Ambulatory long-term jejunal manometry in diabetic patients with cardiac autonomic neuropathy

Concerning alteration of small bowel motility in diabetic patients with autonomic neuropathy controversial data were obtained with stationary manometry and over a limited period of time. The aim of our study was to examine ambulatory 24 h jejunal motility in 15 diabetic patients with cardiac autonomic neuropathy compared with data obtained in 50 healthy controls. Twenty-four hour motility was recorded in the proximal jejunum with a portable datalogger and tube-mounted miniature pressure sensors. Diurnal and nocturnal fasting motility and the motor response to a standardized evening meal of 600 kcal were evaluated by visual and computer-aided analysis. The following abnormalities were found during fasting motility (n = number of patients): absence of phase III over 24 h (n = 2), retrograde migration or simultaneous occurrence of phase III (n = 5). During postprandial motility irregular bursts with tonic baseline elevation (n = 3) and contraction frequencies below the range of controls (n = 8) occurred. Furthermore patients exhibited an inversion of the normal relationship between phase I and phase II during nocturnal MMC – cycles, and discrete clustered contractions were diminished (P < 0.01) in the fasting and digestive state. All patients showed at least one abnormal manometric finding. We conclude that small bowel motility in diabetic autonomic neuropathy is characterized by disturbances in the generation and aboral migration of phase III, an altered circadian variability of the MMC cycle and by postprandial hypomotility.     

The effect of osmolarity and caloric load on small bowel motility

Background Although there is profound knowledge about cyclic fasting motility, the postprandial intestinal motor response is not well investigated. It is intriguing to speculate that nutrient composition alters small bowel motility significantly and, in a clinical setting, may account for adverse gastrointestinal symptoms in enteral nutrition (EN). We aimed to assess the impact of different caloric loads and osmolarities of EN on human jejunal motility. Methods Sixteen healthy subjects underwent a series of duodenal infusions of EN solutions, either with iso‐osmolar solution with different caloric loads (1.32, 2.64, or 3.96 kcal min^?1), or with solutions of different osmolarities with constant caloric loads (300, 600, or 1200 mosmol). Jejunal solid‐state manometry was analyzed over 90 min both visually and using dedicated computer software. Key Results All tested nutrient solutions were able to trigger conversion to a postprandial jejunal motility pattern after a mean lag phase of 9.4 + 2.3 min (P = NS between different nutrient solutions). Different caloric loads did not result in significant differences in small bowel motility. However, increasing osmolarities caused a significant inhibition of contractile and propagative activity. Conclusions & Inferences Small bowel motility under duodenal infusion of nutrient solutions is not influenced by caloric load in a physiological range, whereas high osmolarities inhibit small bowel motility.     

Prognostic yield of esophageal manometry in chronic intestinal pseudo‐obstruction: a retrospective cohort of 116 adult patients

Background Chronic intestinal pseudo‐obstruction (CIPO) refers to a wide and heterogeneous group of neuromuscular disorders, which classically involve the small intestine. However, further investigation is required to determine if motility disturbances involve all parts of the gastrointestinal (GI) tract. Methods Medical records and follow‐up examinations of 116 adult CIPO patients [70F, median age 28 (0–79) years] were reviewed and performed at our institution since 1980. Manometry (esophageal, small bowel and anorectal) and gastric emptying scintigraphy reports were retrieved and analyzed. Survival, home parenteral nutrition requirement, and the inability to maintain sufficient oral feeding was analyzed using univariate and multivariate analysis. Key Results The median follow‐up time was 6 (0.1–30) years. In all, 90% of patients who underwent at least one motility test, with the exception of small bowel manometry, exhibited at least one abnormal pattern. Esophageal manometry was abnormal in 73% of the cases, including 51% with severe ineffective esophageal motility. Anorectal manometry was abnormal in 59% of the cases, including only 17% with severe abnormalities. Gastric emptying was abnormal in 61% of the cases. Only esophageal motor disorders had significant predicting values for survival, home parenteral nutrition requirement, and an inability to maintain sufficient oral feeding. Conclusions & Inferences Our study showed that CIPO was associated with a diffuse involvement of all parts of the GI tract and was not restricted to the small intestine in 90% of the cases studied. Esophageal manometry had a significant prognostic yield and should be systematically performed in CIPO patients.     

