scholarly journals Faecal incontinence is associated with an impaired rectosigmoid brake and improved by sacral neuromodulation

2021 ◽  
Author(s):  
Anthony Y Lin ◽  
Chris Varghese ◽  
Niranchan Paskaranandavadivel ◽  
Sean Seo ◽  
Peng Du ◽  
...  
Keyword(s):  
High Resolution ◽  
Mechanism Of Action ◽  
Faecal Incontinence ◽  
Sacral Neuromodulation ◽  
Colonic Motility ◽  
Distal Colon ◽  
Motor Patterns ◽  
Colonic Manometry ◽  
Stage 1 ◽  
Propagating Contractions

Background and aims: The rectosigmoid brake, characterized by retrograde cyclic motor patterns on high-resolution colonic manometry has been postulated as a contributor to the maintenance of bowel continence. Sacral neuromodulation (SNM) is an effective therapy for faecal incontinence, but its mechanism of action is unclear. This study aims to investigate the colonic motility patterns in the distal colon of patients with faecal incontinence, and how these are modulated by SNM. Methods: A high-resolution fibre-optic colonic manometry catheter, containing 36 sensors spaced at 1-cm intervals, was positioned in patients with faecal incontinence undergoing Stage 1 SNM. One hour of pre-meal and post-meal recordings were obtained followed by pre- and post-meal recordings with suprasensory SNM. A 700-kcal meal was given. Data were analysed to identify propagating contractions. Results: Fifteen patients with faecal incontinence were analysed. Patients had an abnormal meal response (fewer retrograde propagating contractions compared to controls; p=0.027) and failed to show a postmeal increase in propagating contractions (mean 17 +/- 6/h pre-meal vs 22 +/- 9/h post-meal, p = 0.438). Compared to baseline, SNM significantly increased the number of retrograde propagating contractions in the distal colon (8 +/- 3/h pre-meal vs 14 +/- 3/h pre-meal with SNM, p = 0.028). Consuming a meal did not further increase the number of propagating contractions beyond the baseline upregulating effect of SNM. Conclusion: The rectosigmoid brake was suppressed in this cohort of patients with faecal incontinence. SNM may exert a therapeutic effect by modulating this rectosigmoid brake.

Duodenal and proximal jejunal motility inhibition associated with bisacodyl induced colonic high amplitude propagating contractions

2021 ◽  
Author(s):  
Phil G Dinning ◽  
Lukasz Wiklendt ◽  
Marcello C. Costa ◽  
Simon J. H. Brookes ◽  
Maureen Amicangelo ◽  
...  
Keyword(s):  
Small Bowel ◽  
Contractile Activity ◽  
Colonic Motility ◽  
Mean Amplitude ◽  
High Amplitude ◽  
Motor Patterns ◽  
Bowel Motility ◽  
Small Bowel Motility ◽  
Colonic Manometry ◽  
Propagating Contractions

Bisacodyl is a stimulant laxative often used in manometric studies of pediatric constipation to determine if it can initiate propulsive high amplitude propagating contractions. While the effects of bisacodyl infusion on colonic motility are well described, the effects of the drug on other regions of the gut after colonic infusion are not known. The aim of the present study was to characterize the effects of bisacodyl on both colonic and small bowel motility. Methods. Twenty seven children (9.3 + 1.2 years) undergoing simultaneous high resolution antroduodenal and colonic manometry were included. Small bowel and colonic motor patterns were assessed prior to and after colonic infusion of bisacodyl. Patients were divided into 2 groups; responders and non-responders based on the presence of high amplitude propagating contractions (HAPC) after bisacodyl infusion. Results. Nineteen patients were responders. 188 post-bisacodyl HAPCs were identified with a mean count of 10.4 ± 5.5 (range, 3 -22), at a frequency of 0.6 ± 0.2/min and mean amplitude of 119.8 ± 23.6 mmHg.No motor patterns were induced in the small bowel. However, in the 19 responders the onset of HAPCs was associated with a significant decrease in small bowel contractile activity. In the non-responders there was no detectable change in small bowel motility after bisacodyl infusion. Conclusion. Bisacodyl induced HAPCs are associated with a significant reduction in small bowel motility probably mediated by extrinsic sympathetic reflex pathways. This inhibition is potentially related to rectal distension, caused by the HAPC anal propulsion of colonic content.

