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

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Effects of ethanol, xylose, and glucose on canine jejunal motility

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1995.269.3.g363 ◽

1995 ◽

Vol 269 (3) ◽

pp. G363-G369 ◽

Cited By ~ 1

Author(s):

F. Charles ◽

S. F. Phillips

Keyword(s):

Small Bowel ◽

Contractile Activity ◽

Gastrointestinal Symptoms ◽

Phase Iii ◽

Alternate Route ◽

Bowel Motility ◽

Small Bowel Motility ◽

Intravenous Infusions

Ethanol is an important source of calories that can cause certain gastrointestinal symptoms, notably diarrhea. To examine the effects of ethanol on the small bowel, we intraluminally perfused the jejunum of four dogs with ethanol (18, 9, 4.5, and 1.5%, wt/vol), D-xylose (30, 15, 7.5, and 4.5%, wt/vol), or glucose (30 and 5%, wt/vol). In other experiments, these solutes were infused intravenously. Saline was always given by the alternate route; jejunal manometry was recorded during and after the infusions. Phase III of the interdigestive cycle was delayed by all intraluminal infusions except for 4.5 and 1.5% ethanol, 4.5% xylose, and 5% glucose. In addition, the onset of irregular contractile activity was delayed more with intraluminal ethanol than with intraluminal xylose or intraluminal glucose (P < 0.01). When administered intraluminally, ethanol and xylose appeared in blood but only ethanol equilibrated fully between the lumen and blood. Intravenous infusions of ethanol and xylose, but not glucose, also delayed the return of phase III. When given intravenously, ethanol and xylose were recovered from the lumen, whereas glucose never was. Ethanol and xylose had comparable effects on the canine small bowel; they induced prolonged periods of irregular contractile activity and delayed the return of phase III. These effects were seen rapidly when solutes were administered intraluminally and more slowly when they were given intravenously. These results suggest that local luminal mechanisms stimulated by solutes influence small bowel motility, and they imply that the gut recognizes solutes whether or not these molecules are metabolizable.

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

10.1101/2021.11.30.21266844 ◽

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.

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