First translational consensus on terminology and definitions of colonic motility in animals and humans studied by manometric and other techniques

Intraluminal prucalopride increases propulsive motor activities via luminal 5‐HT4 receptors in the rabbit colon

“…The major propulsive motor patterns in all animal models is a pan‐colonic rhythmic activity that has been called “colonic migrating motor complex,” “mass peristalsis,” or “giant contraction” occurring at a frequency around 0.5 cpm in the mouse and rabbit colon and up to 2 cpm in the guinea pig . At a consensus meeting, it was agreed to use the term “colonic motor complex.” In the present study, we show that the characteristics of this motor complex are dramatically different at different levels of excitation. Here, we demonstrate that long‐distance contractions (LDCs) and clusters of fast propagating contractions (FPCs) are both expressions of the colonic motor complex at different levels of excitation.…”

“…When patients are unable to generate HAPWs, they are diagnosed to have “inert colon.” However, evaluating only HAPWs without considering other motor pattern configurations does not constitute a full assessment of colonic motility. We have advocated for the assessment of simultaneous pressure waves, in particular in conjunction with preceding HAPWs, as an essential component of colonic motor function evaluation . The present study shows that a 5‐HT 4 receptor agonist acting from the lumen can evoke the colonic motor complex in its various forms, that is, not only LDCs as the most forceful propulsive motor pattern in the rabbit colon but also several other configurations of propulsive motor patterns such as FPC clusters associated with pressure development.…”

Luminal 5‐HT4 receptors—A successful target for prokinetic actions

“…These include, but are not limited to, colonic migrating motor complexes (CMMCs, mice), giant migrating contractions (GMCs, dogs, rats), migrating spike bursts (cats), long‐distance contractions (LDCs, rabbits) peristaltic contractions (guinea pigs), high‐amplitude propagating contractions (HAPCs, humans), and repetitive propagating pressure sequences (PPSs, humans). To address this issue, it was decided at a consensus meeting to use the term “colonic motor complex” to refer to neurogenic repetitive peaks of pressure and/or electrical activity in the colon (eg CMMCs) and “neural peristalsis” to refer to anterograde propulsive movements triggered by distension with liquids or solids in animals (eg peristaltic contractions, LDCs) (see Table 4). It was also determined at the consensus meeting that HAPCs in humans likely correspond to neural peristalsis and repetitive PPSs likely equate to CMCs in animal colon (see Table 5).…”

“…High‐resolution manometry (HRM) has emerged as a tool to more accurately define human colonic motor patterns and as a method to diagnose colonic motor dysfunction . High‐amplitude pressure waves (HAPWs) measured using standard manometry techniques and further characterized using HRM, are now termed HAPCs . Although relatively infrequent, these are the dominant propulsive motor pattern in human colon and are probably necessary for defecation.…”

When all seems lost: management of refractory constipation—Surgery, rectal irrigation, percutaneous endoscopic colostomy, and more

“…Before surgery, a colonic manometry with or without barostat testing should be performed, where available, to identify colonic inertia, which is defined by impaired responses to a meal and pharmacological stimulation with bisacodyl or neostigmine . However, by comparison to children with chronic constipation, there is limited data on the clinical utility of colonic manometry/barostat testing in adults with refractory constipation . Before a colectomy, gastrointestinal transit should also be assessed when the clinical features suggest an upper gastrointestinal motility disorder.…”