Does body position modify the results of oesophageal high resolution manometry?

Background Oesophageal motility classification using high resolution manometry (HRM) has been established in the supine position. Nevertheless, examination in the sitting position is more physiological. Our aim was to determine if body position modifies oesophago‐gastric junction (OGJ) morphology and oesophageal motility. Methods A total of 100 patients (47 males, mean age 51 years) were included in this study. The oesophageal HRM protocol included examination in supine and sitting positions. Recordings were reviewed by two different operators. Amplitude, duration, velocity, Distal Contractile Integral (DCI) and Pressurization Front Velocity of oesophageal waves induced by swallowing were recorded. Key Results The lower oesophageal sphincter resting pressure was not significantly changed by body position. The sitting position modified the OGJ classification in 12 patients. The inter‐observer agreement to classify OGJ was moderate (kappa = 0.54 and 0.46, in the supine and sitting positions respectively) while it was good to diagnose motility disorders (kappa = 0.72 and 0.83). The percentage of normal waves was lower in the sitting position in comparison with the supine position (56%vs 67%, P < 0.01). The DCI was also lower in the sitting position (1125 mmHg.s.cm vs 1639, P < 0.01) as well as the amplitude of oesophageal waves. Finally the diagnosis was concordant in both positions in 72 patients. Conclusions & Inferences Body position can affect OGJ morphology and oesophageal motility assessment by HRM in some patients. Normal values in the sitting position should thus be determined. Inter‐observer variation for the proposed classification of OGJ morphology must also be taken into account.     

Elevated motility-related transmucosal potential difference in the upper small intestine in the irritable bowel syndrome

The pathophysiology of irritable bowel syndrome (IBS) is complex and incompletely known. Very little has been studied regarding the role of submucous neuronal activity. We therefore measured small intestinal transmural potential difference (PD, reflecting mainly electrogenic chloride secretion), and its linkage with fasting motor activity [migrating motor complex (MMC)] in controls (n = 16) and patients with IBS [n = 23, 14 diarrhoea predominant (d-IBS) and nine constipation predominant (c-IBS)]. Transmural-PD and its relation to MMC phase III was measured by modified multilumen manometry for 3 h in the fasting state using one jejunal and one duodenal infusion line as flowing electrodes. The amplitude and duration of motor phase III was similar in controls and IBS patients, but the propagation speed of phase III was higher in IBS patients. In IBS patients, maximal PD during MMC phase III was significantly elevated in both the duodenum and jejunum (P < 0.05) and the PD decline after phase III was significantly prolonged in the jejunum (P < 0.01). The PD elevation was seen in both duodenum and jejunum in d-IBS patients, but only in the jejunum in the c-IBS patients. On the basis of previous modelling studies, we propose that the enhanced secretion may reflect disturbed enteric network behaviour in some patients with IBS.     

Abnormal small bowel motility in patients with hereditary transthyretin amyloidosis

Background

Gastrointestinal complications are common in hereditary transthyretin amyloid (ATTRm) amyloidosis. The underlying mechanisms have not been fully elucidated, and the patients’ small bowel function remains largely unexplored. The aim of the present study was to compare the small bowel motility in ATTRm amyloidosis patients with that in non‐amyloidosis patient controls.

Methods

ATTRm amyloidosis patients undergoing evaluation for liver transplantation were consecutively investigated with 24‐hour duodenojejunal manometry (n = 19). The somatostatin analogue octreotide was used to induce fasting motility. Patients with age at onset of ≥50 years were defined as late‐onset cases. For each patient, three age‐ and sex‐matched patient controls (n = 57) were selected from the total pool of investigated patients.

