966 High-Resolution Colonic Motility Recordings In Vivo Compared With Ex Vivo Recordings After Colectomy, in Patients With Slow Transit Constipation

Dinning, Philip G.; Sia, Tiong Cheng; Rosli, Reizal Mohd; Kumar, Raghu; Wiklendt, Lukasz; Wattchow, David; Brookes, Simon J.; Costa, M. H. L. D.; Spencer, Nick J.

doi:10.1016/s0016-5085(16)30728-4

Cited by 12 publications

(28 citation statements)

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“…In our own HR manometry studies in healthy adults, we have shown that distal colonic cyclical activity increases within 30‐60 seconds of starting a meal . Interestingly, while regular propagating motor activity is recorded in an organ bath using healthy human sigmoid colons, the 3 cpm cyclical activity is not seen . This suggests that the underlying myogenic mechanism that generates the cyclical activity also requires excitatory neural input to generate visible contractions.…”

Section: Control Of the Rectosigmoid Brakementioning

confidence: 91%

“…16 Interestingly, while regular propagating motor activity is recorded in an organ bath using healthy human sigmoid colons, the 3 cpm cyclical activity is not seen. 80 This suggests that the underlying myogenic mechanism that generates the cyclical activity also requires excitatory neural input to generate visible contractions. In patients with spinal cord injury, 81,82 systemic sclerosis, 83 and diabetes mellitus 84 the distal colonic response to a meal has been shown to be absent.…”

Section: Control Of the Rectosigmoid Brakementioning

confidence: 99%

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The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

Lin

Dinning

Milne

et al. 2017

Clin Exp Pharma Physio

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SummaryThe regulation of gastrointestinal motility encompasses several overlapping mechanisms including highly regulated and coordinated neurohormonal circuits. Various feedback mechanisms or "brakes" have been proposed. While duodenal, jejunal, and ileal brakes are well described, a putative distal colonic brake is less well defined.Despite the high prevalence of colonic motility disorders, there is little knowledge of colonic motility owing to difficulties with organ access and technical difficulties in recording detailed motor patterns along its entire length. The motility of the colon is not under voluntary control. A wide range of motor patterns is seen, with long intervals of intestinal quiescence between them. In addition, the use of traditional manometric catheters to record contractile activity of the colon has been limited by the low number of widely spaced sensors, which has resulted in the misinterpretation of colonic motor patterns. The recent advent of high-resolution (HR) manometry is revolutionising the understanding of gastrointestinal motor patterns. It has now been observed that the most common motor patterns in the colon are repetitive two to six cycles per minute (cpm) propagating events in the distal colon. These motor patterns are prominent soon after a meal, originate most frequently in the rectosigmoid region, and travel in the retrograde direction. The distal prominence and the origin of these motor patterns raise the possibility of them serving as a braking mechanism, or the "rectosigmoid brake," to limit rectal filling. This review aims to describe what is known about the "rectosigmoid brake," including its physiological and clinical significance and potential therapeutic applications. K E Y W O R D Scolon, gastrointestinal motility, gastrointestinal tract, high-resolution manometry, rectosigmoid brake | INTRODUCTIONColonic motility disorders are prevalent in the general population and can have a significant impact on quality of life.1-3 Gastrointestinal transit and the act of defaecation require a coordinated interplay between intrinsic neurohormonal circuits acting on a morphologically intact gastrointestinal tract. These are highly auto-regulated and coordinated events, optimised for ideal transit, maximum absorption, and timely elimination of waste products.Networks of gastrointestinal "brakes" have long been proposed to provide negative feedback controls on gastrointestinal motility. 4-12Duodenal and jejunal brakes are recognised responses to the arrival of nutrient-dense chyme into the upper small intestine, triggering neurohormonal circuits that impart feedback control on gastric emptying, gastric distention and satiety. 6,8 Distally, the ileal brake is capable of a potent inhibition of intestinal motility following the arrival of nutrients, with additional effects including delaying gastric emptying and promoting satiety. 7,10 Motility brakes within the colon and rectum have also been described, though they remain less well established.Published examples include withholding de...

