although high bile acid concentration was found in the duodenogastric reflux in most patients with CF, the less toxic profile of the bile acids might possibly contribute to the low frequency of Barrett's esophagus in CF.

Duodenogastric bile reflux is common in cystic fibrosis.

Patients with cystic fibrosis (CF) have a high incidence of gastroesophageal reflux disease, but few cases of mucosal injury are reported. Duodenogastric reflux has not been studied in CF but has been suggested to have a pathogenic role in producing alkaline injury to the esophageal mucosa. The aim of this study was to analyze the presence of duodenogastric reflux in patients with CF. Ten patients with CF and 7 healthy volunteers participated in the study. Gastroduodenal manometry and intragastric perfusion were performed in all subjects. Gastric perfusate was analyzed for bilirubin and bile acids. Only patients and controls exhibiting normal migrating motor complexes were evaluated. Eight patients with CF had normal motility recordings and had significantly higher gastric bilirubin levels compared with healthy subjects (P = 0.003). The bilirubin concentration was associated with bile acid regurgitation in five patients with CF. All bile acids were conjugated with a high glycine/taurine ratio and low levels of secondary bile acids. Small amounts of keto bile acids were found in two patients. The patients with CF had an increased incidence of duodenogastric reflux compared with healthy subjects. The bile acid composition was typical for CF with low levels of secondary bile acids. Although high bile acid concentration was found in the duodenogastric reflux in most patients with CF, the less toxic profile of the bile acids might possibly contribute to the low frequency of Barrett's esophagus in CF.

Surgical treatment of trauma-induced periodic alternating nystagmus

Purpose To report a new treatment for acquired periodic alternating nystagmus in which medical therapy with baclofen was not tolerated. Design Interventional case report and literature review. Intervention Simultaneous adjustable bilateral retroequatorial horizontal rectus muscle recessions. Main outcome measures Ocular alignment and ocular motility recordings. Results A 30-year-old man had blurred vision after an emergency left temporal craniotomy for gunshot wounds. Ophthalmologic examination revealed periodic alternating nystagmus that was documented by an infrared electronystagmogram. Baclofen was started but was not tolerated. Bilateral lateral and medial retroequatorial rectus muscle recessions were performed and were successful in the treatment of this patient. Conclusion Simultaneous bilateral retroequatorial horizontal rectus recessions may be an effective treatment for intractable acquired periodic alternating nystagmus.

Horizontal rectus tenotomy in patients with congenital nystagmus: results in 10 adults

Objective We wished to determine the effectiveness of horizontal rectus tenotomy in changing the nystagmus of patients with congenital nystagmus and, secondarily, how their visual function changed. Design This was a prospective, noncomparative, interventional case series. Participants Ten adult patients with varied associated sensory defects and oculographic subtypes of congenital nystagmus (including asymmetric periodic or aperiodic alternating nystagmus) and no nystagmus treatment options. Methods By using standard surgical techniques, simple tenotomy of all four horizontal recti with reattachment at the original insertion was accomplished. Search-coil eye movement recordings and clinical examinations were performed before and 1, 6, 24, and 52 weeks after surgery. Main outcome measures The primary outcome measure was the expanded nystagmus acuity function, obtained in “masked” fashion directly from ocular motility recordings. Secondary outcomes included breadth of null zones, preoperative and postoperative masked measures of visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] chart), and the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Results At 1 year after tenotomy and under binocular conditions, 9 of 10 patients had persistent, significant postoperative increases in the expanded nystagmus acuity function of their fixing (preferred) eye; 1 remained high, and 1 was not tested under the same conditions. Average foveation times increased in all 9 fixing (preferred) eyes. Binocular visual acuity measured with the ETDRS chart increased in 5 patients and was unaffected in five, whereas the NEI-VFQ-25 showed an improvement in vision-specific mental health in 9 patients. There were no adverse events. Tenotomy also radically changed the periodicity of one patient's asymmetric periodic or aperiodic alternating nystagmus. Conclusions In 9 of 10 adult patients with clinical and oculographic variations in their congenital nystagmus, tenotomy resulted in significant improvements in a nystagmus measure and subjective visual functions.

Defecation mechanisms after proctocolectomy and ileal pouch--anal anastomosis in dogs.