Key Results

Manometry was judged as abnormal in 58% of the patients and in 26% of the patient controls (P = .01). Patients displayed significantly more daytime phase III migrating motor complexes than patient controls (median 4 vs 2, P < .01), and had a higher frequency of low‐amplitude complexes (16% vs 4%; however, this difference did not reach statistical significance, P = .10). Furthermore, late‐onset patients showed a delay in octreotide response (5.4 vs 3.8 minutes, P < .01), but this was not observed for early‐onset patients or within the control group.

Conclusions and Inferences

Patients with ATTRm amyloidosis displayed abnormalities in their small bowel motility more frequently than non‐amyloidosis patient controls, and the manometric pattern was probably best consistent with a combined neuromyopathic disorder. The delayed octreotide response in late‐onset patients warrants further investigation.     

Motility of the antroduodenum in healthy and gastroparetics characterized by wireless motility capsule

Background The wireless motility capsule (WMC) measures intraluminal pH and pressure, and records transit time and contractile activity throughout the gastrointestinal tract. Our hypothesis is that WMC can differentiate antroduodenal pressure profiles between healthy people and patients with upper gut motility dysfunctions. This study aims to analyze differences in the phasic pressure profiles of the stomach and small intestine in healthy and gastroparetic subjects. Methods Data from 71 healthy and 42 gastroparetic subjects were analyzed. The number of contractions (Ct), area under the pressure curve and motility index (MI = Ln (Ct *sum amplitudes +1)) were analyzed for 60 min before gastric emptying of the capsule (GET), (gastric window) and after GET (small bowel window) and results between groups were compared with the Wilcoxon rank sum test. Key Results Significant differences were observed between healthy and gastroparetic subjects for Ct and MI (P < 0.05). Median values of the motility parameters in gastric window were Ct = 72, MI = 11.83 for healthy and Ct = 47, MI = 11.12 for gastroparetics. In the small bowel, median values were Ct = 144.5, MI = 12.78 for healthy and Ct = 93, MI = 12.12 for gastroparetics. Diabetic subjects with gastroparesis showed significantly lower Ct and MI compared with healthy subjects in both gastric and small bowel windows while idiopathic gastroparetic subjects did not show significant differences. Conclusions & Inferences The WMC is able to differentiate between healthy and gastroparetic subjects based on gastric and small bowel motility profiles.     

Comparison of small‐bowel motility of the human jejunum and ileum

Background Knowledge about human cyclic fasting motility (MMC) and the postprandial response is mostly based on manometric findings in the upper small intestine. Hardly any data exist on human ileal motility, as the acquisition of data has been limited by methodological concerns. The aim was to study human jejunal and ileal motility in an optimized manometric setting. Methods Solid‐state 24‐h‐manometry was performed in the jejunum and ileum of healthy individuals, applying a strict protocol for fasting, resting, and the consumption of a standardized meal. Both visual qualitative and validated computerized quantitative contraction and propagation analysis were performed. Key Results MMC occurs in similar frequency in the jejunum and ileum, but it was significantly shorter in the jejunum at night. By many characteristics, ileal motility was less intense and propagative than jejunal: less migrating clustered contractions, and slower propagation velocity and shorter distance in phases II and III, and postprandially – possibly slowing and enhancing nutrient absorption. Prolonged propagated contractions in some individuals were identified as a unique ileal propulsive pattern. Postprandially, an abrupt conversion to a digestive motility pattern occurs simultaneously independent of the region. Conclusions & Inferences We found similar basic phenomena of fasting and postprandial motility in the jejunum and ileum of healthy humans. However, different calibration of propagative and contractile activity and special motor events in the ileum may account for a different physiological role in digestion. Future studies of small‐bowel motility in healthy and diseased subjects focusing on segmental differences of proximal and distal intestine may be rewarded.     