837 The Spatiotemporal Characteristics of Retrograde Motor Activity in the Distal Colon Defined by High-Resolution Colonic Manometry

2016 ◽  
Vol 150 (4) ◽  
pp. S177 ◽  
Author(s):  
Anthony Y. Lin ◽  
Peng Du ◽  
Jozef Kamp ◽  
Leo K. Cheng ◽  
Philip Dinning ◽  
...  
Keyword(s):  
High Resolution ◽  
Motor Activity ◽  
Distal Colon ◽  
Spatiotemporal Characteristics ◽  
Colonic Manometry

scholarly journals Cholinergic giant migrating contractions in conscious mouse colon assessed by using a novel noninvasive solid-state manometry method: modulation by stressors

2009 ◽  
Vol 296 (5) ◽  
pp. G992-G1002 ◽  
Author(s):  
G. Gourcerol ◽  
L. Wang ◽  
D. W. Adelson ◽  
M. Larauche ◽  
Y. Taché ◽  
...  
Keyword(s):  
High Frequency ◽  
Colonic Motility ◽  
Distal Colon ◽  
High Amplitude ◽  
Corticotrophin Releasing Factor ◽  
Colonic Manometry ◽  
Colonic Motor ◽  
Chronic Stressors ◽  
Giant Migrating Contractions

There is a glaring lack of knowledge on mouse colonic motility in vivo, primarily due to unavailability of adequate recording methods. Using a noninvasive miniature catheter pressure transducer inserted into the distal colon, we assessed changes in colonic motility in conscious mice induced by various acute or chronic stressors and determined the neurotransmitters mediating these changes. Mice exposed to restraint stress (RS) for 60 min displayed distal colonic phasic contractions including high-amplitude giant migrating contractions (GMCs), which had peak amplitudes >25 mmHg and occurred at a rate of 15–25 h−1 of which over 50% were aborally propagative. Responses during the first 20-min of RS were characterized by high-frequency and high-amplitude contractions that were correlated with defecation. RS-induced GMCs and fecal pellet output were blocked by atropine (0.5 mg/kg ip) or the corticotrophin releasing factor (CRF) receptor antagonist astressin-B (100 μg/kg ip). RS activated colonic myenteric neurons as shown by Fos immunoreactivity. In mice previously exposed to repeated RS (60 min/day, 14 days), or in transgenic mice that overexpress CRF, the duration of stimulation of phasic colonic contractions was significantly shorter (10 vs. 20 min). In contrast to RS, abdominal surgery abolished colonic contractions including GMCs. These findings provide the first evidence for the presence of frequent cholinergic-dependent GMCs in the distal colon of conscious mice and their modulation by acute and chronic stressors. Noninvasive colonic manometry opens new venues to investigate colonic motor function in genetically modified mice relevant to diseases that involve colonic motility alterations.

scholarly journals Intraluminal Prucalopride Increases Propulsive Motor Activities in the Human Colon

2020 ◽  
Author(s):  
Mitra Shokrollahi ◽  
Xuan-Yu Wang ◽  
Natalija Milkova ◽  
Jan D Huizinga ◽  
Ji-Hong Chen
Keyword(s):  
High Resolution ◽  
Motor Activity ◽  
Anal Sphincter ◽  
Human Colon ◽  
Delivery Systems ◽  
Enterochromaffin Cells ◽  
Temporal Association ◽  
Pressure Waves ◽  
Motor Patterns ◽  
Colonic Manometry

