Motor patterns of small intestine determined by closely spaced extraluminal transducers and videofluoroscopy

Ehrlein, H. J.; Schemann, Michael; Siegle, M. L.

doi:10.1152/ajpgi.1987.253.3.g259

Cited by 42 publications

(53 citation statements)

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“…It also explains the finding of comparable rate of transit of liquid in the jejunum in phase 2 and the PP period (18). This was also supported by studies in dogs (7,20), using videofluoroscopy and manometry, showing that these propagating PWs were responsible for most of the aboral propulsion of intestinal chyme. These long MII sequences were observed with PW sequences of variable length, suggesting that recording of pressure events can underestimate even flow events of substantial length.…”

Section: Discussionsupporting

confidence: 59%

Study of intestinal flow by combined videofluoroscopy, manometry, and multiple intraluminal impedance

Imam

Sanmiguel

Larive

et al. 2004

American Journal of Physiology-Gastrointestinal and Liver Physi

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Assessment of patterns of flow in the small bowel is difficult. Multiple intraluminal impedance has been recently used for study of flow dynamics in the esophagus. Our aims were 1) to validate multiple intraluminal impedance by correlating impedance events with intestinal flow as detected by fluoroscopy and 2) to determine intestinal flow patterns in the fasting and postprandial period and their correspondence with manometry. First, six healthy subjects underwent simultaneous videofluoroscopic, manometric, and impedance recording from the duodenum. Videofluoroscopy was used to validate impedance patterns corresponding with barium flow in the fasting and postprandial periods. Next, 16 healthy subjects underwent prolonged simultaneous recording of impedance and manometry in both periods. Most flow events were short (10 cm or less), with antegrade flow being the most common. Correspondence between impedance and videofluoroscopy increased with increasing length of barium flow. Impedance corresponded better with flow, at any distance, than manometry. However, impedance and manometric events, when analyzed separately as index events, always corresponded with fluoroscopic flow. The fasting and postprandial periods showed comparable patterns of flow, with frequent, highly propulsive manometric and impedance sequences. Motility index was positively and significantly associated with length of impedance events. Phase 3 of the migrating motor complex could be easily recognized by impedance. Multiple intraluminal impedance can detect intestinal flow events and corresponds better with fluoroscopic flow than manometry. multichannel intraluminal impedance; manometry; fluoroscopy; intestinal motility MULTIPLE INTRALUMINAL IMPEDANCE (MII) is a novel technique that can detect flow in a viscous organ by measuring changes in intraluminal impedance related to the movement of the bolus (24). MII was recently used for measuring bolus transport in the esophagus in health and disease states (12,23,21). The technique is capable of distinguishing between refluxate containing air or liquid (22) and can recognize nonacid reflux, currently undetected by pH monitoring (5). Whereas MII has been increasingly used in the study of esophageal physiology and disease, few data are available concerning its use in the evaluation of small bowel motor function (11).A number of tests is currently in use for the clinical assessment of small bowel motor function. Intestinal transit can be measured by conventional scintigraphy, radio-opaque markers, or breath tests. These methods detect only total transit time and not patterns of flow and can be affected by gastric emptying rate and conditions such as bacterial overgrowth (3). Intraluminal manometry detects contractile patterns but provides only indirect data regarding flow. Fluoroscopic studies are greatly limited because of the radiation exposure involved. Thus MII, a technique that can detect the end result of contractile activity, i.e., the presence and direction of flow in the intestine, may have a dist...

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Section: Discussionsupporting

confidence: 59%

Study of intestinal flow by combined videofluoroscopy, manometry, and multiple intraluminal impedance

Imam

Sanmiguel

Larive

et al. 2004

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Their cyclical pattern suggests that enteric circuits are able to generate bouts of activity at ϳ1-min intervals. Motor patterns with cycle periods in this range have been described in the small intestine of several animal species, with several terminologies such as minute rhythm, intermittent, fatigued, repetitive, or rhythmic activity both in vivo (20,25,43) and ex vivo (26,38,51). Whether such cyclic events may also have some myogenic component in humans remains to be established (28).…”

Section: Neural Circuits Underlying the Propagating Discrete Clusterementioning

confidence: 99%

Neurally mediated propagating discrete clustered contractions superimposed on myogenic ripples in ex vivo segments of human ileum