Effect of intragastric FODMAP infusion on upper gastrointestinal motility,gastrointestinal, and psychological symptoms in irritable bowel syndrome vs healthy controls

Background

The low fermentable oligo‐, di‐, mono‐saccharides and polyol (FODMAP) diet is a treatment strategy to reduce symptoms of irritable bowel syndrome (IBS). Acute effects of FODMAPs on upper gastrointestinal motility are incompletely understood. Our objectives were to assess the acute effects of intragastric FODMAP infusions on upper gastrointestinal motility and gastrointestinal and psychological symptoms in healthy controls (HC) and IBS patients.

Methods

A high‐resolution solid‐state manometry probe and an infusion tube were positioned into the stomach. Fructans, fructose, FODMAP mix, or glucose was intragastrically administered to HC, and fructans or glucose was administered to IBS patients until full satiation (score 0‐5), in a randomized crossover fashion. Manometric measurements continued for 3 hours. Gastrointestinal and psychological symptoms were assessed by questionnaires at predefined time points. The study was registered on www.clinicaltrials.gov (NCT02980406).

Key Results

Twenty HC and 20 IBS patients were included. Fructans induced higher postprandial gastric pressures compared with glucose over both groups (P<.001). Bloating, belching, and pain increased more in IBS over both carbohydrates (P<.041). In addition, IBS patients reported more flatulence and cramps compared with HC following fructans (P<.001). Glucose induced more fatigue and dominance compared with fructans (P=.028, P=.001). Irritable bowel syndrome patients reported a higher increase in anger (P=.030) and a stronger decrease in positive affect (P=.021).

Conclusions & Inferences

The upper gastrointestinal motility response varies between carbohydrates. Irritable bowel syndrome patients are more sensitive to fructan infusion, reflected in their higher gastrointestinal symptom scores. Acute carbohydrate infusion can have differential psychological effects in IBS and HC.     

12Effects of synchronized intestinal electrical stimulation on small intestinal motility in dogs

Our previous studies showed that synchronized gastric electrical stimulation enhanced antral contractions, accelerated gastric emptying in dogs. It has never been reported whether synchronized electrical stimulation could improve small intestinal motility. The aim of this study was to investigate the effects of synchronized intestinal electrical stimulation (SIES) on small bowel motility in both fasting and fed states in dogs. Methods: Five healthy female dogs (18–24 kg) were equipped with a duodenal cannula for the measurement of small bowel motility using manometry. Two pairs of bipolar electrodes were implanted on the small intestinal serosa with an interval of 25 cm; the first one was 10 cm beyond the pylorus and used for stimulation. The experiment was consisted of four sessions in each dog with a randomized order. In the fasting state, 20 min after occurrence of phase III, SIES was initiated and maintained for 45 min, small bowel motility was recorded during the entire experiment, and no stimulation was performed in the control session. In other two sessions, dogs were fed with solid meal at the beginning of the experiment; glucagon (0.1 mg kg^­1) was injected 20 min after feeding, SIES was initiated at the same time for 20 min followed by 20 min recovery period. The stimulus was composed of train of pulses with on‐time of 0.5 s, frequency of 20 Hz, pulse width of 2 ms and amplitude of 4 mA. Results: 1). In the fasting state, SIES induced small intestinal contractions during phase I. The motility index was 5.2 ± 0.6 in the control session and significantly increased to 10.3 ± 0.7 with SIES (P = 0.003). 2). In the fed state, glucagon substantially and significantly inhibited small intestinal motility. The motility index was 11.3 ± 0.7 after feeding and reduced to 3.4 ± 0.5 with glucagon injection (P < 0.001). SIES significantly enhanced glucagon‐induced small intestinal postprandial hypomotility. The motility index was 3.4 ± 0.5 in the control session and increased to 6.0 ± 0.3 with the presence of SIES (P = 0.03). Conclusions: Intestinal electrical stimulation synchronized with intestinal slow waves induces intestinal contractions during phase I and enhanced small intestinal postprandial hypomotility induced by glucagon. SIES may have the therapeutic potential for treating small intestinal motility disorders. (Supported by a grant from American Diabetes Association).     