ABSTRACTBackgroundLuminal application of 5-HT4 receptor agonists can increase peristalsis in the guinea pig, mouse, rat and rabbit colon. Our aim in the present study was to test the effects of intraluminal prucalopride on motor patterns in the human colon.MethodsColonic motor patterns were studied in vivo in a healthy volunteer using High-Resolution Colonic Manometry (HRCM) with an 84-sensor water perfused catheter with 1cm spacing. 5-HT and 5-HT4 receptor immunohistochemistry was performed on human tissue biopsies throughout the colon.Key resultsActivating mucosal 5-HT4 receptors via intraluminal prucalopride enhanced propulsive motor activity in the human colon by increasing occurrence and amplitude of propulsive motor patterns including high-amplitude propagating pressure waves (HAPWs), pancolonic simultaneous pressure waves (SPWs) and HAPW-SPWs. Prucalopride-induced motor patterns had a close temporal association with a significant degree of anal sphincter relaxation and some were accompanied by a strong urge to defecate. Biopsies showed 100% colocalization of the 5-HT4 receptor to enterochromaffin cells throughout the colon and rectum.Conclusions and inferencesActivating luminal 5-HT4 receptors on enterochromaffin cells by intraluminal prucalopride increased propulsive motor activity. 5-HT4 receptors were found only on enterochromaffin cells and not ubiquitous on all epithelial cells. Our data support incorporation of prucalopride in colon-specific drug delivery systems as a prokinetic to treat colonic hypomotility disorders.50 word abstractHigh-resolution colonic manometry and biopsy immunohistochemistry revealed that 5-HT4 receptors in the lumen of the human colon are present exclusively on enterochromaffin cells and that the 5-HT4 agonist prucalopride evokes all major propulsive motor patterns, associated with significant anal sphincter relaxation, when given intraluminally.250-character clinical messageActivating luminal 5-HT4 receptors on enterochromaffin cells by intraluminal prucalopride increased propulsive motor activity in the human colon. Colon-specific delivery systems with a 5-HT4 agonist may become the preferred colon prokinetic.

scholarly journals Hyperactive cyclic motor activity in the distal colon after colonic surgery as defined by high-resolution colonic manometry

2018 ◽  
Vol 105 (7) ◽  
pp. 907-917 ◽  
Author(s):  
R. Vather ◽  
G. O'Grady ◽  
A. Y. Lin ◽  
P. Du ◽  
C. I. Wells ◽  
...  
Keyword(s):  
High Resolution ◽  
Motor Activity ◽  
Distal Colon ◽  
Colonic Surgery ◽  
Colonic Manometry

scholarly journals Characterization of Simultaneous Pressure Waves as Biomarkers for Colonic Motility Assessed by High-Resolution Colonic Manometry

2018 ◽  
Vol 9 ◽  
Author(s):  
Ji-Hong Chen ◽  
Sean P. Parsons ◽  
Mitra Shokrollahi ◽  
Andrew Wan ◽  
Alexander D. Vincent ◽  
...  
Keyword(s):  
High Resolution ◽  
Colonic Motility ◽  
Pressure Waves ◽  
Colonic Manometry

S1262 High-Resolution Colonic Manometry: Have We Been Incorrectly Labeling Colonic Motor Patterns?

2009 ◽  
Vol 136 (5) ◽  
pp. A-224 ◽  
Author(s):  
Philip G. Dinning ◽  
John W. Arkwright ◽  
Michal M. Szczesniak ◽  
Sergio E. Fuentealba ◽  
Neil Blenman ◽  
...  
Keyword(s):  
High Resolution ◽  
Motor Patterns ◽  
Colonic Manometry ◽  
Colonic Motor

Luminally released serotonin stimulates colonic motility and accelerates colonic transit in rats

2007 ◽  
Vol 293 (1) ◽  
pp. R64-R69 ◽  
Author(s):  
Kiyoshi Tsukamoto ◽  
Hajime Ariga ◽  
Chris Mantyh ◽  
Theodore N. Pappas ◽  
Hidenori Yanagi ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Colonic Motility ◽  
Physiological Role ◽  
Distal Colon ◽  
Proximal Colon ◽  
Colonic Transit ◽  
Intraluminal Pressure ◽  
Ex Vivo Model ◽  
Colon Tissue ◽  
Ec Cells