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Section: Control Of the Rectosigmoid Brakementioning

confidence: 91%

Section: Control Of the Rectosigmoid Brakementioning

confidence: 99%

The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

Lin

Dinning

Milne

et al. 2017

Clin Exp Pharma Physio

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“…Finally, our recordings were made in a colon with all extrinsic innervation removed and this will have an effect upon the colonic motor patterns. However, we have shown in the human colon that motor patterns recorded in vivo can also be record ex vivo . Furthermore, despite the disconnection from the extrinsic innervation, the isolated animal colon is still able to generate propulsive motor patterns.…”

Section: Discussionmentioning

confidence: 94%

“…However, we have shown in the human colon that motor patterns recorded in vivo can also be record ex vivo. 31 Furthermore, despite the disconnection from the extrinsic innervation, the isolated animal colon is still able to generate propulsive motor patterns. We demonstrated this in our current study and previously we have shown that the propulsive nature of the motor patterns can be influenced by the luminal content.…”

Section: Discussionmentioning

confidence: 99%

Discriminating movements of liquid and gas in the rabbit colon with impedance manometry

Rosli

Leibbrandt

Wiklendt

et al. 2017

Neurogastroenterology Motil

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“…This suggests that extrinsic input that is present in vivo but is obviously absent ex vivo may be a strong contributor to the pathophysiology of slow transit constipation. Interestingly, while propulsive motor patterns were not present in vivo, patients still produced extensive non‐propagating activity . This led us to hypothesize that noradrenaline would selectively inhibit specific motor patterns, primarily propulsive motor patterns.…”

Section: Introductionmentioning

confidence: 99%

Noradrenaline inhibits neurogenic propulsive motor patterns but not neurogenic segmenting haustral progression in the rabbit colon

Hanman

Chen

Parsons

et al. 2019

Neurogastroenterology Motil

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Background Excessive sympathetic inhibition may be a cause of colon motor dysfunction. Our aim was to better understand the mechanisms of sympathetic inhibition on colonic motor patterns using the rabbit colon, hypothesizing that noradrenaline selectively inhibits propulsive motor patterns. Methods Changes in motor patterns of the rabbit colon were studied ex vivo using noradrenaline and adrenoceptor antagonists and analyzed using spatiotemporal diameter maps. Key Results Noradrenaline abolished propulsive contractions: it abolished the long‐distance contractions (LDCs) from a baseline frequency of 0.8 ± 0.3 and the clusters of fast propagating contractions (FPCs) at a frequency of 14.4 ± 2.8 cpm. Both motor patterns recovered after addition of the α2‐adrenoceptor antagonist yohimbine to a frequency of 0.5 ± 0.2 and 9.9 ± 3.3 cpm, respectively. The β‐adrenoceptor antagonist propranolol did not prevent the loss of propulsive motor patterns with noradrenaline. Noradrenaline did not inhibit haustral boundary contractions and increased the frequency of the myogenic ripples from 8.3 ± 1.4 to 10.5 ± 1.3 cpm which was not affected by yohimbine, propranolol nor the α1‐adrenoceptor blocker prazosin. Conclusions and Inferences Noradrenergic inhibition of propulsive motor patterns is mediated by the α2‐adrenoceptor to inhibit the neurogenic LDCs and the neurogenic clustering of FPCs. The neurogenic haustral boundary contractions are not affected, suggesting that α2‐receptors are on selective neural circuits. The excitatory effect of noradrenaline on ripples may be due to the activation of adrenoceptors on interstitial cells of Cajal, but action on α1‐receptors was excluded. No role for the β‐adrenoceptor was found.

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966 High-Resolution Colonic Motility Recordings In Vivo Compared With Ex Vivo Recordings After Colectomy, in Patients With Slow Transit Constipation

Cited by 12 publications

References 0 publications

The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

Discriminating movements of liquid and gas in the rabbit colon with impedance manometry

Noradrenaline inhibits neurogenic propulsive motor patterns but not neurogenic segmenting haustral progression in the rabbit colon

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