Effect of tegaserod on gut transit in male and female subjects

Tegaserod is a novel selective serotonin receptor type-4 (5-HT(4)) partial agonist that stimulates gastrointestinal (GI) motility. Tegaserod has proven efficacy in irritable bowel syndrome with constipation in women and in men and women with chronic idiopathic constipation. The effects on gastric emptying, small bowel transit and colonic transit have not been studied in detail in male and female subjects. This study aimed therefore to assess the effect of gender on GI transit with and without tegaserod. A randomized, placebo-controlled, double-blind, crossover study was performed in 40 healthy subjects (23 males, 17 females). Each treatment period involved three and a half days of bid treatment with either 6 mg tegaserod or an identical placebo. Transit parameters were assessed by a scintigraphy. Tegaserod significantly accelerated gastric emptying, small bowel and colonic transit times (P<0.05-0.0001). The effect was more apparent in male subjects than in females (P=0.044 to P<0.0001). The most striking prokinetic effects were observed in the upper GI tract (stomach and small intestine). In both healthy male and female subjects, tegaserod markedly accelerated small intestinal transit, and induced a significant increase in gastric emptying time and colonic transit. The results imply that tegaserod is a potent prokinetic agent throughout the GI in both sexes.     

Small bowel motility in functional chronic constipation

Abstract  In functional constipation, three pathophysiological subgroups have been identified: slow-transit constipation (STC); normal-transit constipation (NTC) and outlet delay (OD). Extracolonic manifestations, especially disturbed small bowel motility, are well known to occur in STC, but have rarely been studied in NTC and OD. To perform 24-h-ambulatory jejunal manometry in a large prospective series of clinical patients with chronic constipation of all subtypes. A total of 61 consecutive patients, referred to our tertiary gastroenterologic centre for chronic constipation (48 female, 13 male; mean age 57 (range 20–87) years), underwent jejunal 24-h-ambulatory manometry (standardized meal) after a transit-time study (radio-opaque markers), anorectal manometry, defecography and colonoscopy. Computerized and visual analysis by two independent observers was compared with the normal range of manometric variables, defined by data previously obtained in 50 healthy subjects (Gut 1996;38:859). Five patients were excluded from the study because of coexistence of OD and STC. No patient with OD ( n  = 8), but all patients with STC ( n  = 32) and 94% of patients with NTC ( n  = 16) showed small bowel motor abnormalities; both in postprandial response and fasting motility. The abnormal findings ranged from severe disturbances with complete loss of MMC to subtle changes of contraction parameters that could only be assessed by computerized analysis. No significant differences between STC- and NTC-patients were found. Most findings pointed to an underlying enteric neuropathy. Intestinal prolonged-ambulatory manometry adds valuable information to the pathophysiologic understanding of functional chronic constipation of STC- and NTC-type, however there are no distinct manometric features to differentiate between both.     

Distinctive gastrointestinal motor dysfunction in patients with MNGIE

Background

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease caused by mutations in TYMP, encoding thymidine phosphorylase. Clinically it is characterized by severe gastrointestinal dysmotility associated with cachexia and a demyelinating sensorimotor polyneuropathy. Even though digestive manifestations are progressive and invariably lead to death, the features of gastrointestinal motor dysfunction have not been systematically evaluated. The objective of this study was to describe gastrointestinal motor dysfunction in MNGIE using state-of-the art techniques and to evaluate the relationship between motor abnormalities and symptoms.

Methods

Prospective study evaluating gastrointestinal motor function and digestive symptoms in all patients with MNGIE attended at a national referral center in Spain between January 2018 and July 2022.

