Difficulty in estimating localized bowel contraction by colonic manometry: a simultaneous recording of intraluminal pressure and luminal calibre

Abstract

To examine whether or not intraluminal pressure changes at a site in the human colon reflect with fidelity the local bowel wall contractions or relaxation, endoscopic recording of the changes in colonic calibre as a parameter of the motor events with simultaneous manometry was performed at a fixed site in a prepared sigmoid colon during the interdigestive state. In four of the 12 subjects, a total of 20 phasic pressure waves with an amplitude of 13-22 mmHg and a duration of 13-18 sec were obtained in a 20 min recording session. Eighteen of the 20 phasic pressure waves (90%) were associated not with a decrease (contraction) but with an increase in the calibre (relaxation). The pressure change began 0.2-8.4 sec (mean: 4.5 sec) behind and ended-1.8 to 8 sec (mean: 3.5 sec) ahead of the calibre change. In the other eight subjects, no phasic pressure change was recorded in the presence of an overt calibre change. We conclude that manometric phasic pressure change recorded at a site in the empty human colon is not necessarily correlated with the localized contractile activity. Extrapolation of pressure profiles in the colon to motor events at the manometric site should be cautious.

Impedance Planimetric Description of Normal Rectoanal Motility in Humans

“…1,2,6,[11][12][13] Elongation of the balloon or bag within the lumen is a major source of error in pressure-volume based distention studies, 1,6,12 and pressure-volume based studies do not allow the detection of short segment contractions and relaxations. Rectal impedance planimetry is not affected by these limitations.…”

“…RESULTS: A number of rectoanal motility patterns were observed. A total of 25 episodes with very localized cyclic rectal contractions detected at only one of five channels were observed lasting two to four minutes with a median frequency of three per minute (range, [2][3][4][5][6]. A total of 44 episodes of cyclic rectal contractions propagating over two or more channels were detected lasting 2 to 36 minutes.…”

“…Accordingly, nonoccluding phasic contractions and changes in tone are not necessarily recorded. 1,2 Changes in tone have been measured by a barostat. However, the configuration of the balloon or bag is a source of error with pressure-volume measurement.…”

Ambulatory 24-h colonic manometry in healthy humans

“…Whether solid-state manometry provides a more reliable recording is controversial. In vitro studies showed that the water-perfused system can be unreliable when a perfusion rate of Ͻ0.2 ml/min is used compared with a solid-state system, particularly in the presence of viscous luminal contents (57). This observation is important because previous prolonged studies used perfusion rates of Ͻ0.2 ml/min (1,4,12,24,39).…”

Colonic transit time and pressure based on Bernoulli’s principle

“…Studies with manometers have discussed increasing pressure by contractility of the intestines, but endoscopic research has shown that the pressure increases when the lumen expands. 4 Namely, it is possible that HAPC is not only a continuous conduction of smooth muscle contraction, but is also a flow dynamic pressure transfer phenomenon. It is also known that amplitude of antegrade propagating pressure decreases in the ascending colon and increases from the descending colon to the sigmoid colon, 5 and net hourly forward progress was greater in the left than right colon.…”