The role of intrinsic pouch motility after ileal pouch-anal anastomosis (IPAA) during defecation is still speculative. IPAA was performed in 12 dogs. Defecation mechanisms were evaluated by motility recordings during spontaneous defecation and during expulsion of an endoluminal balloon and by radiography with sequential sector-related gray scale analysis. Spontaneous defecations appeared without significant changes in electrical or mechanical activity of the pouch. Sequential filling of the pouch led to defecation in only seven dogs while the others did not succeed in emptying their pouch even with maximal balloon inflation. Neither strain gauge measurements nor electromyography demonstrated peristaltic contractions of the pouch during defecation while sector-related gray scale analysis revealed strong contractions of the abdominal wall during pouch emptying. Pouch emptying is independent of intrinsic pouch motility. The ileoanal pouch acts as a functionally passive reservoir, and its evacuation is initiated by a rise of the intra-abdominal pressure.

Evaluation of Peristalsis in Multiple Segments of the Guinea-pig Isolated Small Intestine: Optimisation of Tissue Use by Refined In Vitro Methodology

Peristalsis is the aboral movement by which the intestine propels its contents. Since pharmacological research requires an experimental model with which drug-induced modifications of peristalsis can be reliably quantified, we set out to develop and validate an in vitro method for studying peristalsis in multiple gut segments. In our arrangement, up to four 10cm segments isolated from the guinea-pig jejunum and ileum can be set up in parallel and their lumens perfused. Peristalsis was elicited by pressure-evoked wall distension, and the peristalsis-induced changes in the intraluminal pressure were evaluated with software that determined the peristaltic pressure threshold, the frequency, maximal acceleration and amplitude of the peristaltic waves, and the residual baseline pressure. Validation experiments showed that the peristalsis parameters at baseline and after modification by morphine (0.01-10microM) did not differ between segments from the jejunum and ileum, or between segments examined in a consecutive manner. In conclusion, our work succeeded in optimising the use of the guinea-pig jejunum and ileum for multiple recordings of peristalsis in vitro, and in refining the recording and evaluation of peristaltic motility. This system promises to be particularly useful in the pharmacological screening and testing of drugs which modify peristalsis.

Effect of prostaglandin E 2, dl-cloprostenol, and prostaglandin E 2 in combination with d-cloprostenol on uterine motility during diestrus in experimental cows

Prostaglandin F 2α is used in dairy herd management because of its luteolytic properties and for its direct effect on the myometrium in cows diagnosed with endometritis. Prostaglandin E 2 has a contractile effect on the bovine uterus. In human medicine, prostaglandin E 2 is routinely used to maintain labor and to ripen the cervix. We hypothesized, that a combination of prostaglandin F 2α and prostaglandin E 2 would provoke a long-lasting increase in intrauterine pressure (IUP) and uterine motility as compared to either prostaglandin group. Intrauterine pressure was recorded during the diestrus of eight lactating dairy cows using a transcervically placed intraluminal pressure microtransducer. After recording of physiologic uterine motility for 30 min, prostaglandins ( dl-cloprostenol, PGE 2, PGE 2 in combination with d-cloprostenol) or placebo were administered, followed by a 2 h recording period. Significant differences were found for the area under the curve, the mean amplitude and the intrauterine pressure, whereas the number of pressure waves did not differ significantly among treatments. Peak values for area under the curve and mean amplitude were found during the first 15 min for the combination of PGE 2 and d-cloprostenol. During the last 15 min of the recording session, area under the curve and mean amplitude were increased only for the combination of PGE 2 and d-cloprostenol as compared to placebo. Although PGF 2α and PGE 2 provoke an increase in intrauterine pressure, only their combination guarantees a significant effect over a 2 h recording period.

Activation of vanilloid (VR1) receptors by capsaicin stimulates release of brain derived neurotrophic factor from enteric sensory neurons

0.2 (p<0.01). The contraction amplitude was not changed. Mean plasma GLP-1 was 87.6 +/-10.4 and 129.3 + / 6 7 pmolFL, respectively. In patients with IBS, GLP-1 1.2 pmolflag/ rain reduced the MMCs and reduced the contraction frequency from 1.6 +/-0.2 to 1.0 + / 02 per rain (p<:0.05) and motility index from 4.8 +/-0.1 to 4.1 +/-0.3 Ln ~(mmHg * s/rain) (p<0.21); GLP-I 2.5 pmol/kg/min reduced the MMCs and the contraction frequency from 1.7 +/-0.2 to 10 +/-0.2 per rain (p<0.01) and the motility index from 5.1 +/-0.2 to 4.0 + A 0 4 (p<0.01) at the same recording point with no effect on the contraction amplitude. Motility recordings from the antrum and duodenum displayed a similar change with GLP-1. Mean plasma concentration was 91.7 +/-22.6 and 176.1 +/-28.2 pmol/L, respectively. During infusion with GLP-1 plasma levels of PYY were reduced while plasma levels of GLP-2 were unchanged compared to saline CONCLUSION: GLP-1 reduces motility in the antroduodenal region and inhibits the MMC in healthy subjects and IBS patients. Thus, GLP-1 may alleviate symptoms in patients with motility-related gastrointestinal pain or discomfort.

