Sigmoid motility in diverticular disease and the irritable bowel syndrome.

Abstract

Measurements of motility of the alimentary tract are important in the understanding of gut physiology and the mechanism of symptoms. While the oesophagus, stomach and small intestine are readily accessible by oral transtubation, this does not apply to the colon. Most of the published data on colonic intraluminal pressures (IP's) derive from tube assemblies, positioned in the bowel through a rigid sigmoidoscope. Consequently the more proximal parts of the large intestine, including the potentially very interesting sigmoid, have remained unexplored. In this study we report a method for placing pressure sensitive tube assemblies in the more proximal colon at colonoscopy. Results of intraluminal pressure measurements in the sigmoid colon in controls, patients with the irritable bowel syndrome (IBS), or with diverticular disease (DD) are described. residue diet for 48 h previously. Bowel cleansing was done with 1 1 oral mannitol 10% on the morning of colonoscopy, under sedation with pethidine 50 mg and diazepam 10-20 mg iv. After routine examination of the bowel to the caecum the colonoscope was withdrawn to the transverse colon and any loops present were straightened. Four angiology guide wires (Kimal Scientific 5SU400, length 4 m) were introduced into the bowel lumen through the biopsy channel; the colonoscope was then withdrawn, leaving the guide wires in situ. Radio-opaque open ended PVC tubes (OET's, length 1-7 m, id 1-2 mm) marked at intervals of 10 cm were threaded over each guide wire for approximately 1 m of their length. The guide wires were then withdrawn and the four OET's taped securely to the buttock.After a normal supper and the night spent in the ward, the patients returned to the laboratory, having fasted since midnight. The position of the OET's was adjusted under fluoroscopic control and with reference to the external markings, so, that the tips were at 25, 35, 45, and 55 cm from the anal margin (Fig.

Diet, ageing and genetic factors in the pathogenesis of diverticular disease

“…Paradoxically, inflating a balloon in the colon of individuals with DD induces the musculature of the colonic wall to yield to the increasing luminal pressure more quickly than in controls [38,39] . In addition, these and later studies indicate increased colonic motility (as assessed by number and amplitude of bowel wall contractions) in the sigmoid colon of individuals with left-sided DD [40,41] , and also in the ascending colon of patients with right-sided diverticulosis [42] . These classical studies were generally performed with low numbers and failed to account for age, gender, physical activity or body fat percentage; the physiological observations were made under artificial conditions, i.e.…”

Is Anorectal Myectomy useful for Hirschsprung’s Disease and its Allied Disorders?

“…Patients with abnormalities of colonic transit respond poorly to traditional oral pharmaceutical preparation after ARM [1][2][3][4] , and those with colonic inertia such as a redundant colon and colonic diverticula have impaired colon motility [23][24][25] . Arhan et al 26) reported that anal stenosis is associated with abnormal function of rectum and the anal sphincter.…”

Pathophysiological aspects of diverticular disease of colon and role of large bowel motility

“…Similar contrasting results were reported from myolectrical studies of the rectosigmoid area [52,53] . However, more recent studies, carried out in the true sigmoid and descending colon (and, therefore, investigating colonic segments actually bearing diverticula) are available, which showed an increased motor activity in such patients (both symptomatic and asymptomatic) with respect to controls [54,55] . This abnormal motility was reduced following surgery [56] .…”