Background
Until recently, investigations of the normal patterns of motility of the healthy human colon have been limited by the resolution of in vivo recording techniques.
Methods
We have used a new, high-resolution fiber-optic manometry system (72 sensors at 1-cm intervals) to record motor activity from colon in 10 healthy human subjects.
Key Results
In the fasted colon, on the basis of rate and extent of propagation, four types of propagating motor pattern could be identified: (i) cyclic motor patterns (at 2–6/min); (ii) short single motor patterns; (iii) long single motor patterns; and (iv) occasional retrograde, slow motor patterns. For the most part, the cyclic and short single motor patterns propagated in a retrograde direction. Following a 700 kCal meal, a fifth motor pattern appeared; high-amplitude propagating sequences (HAPS) and there was large increase in retrograde cyclic motor patterns (5.6±5.4/2 h vs 34.7±19.8/2 h; p < 0.001). The duration and amplitude of individual pressure events were significantly correlated. Discriminant and multivariate analysis of duration, gradient, and amplitude of the pressure events that made up propagating motor patterns distinguished clearly two types of pressure events: those belonging to HAPS and those belonging to all other propagating motor patterns.
Conclusions & Inferences
This work provides the first comprehensive description of colonic motor patterns recorded by high-resolution manometry and demonstrates an abundance of retrograde propagating motor patterns. The propagating motor patterns appear to be generated by two independent sources, potentially indicating their neurogenic or myogenic origin.
In patients with STC a meal fails to induce the normal increase in the distal colonic cyclic propagating motor patterns. We propose that these data may indicate that the normal extrinsic parasympathetic inputs to the colon are attenuated in these patients.
SNS modulates colonic motility in patients with faecal urge incontinence. These data suggest that SNS may improve continence and urgency through alteration of colonic motility, particularly by increasing retrograde PSs in the left colon.
In patients with slow-transit constipation, suprasensory SNS increased the frequency of colonic PSs, whereas subsensory SNS stimulation did not. This has implications for the design of therapeutic trials and the clinical application of the device.
Graduated compression bandaging of the lower limbs is the primary therapy for venous leg ulcers with its efficacy believed to be predominantly dependent on the amount and the distribution of the compressive pressure applied. There has been on-going demand for an ideal sensor to facilitate in-vivo monitoring of the sub-bandage pressure. Several methods and devices have been reported but each has its limitations, such as bulkiness, low tolerance to movement, susceptible to thermal noise and single point sensing. An optical fiber force sensor is demonstrated, consisting of two arrays of fiber Bragg grating (FBG) entwined in a double helix form and packaged with contact-force sensitivity. This sensor array has inherent temperature immunity and is capable of real-time, distributed sensing of sub-bandage pressure. The calibration results of the sensor array, as well as the validation human trial results, are presented.
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