Fully automated analysis of colonic manometry recordings.

The purpose of this study was to develop a computer program for fully automated analysis of all presently known motor patterns in human colonic motility recordings. Colonic pressure recordings obtained from 24 healthy volunteers were used. Algorithms were developed for the detection and numerical analysis of five types of pressure waves: antegrade, retrograde, simultaneous, high-amplitude and isolated pressure waves. Furthermore, periodical motor activity was quantified. Validation was performed by comparison with visual analysis by two experienced observers. Patterns recorded during day- and night-time were compared using multiple-factor analysis of variance with Bonferroni correction. Automated analysis correlated well with visual peak detection (r = 0.98, P <0.01) and detection of antegrade pressure waves (r = 0.98, P <0.01). Most motor patterns showed a diurnal variation. During the night, prevalences of antegrade (938 vs 455; P <0.05), retrograde (112 vs 81; P <0.05), high-amplitude (12.9 vs 1.3; P <0.05), isolated pressure waves (1114 vs 765; P <0.05), and periodic motor activity were decreased (7.33 vs 4.47%; P <0.05). However, when expressed as percentage of absolute numbers of pressure waves, prevalences remained constant. In conclusion, fully automated analysis of all hitherto described colonic motility patterns is feasible. During the night, overall wave prevalences markedly decreased, but the distribution over the various motor patterns was preserved.

Telemetric Small Intestinal Motility Recording in Awake Rats

Introduction: Ideally, gastrointestinal motility recording should be done in freely moving, stress-free animals. However, no such method is currently available for rats. Methods: Two NiCr electrodes were sutured to the jejunum and connected to an implantable electromyographic (EMG) transmitter in rats. EMG signals were radio-transmitted to a receiver placed at the bottom of the rats’ home cages. Results: Fasting and postprandial jejunal EMG signals could be detected by telemetry. Phase III contractions of the MMC were easy to identify visually and occurred at a rate of about 4.8 per hour. Feeding disrupted the phasic contraction pattern 15 min after the start of food intake and lasted for 2 h. The motility index (MI, area under the curve) was calculated and increased postprandially. Conclusion: Telemetric transmission of rat gastrointestinal EMG signals is feasible and results are comparable to those given in the literature.

Ocular motility in genetically defined autosomal dominant cerebellar ataxia

PURPOSE: To describe ocular motility in patients having genetically characterized dominant cerebellar ataxia. DESIGN: Observational case series. METHOD: Nine ataxic adults having the following molecular genetic diagnoses underwent ophthalmic examination and ocular motility recordings: four with spinocerebellar ataxia type 6 (SCA-6), three with SCA-3, one with SCA-1, and one with episodic ataxia type 2 (EA-2). RESULTS: Versions were normal in eight patients. Most were orthotropic, but one with SCA-3 had exotropia at near. The near point of convergence was remote in five patients. Eight of nine patients had horizontal nystagmus evoked by lateral gaze. All patients with SCA-6 had downbeat nystagmus. Downbeat nystagmus was absent in SCA-1, SCA-3, and EA-2. Three patients with SCA-6 and one with EA-2 had symptomatic improvement when treated with acetazolamide. CONCLUSION: Patients with genetically defined dominant cerebellar ataxia generally had normal binocular alignment and versions and only mild vergence impairment. Downbeat nystagmus was strongly associated with the SCA-6 mutation, whose associated episodes of dizziness and imbalance may be relieved by acetazolamide.

Effects of seirogan (wood creosote) on propulsive colonic motility and stool characteristics in ambulatory mini-pigs.

Our goal was to determine whether Seirogan, an herbal medicine used as an antidiarrheal agent, modifies colonic function, including motility. Experiments were performed on four female Yucatan mini-pigs with established permanent cecal fistulas providing direct access to the colon. Long-term recordings of proximal colonic motility were accomplished by a solid-state probe (six pressure ports 10 cm apart), and a motility index was calculated. Stool viscosity was also measured. The laxative bisacodyl (15 mg/kg) was used to induce colonic motility (increase in motility index) and stool softening, prior to investigating the effect of Seirogan (2-15 mg/kg per os twice a day) or a vehicle control. Seirogan (15 mg/kg), but not the placebo, reversed the bisacodyl-induced stool softening and restored the motility index to normal values by reducing the number of propagating contractions. Taken together the results suggest that inhibition of proximal colonic motility by Seirogan may contribute to its antidiarrheal action.