Enterochromaffin (EC) cells of the epithelial cells release 5-HT into the lumen, as well as basolateral border. However, the physiological role of released 5-HT into the lumen is poorly understood. Concentrations of 5-HT in the colonic mucosa, colonic lumen, and feces were measured by HPLC in rats. To investigate whether intraluminal 5-HT accelerates colonic transit, 5-HT and 51Cr were administered into the lumen of the proximal colon, and colonic transit was measured. To investigate whether 5-HT is released into the lumen, we used an ex vivo model of isolated vascularly and luminally perfused rat proximal colon. To investigate whether luminal 5-HT is involved in regulating stress-induced colonic motility, the distal colonic motility was recorded under the stress loading, and a 5-HT3 receptor antagonist (ondansetron, 10−6 M, 0.5 ml) was administered intraluminally of the distal colon. Tissue content of 5-HT in the proximal colon (15.2 ± 4.3 ng/mg wet tissue) was significantly higher than that in the distal colon (3.3 ± 0.7 ng/mg wet tissue), while fecal content and luminal concentration of 5-HT was almost the same between the proximal and distal colon. Luminal administration of 5-HT (10−6–10−5 M) significantly accelerated colonic transit. Elevation of intraluminal pressure by 10 cmH2O significantly increased the luminal concentration of 5-HT but not the vascular concentration of 5-HT. Stress-induced stimulation of the distal colonic motility was significantly attenuated by the luminal administration of ondansetron. These results suggest that luminally released 5-HT from EC cells plays an important role in regulating colonic motility in rats.

scholarly journals A35 ASSOCIATIONS BETWEEN AUTONOMIC DYSFUNCTION, COLONIC DYSMOTILITY AND ABSENT DEFECATION REFLEXES IN PATIENTS WITH CHRONIC REFRACTORY CONSTIPATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-278
Author(s):  
L Liu ◽  
N Milkova ◽  
M Ali ◽  
K Sharma ◽  
J D Huizinga ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
High Resolution ◽  
Autonomic Dysfunction ◽  
Sympathetic Tone ◽  
Stress Index ◽  
Autonomic Reactivity ◽  
Autonomic Tone ◽  
Autonomic Nervous ◽  
Colonic Manometry

Abstract Background A defecation reflex involves sensory information from the colon sent to the central nervous system which results in propulsive motor patterns in the colon through programmed neural activity from the autonomic nervous system. Neurological causes of constipation are recognized but specific neurological pathways that contribute to pathophysiology of the disease is underexplored. Diagnosis and treatment usually do not involve the autonomic nervous system. Aims Our objective was to assess autonomic dysfunction and abnormal defecation reflexes as a possible cause of chronic constipation. Methods Defecation reflexes were assessed by high-resolution colonic manometry through balloon distention, meal intake, and rectal bisacodyl. Specific heart rate variability (HRV) parameters were used to assess general orthostatic autonomic reactivity, and autonomic functioning during high resolution colonic manometry, in 14 patients with chronic refractory constipation considered for surgery. Results All patients had a unique combination of motility, reflex ability and HRV profiles. Patients overall did not generate HAPWs or had lower HAPW amplitude and lower propulsive activity compared to healthy individuals. Half of the 14 patients were tested to have high sympathetic tone based on Baevsky’s stress index prior to HRCM, and 11 of the patients had sympathetic hyper-reactivity and/or low parasympathetic reactivity to at least one type of colonic stimulation during HRCM. Abnormal autonomic tone or autonomic reactivity to colonic stimulation was present in all four patients with absence of the vagosacral defecation reflex. Five of the seven patients with absence of the sacral defecation reflex showed high sympathetic tone or high sympathetic reactivity to stimulation. Only two patients had abnormality in coloanal coordination and this was associated with low parasympathetic reactivity to stimulation in both patients. Conclusions The assumption that colonic resection was needed to remove an inert colon was wrong in most patients, but most patients had some form of reflex abnormality. Sympathetic dominance far outweighed parasympathetic dysfunction. Incorporation of assessments of defecation reflexes and autonomic nervous system activity into diagnosis of chronic refractory constipation provides a comprehensive pathophysiological understanding of specific defective neurological pathways contributing to dysmotility. This forms the basis for our individualized treatment efforts through sacral neuromodulation. Funding Agencies CIHR

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