Key Results

In this period, five patients diagnosed of MNGIE (age range 16–46 years, four men) were evaluated. Esophageal motility by high-resolution manometry was abnormal in four patients (two hypoperistalsis, two aperistalsis). Gastric emptying by scintigraphy was mildly delayed in four and indicative of gastroparesis in one. In all patients, small bowel high-resolution manometry exhibited a common, distinctive dysmotility pattern, characterized by repetitive bursts of spasmodic contractions, without traces of normal fasting and postprandial motility patterns. Interestingly, objective motor dysfunctions were detected in the absence of severe digestive symptoms.

Conclusions and Inferences

MNGIE patients exhibit a characteristic motor dysfunction, particularly of the small bowel, even in patients with mild digestive symptoms and in the absence of morphological signs of intestinal failure. Since symptoms are not predictive of objective findings, early investigation is indicated.     

Physiological variations in blood glucose concentration affect oesophageal motility and sensation in normal subjects

Background/aims: a marked elevation in the blood glucose concentration (≈ 15 mmol L^?1) slows oesophageal peristalsis. Recent studies indicate that changes in blood glucose within the normal postprandial range affect gastric motility and emptying. The aim of this study was to investigate whether such alterations in blood glucose also affect oesophageal motility. Methods: in eight healthy subjects oesophageal motility and sensation to balloon distension were measured on two separate days while blood glucose concentrations were stabilized with an insulin-glucose clamp at 4 mmol L^?1 and 8 mmol L^?1. Results: peristaltic velocity in the proximal oesophagus and over the oesophagus as a whole was faster at a plasma glucose concentration of 8 mmol L^?1 compared with those at 4 mmol L^?1 (proximal 3.3 ± 0.3 cm s^?1 vs 2.6 ± 0.2 cm s^?1, P < 0.05, total 3.1 ± 0.2 cm s^?1 vs 2.7 ± 0.2 cm s^?1, P < 0.005) but there were no differences in wave amplitude or duration, or basal lower oesophageal sphincter pressure (LOSP). The threshold for initial perception of oesophageal distension was lower at a plasma glucose of 8 mmol L^?1 (2.9 ± 0.5 mL vs 4.9 ± 1.0 mL, P < 0.05). Conclusions: physiological variations in plasma glucose concentration influence oesophageal motility and sensation. These observations suggest that in order to minimize effects of varying plasma glucose levels on oesophageal motility, manometry should be performed under the same fasting or fed conditions when oesophageal motor function is evaluated.     

Vagal control of fasting somatostatin levels

Abstract The relationship between fasting intestinal motility, plasma concentration of somatostatin and vagal integrity was examined in four conscious dogs. Small intestinal motility was recorded using subserosally implanted bipolar electrodes. The cervical vagosympathetic trunks, previously isolated in skin loops, were blocked by cooling. In the fasted state, peaks in somatostatin concentration were observed during phase III of the migrating myoelectric complex (MMC). During vagal blockade, small intestinal MM***Cs persisted but with phase II being absent or decreased in duration in the duodenum and upper jejunum. Somatostatin levels significantly decreased to below the basal levels observed prior to blockade. No cycling of somatostatin levels was evident during the period of vagal blockade. Upon termination of vagal cooling, normal motility returned and somatostatin levels returned to their pre-blockade levels. In conclusion: (1) plasma somatostatin levels cycle with phase III of the MMC in the upper small intestine; (2) the cycling of fasting somatostatin concentrations is primarily dependent upon intact vagal pathways; and (3) basal plasma somatostatin levels are in part vagally dependent.     

Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome

Background The profile of intestinal organic acids in irritable bowel syndrome (IBS) and its correlation with gastrointestinal (GI) symptoms are not clear. We hypothesized in this study that altered GI microbiota contribute to IBS symptoms through increased levels of organic acids. Methods Subjects were 26 IBS patients and 26 age‐ and sex‐matched controls. Fecal samples were collected for microbiota analysis using quantitative real‐time polymerase chain reaction and culture methods, and the determination of organic acid levels using high‐performance liquid chromatography. Abdominal gas was quantified by image analyses of abdominal X‐ray films. Subjects completed a questionnaire for GI symptoms, quality of life (QOL) and negative emotion. Key Results Irritable bowel syndrome patients showed significantly higher counts of Veillonella (P = 0.046) and Lactobacillus (P = 0.031) than controls. They also expressed significantly higher levels of acetic acid (P = 0.049), propionic acid (P = 0.025) and total organic acids (P = 0.014) than controls. The quantity of bowel gas was not significantly different between controls and IBS patients. Finally, IBS patients with high acetic acid or propionic acid levels presented with significantly worse GI symptoms, QOL and negative emotions than those with low acetic acid or propionic acid levels or controls. Conclusions & Inferences These results support the hypothesis that both fecal microbiota and organic acids are altered in IBS patients. A combination of Veillonella and Lactobacillus is known to produce acetic and propionic acid. High levels of acetic and propionic acid may associate with abdominal symptoms, impaired QOL and negative emotions in IBS.     

Swallows, oesophageal and gastric motility in normal subjects and in patients with gastro-oesophageal reflux disease: a 24-h pH-manometric study

Background: the motor aspects underlying gastro-oesophageal reflux disease (GORD) are still not completely clear. Aim: to evaluate the relationship between oesophageal and gastric motility in GORD patients. Patients: twelve patients with grade I–II oesophagitis, mean age 45 yr, and 10 healthy subjects, mean age 42 yr, were studied. Methods: a pH-manometry was performed to analyse oesophageal and gastric motility, swallows and oesophageal pH values for the whole 24-h period, and for the 2-min period before and after each reflux episode. Results: as compared to controls, GORD patients showed in the 24-h period, a greater number of swallows (P < 0.01) and a lower percentage of post deglutitive propagated oesophageal body waves (P < 0.05). The number of migrating motor complexes (MMC) was similar in the two groups, with a lower amplitude of phase III gastric waves in GORD. During MMC reflux episodes were seen only in GORD patients. After refluxes an increase in swallows, simultaneous and secondary oesophageal waves were detected in GORD patients, with a reduction of primary peristalsis. Isolated gastric contractions preceded reflux episodes more frequently in GORD patients than in controls. Conclusions: GORD patients showed an increase in swallows with altered post-deglutitive oesophageal motility and a reduced amplitude of gastric MMC. Moreover small contractions of gastric antrum are present before acid refluxes, suggesting a multifactorial pathogenesis of the disease.     

Gastrointestinal motor activity associated with postoperative ileus and emesis

The gastrointestinal motor activity associated with post-operative ileus and emesis has not been fully elucidated. This study has evaluated gastric and small-bowel motility in six patients before and after cholecystectomy and in six healthy volunteers, by solid-state manometry. Nausea and vomiting were recorded post-operatively. After surgery, fasting motor abnormalities including (a) total gastric quiescence and (b) small-bowel ‘phasic-bursts’ of contractions were observed in all patients. Phasic bursts (PB) resembled phase III of the migrating motor complex (MMC) on initial visual inspection, but further analysis revealed that they were of shorter duration (3.4 ±.2 min [PB] vs 6.4 ± 0.8 min [MMC], [mean ± SEM] P < 0.01), lower contraction frequency (6.4 ± 0.1 contractions min ^?1 [PBj vs 10 ± 0.3 contractions min^?1 [MMC] [mean ± SEM] P < 0.01) and shorter periodicity (36.4 ± 3 min [PB] vs 70.0 ± 6 min [MMC] [mean ± SEM] P < 0.01). Four patients experienced nausea during phasic burst activity. Vomiting was only observed in association with retrograde phasic-bursts, which migrated through the duodenum to the stomach. This study has shown consistent gastrointestinal motor abnormalities in the immediate post-operative state.