Kuizenga

Sia

Dodds

et al. 2015

American Journal of Physiology-Gastrointestinal and Liver Physi

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Kuizenga MH, Sia TC, Dodds KN, Wiklendt L, Arkwright JW, Thomas A, Brookes SJ, Spencer NJ, Wattchow DA, Dinning PG, Costa M. Neurally mediated propagating discrete clustered contractions superimposed on myogenic ripples in ex vivo segments of human ileum. Am J Physiol Gastrointest Liver Physiol 308: G1-G11, 2015. First published November 13, 2014; doi:10.1152/ajpgi.00230.2014.-Narrow muscle strips have been extensively used to study intestinal contractility. Larger specimens from laboratory animals have provided detailed understanding of mechanisms that underlie patterned intestinal motility. Despite progress in animal tissue, investigations of motor patterns in large, intact specimens of human gut ex vivo have been sparse. In this study, we tested whether neurally dependent motor patterns could be detected in isolated specimens of intact human ileum. Specimens (n ϭ 14; 7-30 cm long) of terminal ileum were obtained with prior informed consent from patients undergoing colonic surgery for removal of carcinomas. Preparations were set up in an organ bath with an array of force transducers, a fiberoptic manometry catheter, and a video camera. Spontaneous and distension-evoked motor activity was recorded, and the effects of lidocaine, which inhibits neural activity, were studied. Myogenic contractions (ripples) occurred in all preparations (6.17 Ϯ 0.36/min). They were of low amplitude and formed complex patterns by colliding and propagating in both directions along the specimen at anterograde velocities of 4.1 Ϯ 0.3 mm/s and retrogradely at 4.9 Ϯ 0.6 mm/s. In five specimens, larger amplitude clusters of contractions were seen (discrete clustered contractions), which propagated aborally at 1.05 Ϯ 0.13 mm/s and orally at 1.07 Ϯ 0.09 mm/s. These consisted of two to eight phasic contractions that aligned with ripples. These motor patterns were abolished by addition of lidocaine (0.3 mM). The ripples continued unchanged in the presence of this neural blocking agent. These results demonstrate that both myogenic and neurogenic motor patterns can be studied in isolated specimens of human small intestine. small intestine; motor patterns; enteric nervous system; myogenic; neurogenic PROPULSION AND MIXING OF INTESTINAL CONTENTS along the digestive tract are essential for normal digestion. The motor patterns underlying these functions are due to the coordinated contractions and relaxations of the smooth muscle layers of the intestine. The internal circular smooth muscle layer and the external longitudinal smooth muscle layer are controlled by two main mechanisms. Myogenic activity is driven by the nonneural pacemaker cells, the interstitial cells of Cajal. Neurogenic control is mediated by circuits in the enteric nervous system. These two types of activity combine to generate the motor patterns that mix and propel luminal content (14,29). Most of our understanding of these mechanisms has been derived from animal studies. Although the basic functions of the gastrointestinal tract are similar between human and animals, there are si...

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“…Hence, in the last decade, biomechanical data obtained by balloon distension or bolus injection have gained increasing interest in motility research. Data in the literature pertaining to the mechanical aspects of duodenal function are concerned with the contraction patterns (6,19,27), the length-tension relationship in circular and longitudinal tissue strips in vitro (36), flow patterns (33), compliance, and tension-strain relationship (29). Conventional methods, such as manometry and radiology do not provide exact assessment of CSA and distensibility during luminal balloon distension; volume-based systems suffer from errors due to elongation of the balloon, contraction-induced volume variations, and compressibility of the air; and ultrasound systems are quite expensive.…”

Section: Mechanical Aspectsmentioning

confidence: 99%

Sensory and biomechanical responses to ramp-controlled distension of the human duodenum

Gao

Arendt‐Nielsen

Liu

et al. 2003

American Journal of Physiology-Gastrointestinal and Liver Physi

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gersen. Sensory and biomechanical responses to ramp-controlled distension of the human duodenum. Am J Physiol Gastrointest Liver Physiol 284: G461-G471, 2003. First published November 13, 2002 10.1152/ajpgi.00456.2001.-The aim of this study was to develop a new method for investigation of the relationship among the mechanical stimulus, the biomechanical properties, and the visceral perception evoked by volume/ramp-controlled distension in the human duodenum in vivo. An impedance planimetric probe for balloon distension was placed in the third part of the duodenum in seven healthy volunteers. Distension of the duodenum was done at infusion rates of 10, 25, and 50 ml/min. The pump was reversed when level 7 was reached on a visual analog scale ranging from 0 to 10. Distensions were done with and without the administration of the antimuscarinic drug butylscopolamine. The total circumferential tension (T total) and the passive circumferential tension (Tpassive) were determined from the distension tests without and with the administration of butylscopolamine, respectively. T total and Tpassive showed an exponential behavior as a function of strain (a measure of deformation). The active circumferential tension (T active) was computed as TtotalϪTpassive and showed a bellshaped behavior as a function of strain. At low distension intensities, the intensity of sensation at 10 ml/min was significantly higher than that obtained at 25 and 50 ml/min. The coefficient of variation at the pain threshold for circumferential strain (average 4.34) was closer to zero compared with those for volume (8.72), pressure (31.22), and circumferential tension (31.55). This suggests that the mechanoreceptors in the gastrointestinal wall depend primarily on circumferential strain. The stimulus-response functions provided evidence for the existence of low-and high-threshold mechanoreceptors in the human duodenum. Furthermore, the data suggest that high-threshold receptors are nonadapting.cross-sectional area; distensibility; duodenum; pain; lengthtension relationship VISCERAL PAIN IS ONE OF THE most frequent reasons patients seek medical attention. It is well known that distension of the gastrointestinal tract elicits reflexmediated inhibition and stimulation of motility via intrinsic or extrinsic neural circuits and induces visceral perception, such as pain. Previous studies (17,18,37) demonstrate that mechanoreceptors located in the intestinal wall play an important role in the sensory stimulus-response function. From animal studies, it seems evident that some receptors have a high threshold to mechanical stimuli and an encoding function that is evoked by stimuli within the noxious range. Other receptors have a low threshold to mechanical stimuli and an encoding function that spans the range of stimulation intensity from innocuous to noxious (3). Furthermore, some evidence obtained in animal studies indicates that the mucosal nerve endings act as rapidly adapting mechanoreceptors, whereas the intramuscular endings act as slowly adapting mechan...

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Motor patterns of small intestine determined by closely spaced extraluminal transducers and videofluoroscopy

Cited by 42 publications

References 0 publications

Study of intestinal flow by combined videofluoroscopy, manometry, and multiple intraluminal impedance

Study of intestinal flow by combined videofluoroscopy, manometry, and multiple intraluminal impedance

Neurally mediated propagating discrete clustered contractions superimposed on myogenic ripples in ex vivo segments of human ileum

Sensory and biomechanical responses to ramp-controlled distension of the human duodenum

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