Pan-Colonic Pressurizations Associated With Relaxation of the Anal Sphincter in Health and Disease: A New Colonic Motor Pattern Identified Using High-Resolution Manometry

Abstract

Pan-colonic pressurizations associated with relaxations of the anal sphincter represent a new colonic motor pattern that seems to be defective in patients with treatment-refractory chronic constipation and may have a role in the transport of colonic gas and in the facilitation of the propagating sequence-induced colonic transport.

Exploring gastrointestinal variables affecting drug and formulation behavior: Methodologies, challenges and opportunities

“…In a study with a fiber-optic catheter, the majority of activity in the postprandial period were retrograde propagating sequences, mainly occurring in the sigmoid region (Dinning et al, 2013). The relevance of simultaneous pressurization sequences, previously observed in conventional manometry studies, was confirmed in several studies using a HRM solid state catheter (Chen et al, 2014;Corsetti et al, 2016). Based on preliminary data in healthy adults, this activity seems to represent the most frequent colonic motor pattern, which increases significantly during the meal and decreases afterwards, in concert with increased occurrence of retrograde propagating colonic sequences in the left colon (Chen et al, 2014;Corsetti et al, 2016).…”

“…Two types of catheters have been applied: a fiber-optic catheter with up to 90 recording sensors spaced 1 cm from each other (Dinning et al, 2013) and a solid state catheter with up to 40 pressure sensors spaced 1-2.5 cm from each other (Chen et al, 2014;Corsetti et al, 2016). In a study with a fiber-optic catheter, the majority of activity in the postprandial period were retrograde propagating sequences, mainly occurring in the sigmoid region (Dinning et al, 2013).…”

Editorial: Identifying Colonic Motor Dysfunction in Chronic Constipation with High-Resolution Manometry: Pan-Colonic Pressurizations

“…More recently, research studies have used high resolution manometry catheters, in which the sensors are more closely spaced, i.e., 2.5 cm in this study (9) and 1 cm in other studies. (10, 11) Compared to non-high resolution catheters, high resolution catheters more accurately detect the frequency, morphology, and directionality of colonic propagating sequences.…”

“…(9) Because the proximal location of the motility catheter varied among subjects, it is unclear if these pressure events were recorded in the entire colon in all subjects. These pan colonic pressurizations occurred more frequently after eating and cholinergic stimulation, were associated with the desire to pass flatus, and were less frequent in slow transit constipation.…”

“…While some of those studies did not record pressures throughout the colon, this discrepancy is puzzling, because Corsetti observed that pan colonic pressurizations occurred frequently, at an average of 85 ± 38 (Mean ± SD) times over 7 hours, or approximately every 5 minutes. (9) Studies with other HRM catheters have shown that when the space between sensors is reduced from 2 to 1 cm, twice as many propagated sequences were identified. (10) Therefore, it is conceivable that some rapidly propagated pressure events might have been misidentified as simultaneous events in this study, where adjacent sensors were separated by 2.5 cm.…”