Evaluation of the Barostat for Recordings of Gastrointestinal Motility

Background: The barostat has been used to investigate gastrointestinal motility. No detailed technical evaluation to characterize the properties of this device for motility recordings has been reported. We, therefore, aimed to test the barostat in vitrounder standardized conditions. Methods: Barostat and manometry recordings were performed using a combined catheter in a pressure chamber. Some of the experiments were made in pig sigmoid colon in order to mimic recordings in a hollow organ. Data are mean ± SD. Results: Baseline changes of the bag volume under constant conditions were 3.9 ± 2.0%. The bag volume increased by 4.5 ± 1.1% with a temperature increase from 22 to 37°C (p < 0.05). At external pressures above the bag operating pressure, the barostat bag collapsed, while only minimal volume reductions occurred at external pressures below the bag pressure. Barostat recordings of pressure events were delayed when compared with manometry and not linearly related to the pressure increases. Conclusion: The influence of temperature changes on barostat recordings is small. The volume decrease in the barostat bag is not linearly related to the external pressure increase and influenced by the operating pressure in the bag. This experimental study provides insight and caveats for those planning to use the barostat device for motility recordings of the gastrointestinal tract.

Clinical and oculographic response to Tenuate Dospan (diethylpropionate) in a patient with congenital nystagmus

PURPOSE: We report a female adult with congenital nystagmus who responded with improved visual function and oculographic parameters after taking the anorexic diet drug Tenuate Dospan (diethylproprionate; Watson Laboratories, Inc., Corona, California). METHODS: Observational case report. Clinical ophthalmic examination and ocular motility recordings were performed before and after administration of the drug Tenuate Dospan. RESULTS: The binocular visual acuity of the patient improved from 20/70 to 20/50, her exotropic deviation decreased from 12 to 4 prism diopters, her stereopsis increased from none to 200 seconds/arc, and her ocular motility recordings showed increased foveation periods and a broadened null zone. CONCLUSION: For unexplained reasons, the anorexic stimulant Tenuate Dospan “paradoxically” improved the nystagmus and binocular function in this patient with congenital nystagmus. This observation may be the basis for investigation of a new pharmacological treatment approach to patients with congenital nystagmus or strabismus.

Twenty-four hour recordings of colonic motility in patients with diverticular disease: evidence for abnormal motility and propulsive activity.

Diverticular disease of the colon is one of the most common pathologic entities in western countries. Although altered motility of the large bowel is commonly believed to be one of the major pathophysiologic mechanisms, no convincing evidence has been reported yet. In fact, only a few conflicting studies concerning distal colonic motility (with no information on forceful propulsive activity) are available in the literature. The purpose of the present study was to investigate basal and stimulated (postprandial) colonic motility from the transverse (not affected), descending, and sigmoid colon in patients with diverticular disease, together with detection of high-amplitude propagated contractions (mass movements). Motility data from patients were compared with those obtained in healthy control subjects. Ten patients and 16 control subjects of both sexes were recruited for the study. In all subjects, colonic motility was recorded for a 24-hour period by a colonoscopically positioned manometric catheter. Two 1000-kcal mixed meals were served during the study. Compared with control subjects, patients with diverticular disease displayed significantly increased amounts of motility in the affected segments; the response to a physiologic stimulus (meal) was also abnormal in the patients' group. Diverticular disease patients also had a significant increase of forceful propulsive activity compared with control subjects (average = 10.3 +/- 2.7/subject/day high-amplitude propagated contractions for patients and 5.5 +/- 0.8/subject/day for control subjects; P = 0.051); interestingly, about 20 percent of such activity was abnormal, being propagated in a retrograde fashion. We concluded that patients with diverticular disease of the colon have abnormal motor and propulsive activities of the large bowel, which are confined to the affected segments.

Onset of oscillopsia after visual maturation in patients with congenital nystagmus

Purpose To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. Design Retrospective, observational, case series. Participants Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. Intervention Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. Main outcome measures Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10°/second. Results One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10°/second and an overall decreased intensity (amplitude/frequency) of the nystagmus. Conclusions Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.

Motor function of the large intestine and flow of digesta in sheep

In sheep, the motor function of the large intestine is not fully understood. Therefore, ileo-caecal-colonic motility was investigated by chronically implanted extraluminal strain gauge transducers and simultaneous videofluoroscopy. Motility parameters were evaluated manually and by computer analysis. The ileal motility was characterized by slowly propagating peristaltic waves and by giant contractions sweeping the ileal contents into the caecum. The dominant motor patterns of the caecum and the first flexure of the proximal colon were peristaltic and antiperistaltic waves resulting in a vigorous mixing and prolonged storage of digesta. In contrast, the proximal colon beyond the first flexure only showed peristaltic waves propelling digesta from the caecum to the spiral colon. The aboral transport from the caecum to the spiral colon was supported by caecal and colonic giant contractions which differed significantly from the peristaltic waves . The spiral colon mainly exhibited clusters of contractions. These consisted of prolonged tonic contractions superimposed by high frequency phasic contractions. The prolonged tonic contractions divided the digesta into small boli and pushed them aborally due to a slow aboral migration. Additionally, peristaltic waves and giant contractions caused filling and rapid transport of digesta along the spiral colon. In conclusion, the ileal, caecal and colonic motor patterns and the flow of digesta along the ileum and large intestine of sheep could be clearly identified by recording of motility combined with videofluoroscopy. The various segments of the large intestine showed different motor patterns providing storage, mixing and aboral transfer of digesta.

Colon interposition for esophageal replacement: isoperistaltic or antiperistaltic? Experimental results

Background. Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice. Methods. In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically in 4 dogs. Three months later five strain-gauges were implanted and evacuation was investigated by motility testing, barium studies, and scintigraphy. Results. Motility recording showed normal colon motility in the excluded loops. Quiescent states (duration 40.2 ± 13.6 minutes) were followed by contractile states (duration 7.5 ± 2.4 minutes, frequency 3.3 ± 0.6 per minute). The main peristaltic direction of isoperistaltic loops was isoperistaltic, and the main peristaltic direction of antiperistaltic loops was antiperistaltic. Evacuation took place exclusively during the contractile status. Half time emptying was more rapid in isoperistaltic loops (35 ± 11 vs 69 ± 16 minutes). The content of antiperistaltic loops was held back by antiperistaltic activity. Application of oatmeal porridge into the loops shortened the quiescent status from 40.2 to 13.2 ± 4.8 minutes. Conclusions. The colon graft for esophageal replacement is an active system. Food is stored during the quiescent states and evacuated during the contractile states. The original peristaltic direction is preserved so that retroperistalsis in antiperistaltic loops may lead to patient discomfort and pulmonary complications.

Esophageal motility disorders in critically ill patients: a 24-hour manometric study.

Impaired tubular esophageal motility is involved in the pathogenesis of gastroesophageal reflux disease, which, in turn, has been shown to cause nosocomial pneumonia in critically ill patients. As multiple factors are involved, this pilot study was undertaken to evaluate whether, similarly, impaired esophageal motility may contribute to nosocomial infections by determining esophageal motility in critically ill patients undergoing mechanical ventilation and sedation in comparison to that of a healthy control group. Open, single-centered study. Fifteen consecutive ventilated intensive care unit (ICU) patients with different diseases and three regimens of analgo-sedation were included: group 1: no analgo-sedation, group 2: ketamine and benzodiazepines, and group 3: fentanyl and benzodiazepines. Six healthy volunteers were studied as controls. Twenty-four hour esophageal anterograde (propulsive) and retrograde motility changes were assessed by a manometry system. The frequencies of contractions were 0.67 +/- 0.1/min (no analgo-sedation) 0.093 +/- 0.02 (ketamine) and 0.076 +/- 0.01 (fentanyl) (p < 0.05 as compared to controls). The amplitudes (% of maximum) were 98 % (control), 58 % (analgo-sedation), 38 % (ketamine) and 42 % (fentanyl; p < 0.05 for the comparison of fentanyl and ketamine with controls). Whereas the percentage of propulsive contractions was significantly decreased in patients (no sedation: 45 %, ketamine: 34 %; fentanyl: 35 %, p < 0.05) as compared to controls (72 %), the percentage of retrograde contractions increased: no sedation: 29 %, ketamine: 34 % and fentanyl: 37 % as compared to controls: 10 %, p < 0.05. Analysis according to the underlying diseases showed marked inhibition of motility parameters within any disease group in comparison with controls. Irrespective of the underlying disease, propulsive motility of the esophageal body is significantly reduced during any kind of sedation in critically ill patients. Possibly central as well peripheral drug-related effects are involved in such a depression. Twenty-four hour motility recordings appear to be a valuable and feasible method to quantify and analyze esophageal motor disorders in critically ill patients.